Bipolar Disorder Flashcards
(39 cards)
What is a manic episode?
Distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting AT LEAST 1 WEEK.
*Duration doesn’t matter is hospitalization is necessary
To call it a Manic episode you must have how many of the characteristics and for how long…
Must have 3 of the characteristics
4 if the mood is irritable
A week long
Criteria for Manic Episode…
- Inflated Self esteem and gradiosity
- Decreased need for sleep
- More talkative
- Racing thoughts
- Distractibility
- Increased goal directed activity
- Excessive involvement in activities with potential for high painful consequences
HYPOmania Episodes…
Period of abnormal mood similar to manic (dx criteria same), but lasts 4 days and is not sever enough to:
- CAUSE MARKED IMPAIRMENT IN SOCIAL OR OCCUPATIONAL FUNCTIONING
- CAUSE HOSPITALIZATION
To call it a Major Depressive Episode you must have what….
5 of the criteria during the same 2 week period with one of the symptoms being:
- Depressed Mood
- Loss of Interest
Major Depressive Episode Criteria….
- Depressed Mood
- Diminished interest/pleasure
- Weight loss or gain
- Insomnia or LOTS OF SLEEP
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Worthlessness or guilt
- Cant concentrate
- Thoughts of death
Bipolar ONE Disorder Criteria….
Have ONE Manic Episode
But current/Most recent episode can be manic/hypomanic/depressed/Unspecified
Rapid cycling…
AT LEAST 4 episodes in 12 months
Bipolar TWO Disorder Criteria…
History or Presence of:
-One or more Major Depressive Episodes
-At least one Hypomanic Episodes
NOOOOOOO MANIC EPISODES*
Cyclothymic Disorder Criteria…
FOR AT LEAST TWO YEARS
- Hypomania symptoms without meeting criteria for an actual episode
- Depressive symptoms without meeting criteria for an actual episode
During the 2 years, pt not without symptoms for 2months at a time*
Manic Episode: Pt has never been treated before and is SEVERELY episodic right now, whats treatment look like?
Lithium or Valproate
IN COMBO WITH
Antipsychotic (Olanzapine, SGAs)
Manic Episode: Pt has never been treated before and is having an episode right now, whats treatment look like?
Since not SEVERE:
Monotherapy–>Lithium, Valproate, Antipsychotic (Olanzapine)
Short Term Adjunct Benzo–>Lorazepam
Alternates: Carbamazepine and Oxcarbazepine in lieu of Lithium or Valproate or other SGA
If Manic Episode has mixed features what is best? Lithium or Valproate?
Valproate
Best Benzo to treat Catatonia
Lorazepam
Manic Episode: Symptoms are inadequately controlled after 10-14 days of treatment with optimized doses of first line meds what are your options?
- Add another 1st line med
- Add Carbamazepine Oxcarbazepine
- Add an Antipsychotic if one not already
- Switch Antipsychotic is already on one
SGA that is particularly helpful in Refractory manic epis
Clozapine
Indication for severe treatment resistant mania
ECT
Acute Depression: Patient has never received treatment what is the possible treatment?
- Lithium or Lamotrigine
- Quetiapine and Lurasidone –>Monotherapy
ECT is considered for….
Life-threatening inanition, suicidality, or severe depression, tx resistant depression or catatonic features
Acute Depression: Pt has breakthrough depressive episode on the maintenance treatment, what do you do?
- Optimize the medication dose
- Make sure serum levels are within range, may need to increase dosing to get to the higher levels of that range
Acute Depression: Pt fails to respons to optimized maintenance treatment, what are options?
- Add an antipsychotic
- Add Lamotrigine
- Adjuct Antidepressant: Bupropion or Paroxetine
For ACUTE TX of Depression, when should you initiate antidepressants?
ONLY as adjunct if previous positive response to antidepressants
When should you avoid giving an antidepressant?
RAPID CYCLING
Also if “mixed features”
For MAINTENANCE TX of Depression, when should antidepressants be considered?
If patient relapses into a depressive episode after stopping antidepressant therapy
