Bipolar Disorders

Question 1

mania DSM-IV definitions

Answer 1

distinct, abnormal, elevated, expansive or irritable mood for 7 day minimum. at least 3 symptoms: increased self esteem, decreased sleep, increased speech, racing thoughts, distractibility, increased activity, increased dangerous impulsivity

Question 2

DTRHIGH

Answer 2

distractible, talkative, racing thoughts, hyperactive, impulsive, grandiose, hyposomnic

Question 3

hypomania

Answer 3

milder mania. at least 4 days or more. no psychosocial consequences. symptoms provide an unequivocal change in function, personality, that is clearly noted by others. not severe enough to cause impairment

Question 4

major depressive episode

Answer 4

pervasive sad, down, or irritable mood. greater than 2 weeks. must cause distress/dysfunction. cannot be due to another disorder, medical condition etc

Question 5

bipolar 1

Answer 5

Mania + major depressive disorder. cycle from mania to depressive. rapid cycling type has 4 or more cycles per year.

Question 6

bipolar 2

Answer 6

hypomania + major depressive disorder. cycle from hypomania to major depression.

Question 7

cyclothymia

Answer 7

cycle between hypomania and minor depression. may become very suicidal because they are so used to being in hypomanic mindset. often takes a decade to obtain correct diagnosis. usually more time being depressed than manic. half of patients do not remember or report previous mania.

Question 8

what do women have more of?

Answer 8

bipolar 2

Question 9

etiology

Answer 9

high genetic association. altered neurotransmitter activity. kindling hypothesis: too much neuronal limbic firing. seizure and anti-epilepsy drug model via Na channel blockade

Question 10

do you use antidepressants for bipolar depression?

Answer 10

try not to use them. avoid antidepressants that increase multiple monoamine neurotransmitter and favor lower doses of much simpler SSRIs. use a mood stabilizer first if you have to use them

Question 11

antipsychotics for bipolar disorders

Answer 11

atypical antipsychotics approved. block dopamine 2 receptor which treats mania. block 5HT2a receptor which treats depression. some stimulate 5HT1a receptors, some have SSRI properties, some have NRI properties, some block 5HT2c, 5HT3, 5HT7 which have antidepressant linkings

Question 12

antimanic agents

Answer 12

psychotherapy doesnt work for mania. lithium: provides Ca membrane stability and promotes neuronal health. divalproex increases GABA activity. carbamazepine blocks Na channels. atypical antipsychotics block D2 receptors and increase neuronal health (risperidone, aripiprazole

Question 13

psychotherapy

Answer 13

works for depressed phase. many forms and syles will help. education is key