Bipolar Disorders Flashcards
(110 cards)
1
Q
What two core dimensions define all bipolar-spectrum disorders?
A
Pathological oscillations in mood (elevated/irritable ↔ depressed) and in energy/activity.
2
Q
What are the hallmark mood states required for a manic episode?
A
An abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy.
3
Q
How long must manic symptoms persist to meet DSM-5-TR duration criteria?
A
At least one week, or of any duration if hospitalisation is necessary.
4
Q
How does hypomania differ from mania in duration and severity?
A
Duration is a minimum of four consecutive days and the episode is not severe enough to cause marked functional impairment or require hospitalisation.
5
Q
Which symptoms (besides mood elevation) count toward the manic/hypomanic symptom list?
A
Grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity/psychomotor agitation, and risky behaviour.
6
Q
How many ancillary symptoms are required in mania when mood is elevated/expansive?
A
At least three (or four if mood is only irritable).
7
Q
What DSM-5-TR specifier captures simultaneous opposite-pole symptoms?
A
“With mixed features,” applied when ≥3 symptoms of the opposite pole appear during an episode.
8
Q
What episode is required to diagnose Bipolar I Disorder?
A
One lifetime manic episode; a major depressive episode is common but not required.
9
Q
What is the typical age of onset for Bipolar I Disorder?
A
Clustered around 18 years, with a broader range extending into the 30s.
10
Q
What is the approximate lifetime prevalence of Bipolar I Disorder?
A
About 0.6–1 percent.
11
Q
What is the sex ratio in Bipolar I Disorder?
A
Roughly equal (female : male ≈ 1 : 1).
12
Q
What proportion of individuals with Bipolar I experience psychotic features during mania?
A
A majority; most patients experience hallucinations or delusions in at least one manic episode.
13
Q
What is the estimated suicide mortality in Bipolar I Disorder?
A
Up to 15–20 percent die by suicide, and over half attempt at least once.
14
Q
How heritable is Bipolar I Disorder?
A
Genetic contribution estimated at 60–85 percent with polygenic overlap with major depression and schizophrenia.
15
Q
What percentage of people with a first manic episode will have future mood episodes?
A
Approximately 90 percent.
16
Q
List commonly applied DSM-5-TR specifiers for Bipolar I.
A
Rapid cycling, melancholic features, atypical features, anxious distress, mixed features, seasonal, peripartum, psychotic features.
17
Q
Name the first-line maintenance pharmacological treatments for Bipolar I.
A
Lithium, valproate, lamotrigine, and several atypical antipsychotics.
18
Q
Which psychotherapies have proven relapse-prevention value in Bipolar I?
A
Psychoeducation, cognitive-behavioural therapy (CBT), and family-focused therapy.
19
Q
What episodic pattern defines Bipolar II Disorder?
A
At least one hypomanic episode and at least one major depressive episode, with no history of mania.
20
Q
How does the age of onset of Bipolar II usually compare with Bipolar I?
A
Onset is later, commonly in the mid-20s.
21
Q
What is the lifetime prevalence of Bipolar II Disorder?
A
Approximately 0.8 percent.
22
Q
Is Bipolar II considered clinically milder than Bipolar I?
A
No; time spent depressed is greater, functional impairment substantial, and suicide rates comparable.
23
Q
Which pattern of episode frequency is more common in Bipolar II than in Bipolar I?
A
Rapid cycling (≥4 mood episodes per year).
24
Q
Why must antidepressant monotherapy be used cautiously in Bipolar II?
A
It can precipitate hypomania and induce rapid cycling.
25
Name two mood-stabilising agents favoured for Bipolar II depression.
Lamotrigine and quetiapine (lithium is also effective).
26
Which differential diagnoses are critical to exclude before confirming Bipolar II?
Cyclothymia, borderline personality disorder, ADHD, and substance-induced mood disorder.
27
Which psychotherapy focus is particularly important for Bipolar II clients?
Illness insight, strict sleep–wake routine, and early recognition of subtle hypomanic cues.
28
What duration of symptoms defines Cyclothymic Disorder in adults?
At least two consecutive years of numerous periods of hypomanic and depressive symptoms without meeting full criteria for either pole, and no symptom-free interval >2 months.
29
What proportion of cyclothymic patients convert to full Bipolar I or II over time?
Roughly one-third.
30
Why is cyclothymia often misdiagnosed?
Subthreshold symptoms may be mistaken for temperamental extremes or personality pathology.
31
Which comorbid disorders frequently complicate cyclothymia?
Substance misuse, ADHD, and borderline personality traits.
32
What psychotherapeutic approach is recommended for rhythm stabilisation in cyclothymia?
Interpersonal and Social Rhythm Therapy (IPSRT).
33
When can mood elevation be diagnosed as Substance-/Medication-Induced Bipolar Disorder?
When manic/hypomanic symptoms arise during or soon after intoxication, withdrawal, or exposure to a substance known to produce such effects.
34
Give three substances or medication classes commonly triggering manic states.
Corticosteroids, stimulants (e.g., amphetamines, cocaine), L-dopa, and some antidepressants.
35
What clinical clue distinguishes substance-induced episodes from primary bipolar disorder?
Resolution of symptoms once the drug clears the body (unless toxic brain injury has occurred).
36
Which settings require heightened vigilance for iatrogenic mania?
Emergency units, oncology (high-dose steroids), and geriatric wards with polypharmacy.
37
What is required to diagnose Bipolar Disorder Due to Another Medical Condition?
A causal pathophysiological link between the manic/hypomanic presentation and a medical illness (e.g., Cushing disease, multiple sclerosis, stroke, hyperthyroidism).
38
Which neuroanatomical lesion location is classically associated with secondary mania?
Right frontotemporal stroke or lesion.
39
How is treatment prioritised when bipolar symptoms stem from a medical illness?
Address the underlying medical condition while providing symptomatic mood-stabilising therapy.
40
When should the label 'Other Specified Bipolar and Related Disorder' be used?
When bipolar-like presentations cause distress/impairment but fall short of full criteria, and the clinician records the specific reason (e.g., 'short-duration hypomanic episodes').
41
When is 'Unspecified Bipolar and Related Disorder' the appropriate diagnosis?
In emergency or time-limited settings where a detailed specification is impossible, yet bipolar illness is suspected.
42
What percentage of manic or hypomanic episodes are only recalled retrospectively when family is consulted?
Up to 50 percent, underscoring the need for collateral histories.
43
Why must South-African clinicians distinguish cultural exuberance from psychopathology?
High-energy states in spiritual or cultural ceremonies might resemble mania but are contextually normative.
44
Which twin epidemics in Southern Africa can mimic or worsen bipolar presentations?
Trauma exposure and HIV-related neuropsychiatric syndromes.
45
Which substances are particularly implicated in precipitating or worsening mood instability in South Africa?
Methamphetamine and alcohol.
46
What integrated treatment model is recommended for dual-diagnosis (bipolar + substance use) presentations?
Concurrent mood stabilisation and evidence-based substance-use interventions (e.g., motivational interviewing plus relapse-prevention pharmacotherapy).
47
What is the single best predictor of future manic episodes?
A personal history of a manic episode.
48
Which mood stabiliser uniquely reduces suicide risk in bipolar disorder?
Lithium.
49
What circadian-related factor often precipitates manic relapses?
Sleep deprivation or circadian rhythm disruption.
50
How do DSM-5-TR specifiers enhance clinical practice for bipolar disorders?
They guide prognosis, tailor treatment (e.g., managing anxious distress or rapid cycling), and improve communication among providers.
51
Summarise the overall course pattern of untreated bipolar disorders.
Recurrent episodes punctuated by residual inter-episode symptoms, with progressive neurobiological and psychosocial burden if not effectively treated.
52
State the global disability ranking of bipolar disorders according to recent WHO estimates.
Among the top ten causes of disability-adjusted life years (DALYs) for young adults.
53
What primary prevention measures can delay or avert first manic episodes in high-risk youth?
Psychoeducation, stress-management strategies, controlled sleep-wake schedules, and prompt treatment of prodromal depressive episodes.
54
Which neurobiological systems show consistent dysregulation across the bipolar spectrum?
Frontolimbic networks (amygdala-prefrontal connectivity), dopaminergic reward circuits, and circadian clock gene expression.
55
How does DSM-5-TR emphasise dimensional assessment of bipolar disorders?
By endorsing specifiers (mixed features, anxious distress) and recommending rating scales (e.g., Young Mania Rating Scale, Montgomery–Åsberg Depression Rating Scale) for every visit.
56
What two core dimensions define all bipolar-spectrum disorders?
Pathological oscillations in mood (elevated/irritable ↔ depressed) and in energy/activity.
57
What are the hallmark mood states required for a manic episode?
An abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy.
58
How long must manic symptoms persist to meet DSM-5-TR duration criteria?
At least one week, or of any duration if hospitalisation is necessary.
59
How does hypomania differ from mania in duration and severity?
Duration is a minimum of four consecutive days and the episode is not severe enough to cause marked functional impairment or require hospitalisation.
60
Which symptoms (besides mood elevation) count toward the manic/hypomanic symptom list?
Grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity/psychomotor agitation, and risky behaviour.
61
How many ancillary symptoms are required in mania when mood is elevated/expansive?
At least three (or four if mood is only irritable).
62
What DSM-5-TR specifier captures simultaneous opposite-pole symptoms?
"With mixed features," applied when ≥3 symptoms of the opposite pole appear during an episode.
63
What episode is required to diagnose Bipolar I Disorder?
One lifetime manic episode; a major depressive episode is common but not required.
64
What is the typical age of onset for Bipolar I Disorder?
Clustered around 18 years, with a broader range extending into the 30s.
65
What is the approximate lifetime prevalence of Bipolar I Disorder?
About 0.6–1 percent.
66
What is the sex ratio in Bipolar I Disorder?
Roughly equal (female : male ≈ 1 : 1).
67
What proportion of individuals with Bipolar I experience psychotic features during mania?
A majority; most patients experience hallucinations or delusions in at least one manic episode.
68
What is the estimated suicide mortality in Bipolar I Disorder?
Up to 15–20 percent die by suicide, and over half attempt at least once.
69
How heritable is Bipolar I Disorder?
Genetic contribution estimated at 60–85 percent with polygenic overlap with major depression and schizophrenia.
70
What percentage of people with a first manic episode will have future mood episodes?
Approximately 90 percent.
71
List commonly applied DSM-5-TR specifiers for Bipolar I.
Rapid cycling, melancholic features, atypical features, anxious distress, mixed features, seasonal, peripartum, psychotic features.
72
Name the first-line maintenance pharmacological treatments for Bipolar I.
Lithium, valproate, lamotrigine, and several atypical antipsychotics.
73
Which psychotherapies have proven relapse-prevention value in Bipolar I?
Psychoeducation, cognitive-behavioural therapy (CBT), and family-focused therapy.
74
What episodic pattern defines Bipolar II Disorder?
At least one hypomanic episode and at least one major depressive episode, with no history of mania.
75
How does the age of onset of Bipolar II usually compare with Bipolar I?
Onset is later, commonly in the mid-20s.
76
What is the lifetime prevalence of Bipolar II Disorder?
Approximately 0.8 percent.
77
Is Bipolar II considered clinically milder than Bipolar I?
No; time spent depressed is greater, functional impairment substantial, and suicide rates comparable.
78
Which pattern of episode frequency is more common in Bipolar II than in Bipolar I?
Rapid cycling (≥4 mood episodes per year).
79
Why must antidepressant monotherapy be used cautiously in Bipolar II?
It can precipitate hypomania and induce rapid cycling.
80
Name two mood-stabilising agents favoured for Bipolar II depression.
Lamotrigine and quetiapine (lithium is also effective).
81
Which differential diagnoses are critical to exclude before confirming Bipolar II?
Cyclothymia, borderline personality disorder, ADHD, and substance-induced mood disorder.
82
Which psychotherapy focus is particularly important for Bipolar II clients?
Illness insight, strict sleep–wake routine, and early recognition of subtle hypomanic cues.
83
What duration of symptoms defines Cyclothymic Disorder in adults?
At least two consecutive years of numerous periods of hypomanic and depressive symptoms without meeting full criteria for either pole, and no symptom-free interval >2 months.
84
What proportion of cyclothymic patients convert to full Bipolar I or II over time?
Roughly one-third.
85
Why is cyclothymia often misdiagnosed?
Subthreshold symptoms may be mistaken for temperamental extremes or personality pathology.
86
Which comorbid disorders frequently complicate cyclothymia?
Substance misuse, ADHD, and borderline personality traits.
87
What psychotherapeutic approach is recommended for rhythm stabilisation in cyclothymia?
Interpersonal and Social Rhythm Therapy (IPSRT).
88
When can mood elevation be diagnosed as Substance-/Medication-Induced Bipolar Disorder?
When manic/hypomanic symptoms arise during or soon after intoxication, withdrawal, or exposure to a substance known to produce such effects.
89
Give three substances or medication classes commonly triggering manic states.
Corticosteroids, stimulants (e.g., amphetamines, cocaine), L-dopa, and some antidepressants.
90
What clinical clue distinguishes substance-induced episodes from primary bipolar disorder?
Resolution of symptoms once the drug clears the body (unless toxic brain injury has occurred).
91
Which settings require heightened vigilance for iatrogenic mania?
Emergency units, oncology (high-dose steroids), and geriatric wards with polypharmacy.
92
What is required to diagnose Bipolar Disorder Due to Another Medical Condition?
A causal pathophysiological link between the manic/hypomanic presentation and a medical illness (e.g., Cushing disease, multiple sclerosis, stroke, hyperthyroidism).
93
Which neuroanatomical lesion location is classically associated with secondary mania?
Right frontotemporal stroke or lesion.
94
How is treatment prioritised when bipolar symptoms stem from a medical illness?
Address the underlying medical condition while providing symptomatic mood-stabilising therapy.
95
When should the label 'Other Specified Bipolar and Related Disorder' be used?
When bipolar-like presentations cause distress/impairment but fall short of full criteria, and the clinician records the specific reason (e.g., 'short-duration hypomanic episodes').
96
When is 'Unspecified Bipolar and Related Disorder' the appropriate diagnosis?
In emergency or time-limited settings where a detailed specification is impossible, yet bipolar illness is suspected.
97
What percentage of manic or hypomanic episodes are only recalled retrospectively when family is consulted?
Up to 50 percent, underscoring the need for collateral histories.
98
Why must South-African clinicians distinguish cultural exuberance from psychopathology?
High-energy states in spiritual or cultural ceremonies might resemble mania but are contextually normative.
99
Which twin epidemics in Southern Africa can mimic or worsen bipolar presentations?
Trauma exposure and HIV-related neuropsychiatric syndromes.
100
Which substances are particularly implicated in precipitating or worsening mood instability in South Africa?
Methamphetamine and alcohol.
101
What integrated treatment model is recommended for dual-diagnosis (bipolar + substance use) presentations?
Concurrent mood stabilisation and evidence-based substance-use interventions (e.g., motivational interviewing plus relapse-prevention pharmacotherapy).
102
What is the single best predictor of future manic episodes?
A personal history of a manic episode.
103
Which mood stabiliser uniquely reduces suicide risk in bipolar disorder?
Lithium.
104
What circadian-related factor often precipitates manic relapses?
Sleep deprivation or circadian rhythm disruption.
105
How do DSM-5-TR specifiers enhance clinical practice for bipolar disorders?
They guide prognosis, tailor treatment (e.g., managing anxious distress or rapid cycling), and improve communication among providers.
106
Summarise the overall course pattern of untreated bipolar disorders.
Recurrent episodes punctuated by residual inter-episode symptoms, with progressive neurobiological and psychosocial burden if not effectively treated.
107
State the global disability ranking of bipolar disorders according to recent WHO estimates.
Among the top ten causes of disability-adjusted life years (DALYs) for young adults.
108
What primary prevention measures can delay or avert first manic episodes in high-risk youth?
Psychoeducation, stress-management strategies, controlled sleep-wake schedules, and prompt treatment of prodromal depressive episodes.
109
Which neurobiological systems show consistent dysregulation across the bipolar spectrum?
Frontolimbic networks (amygdala-prefrontal connectivity), dopaminergic reward circuits, and circadian clock gene expression.
110
How does DSM-5-TR emphasise dimensional assessment of bipolar disorders?
By endorsing specifiers (mixed features, anxious distress) and recommending rating scales (e.g., Young Mania Rating Scale, Montgomery–Åsberg Depression Rating Scale) for every visit.
