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Year 2 Psych exam I > Bipolar, Vertrees > Flashcards

Flashcards in Bipolar, Vertrees Deck (48):
1

definition of bipolar

refers to group of disorders in which patient has sustained mood episodes in both directions

2

types of bipolar disorders

bipolar I
bipolar II
cyclothymic
substance/medication induced bipolar

3

mood disorders are based on what episode types

manic, depressed, hypomanic, dysthymic persistence

4

which bipolar type is equal for genders

bipolar I

5

total bipolar affective disorders occur more in W or M

W:M 3:2

6

median age onset BAD

earlier in men
usually around 25 yrs

7

what is criteria for manic episode

presence of abnormally elevated, expansive or irritable mood for at least one week (or less if need hospitalization)
+ 3 Sx (on another flash card)

8

Sx or characteristics of bipolar disorder

inflated self esteem or grandiosity
decreased need for sleep
more talkative or pressured
flight o ideas/subjective racing thoughts
distractibility
increased goal directed activity
excessive involvement in pleasurable activities

9

what will classify episode from anti depressant Tx to be manic

if continues past expected physiologic effect

10

how do manic episodes affect life

causes impairment in occupational, social, relationships or results in hospitalization to prevent harm to self or others

11

clinical findings in mania

mood is either irritable, expansive or euphoric
a lot of emotional outpouring
pressured, trangential speech
more energy
distractible
loss of consideration for consequences
faster thoughts, flighty ideas
fundamental truths become all encompassing
gradiosity

12

course of mania

onset usually abrupt
last week-months
shorter than depressive episodes
preceded or followed by depression

13

in the course of mania when is highest risk of suicide

subsequent depressive episode

14

hypomanic episode

persistent elevated, expansive or irritable with 3+ manic Sx
Does NOT markedly impair social/occupational functioning
no hospitalization needed, no psychotic features

15

which type mood episodes have high rate of psychotic eatures

peri partum

16

Bipolar I classification

al least 1 manic episode
classified as type of most recent episode: manic, depressed, hypomanic

17

Bipolar II criteria

hypomanic episodes and major depressive episodes
relatives have higher rate in Bipolar II than I
higher rate of comorbidity with substance abuse disorders

18

cyclothymic disorder

chronic fluctuating disturbance between periods of hypomanic Sx and periods of depressive Sx
minimum course 2 years

19

Tx cyclothymic disorder

lithium

20

cyclothymic disorder patients sensitive to what Tx

antidepressant induced hypomania

21

catatonia

not moving body, very odd

22

what are mixed features of bipolar disorder

manic or hypomanic episode with significant depressive Sx
mood and Sx picture alternates rapidly
significantly elevated suicide risk

23

stimulants that can cause bipolar like disorder

amphetamine, PCP, cocaine
antidepressants

24

what exogenous steroida can cause bipolar like disorder

HRT, testosterone PEDs

25

what endogenous endocrine disorders present like bipolar

hyperthyroidism
pheo

26

neuro presentations like bipolar

fronto temporal dementia

27

bipolar fam Hx increases risk for

major depressive disorder and bipolar affective disorder

28

bipolar in monozygotic twins

70-90%

29

FDA approved mood stabilizers in mania

lithium, valproate, carbamazepine

30

which antipsychotic can be monotherapy in bipolar disorder

olanzapine

31

mood stabilizers in maintenance of bipolar

lamotrigine, adjunctive anti-psychotics
benzos

32

top drug for bipolar BAD II

lamotrigine

33

key in Tx plan for bipolar

psychoeducation

34

depression episode ends but pyschosis continues

schizophrenia

35

male with incident at work took LOA
began to feel better than ever, colors have new meanings and he is beyond sleep
having true understanding of god and suspected wife poisoning him
Dx

bipolar I, MRE manic with psychosis

36

male with incident at work took LOA
began to feel better than ever, colors have new meanings and he is beyond sleep
having true understanding of god and suspected wife poisoning him
wants to kills security gueard

place patient on 72 hr mental health hold
call wife

37

male with incident at work took LOA
began to feel better than ever, colors have new meanings and he is beyond sleep
having true understanding of god and suspected wife poisoning him
Hx from wife: 2 hosp for bipolar managed by valproate and she thinks hes off meds

obtain VPA level and LFTs
CBC (CPA cause thrombocytopenia
lipid panel
BMP and TSH

38

man off his valproate also showing elevated LFTs
Tx plan

start lithium
start atypical antipsychotic for psychotic Sx
check hepatitis serologies

39

34 y.o F politician withdrawn, sleeps 12 hrs, poor appetite and can't keep up, LOA work
blunted, latent in speech and hears voices
had 2 prev depressive episodes no psychotic
has periods high energy and works excessively little sleep, mother BAD I
Dx?

bipolar II, MRE depressed, w/psychosis (voices)

40

34 y.o F politician withdrawn, sleeps 12 hrs, poor appetite and can't keep up, LOA work
blunted, latent in speech and hears voices
had 2 prev depressive episodes no psychotic
has periods high energy and works excessively little sleep,
admit and start on lithium SSRI and risperidone and elevated suicide precautions
comes back 6 mo later, fight at work, maxed out credit cards, no sleep , singing
Dx now?

bipolar I MRE manic(lose job/spent money) with psychosis(spent all money in gamble)

41

M surgeon who took baseball bat to car in his spot
pressure hyperverbal and very labile
agressive and gradiosity new
picking at own skin
labs to order?

BMP
CBC
urine drug screen
LFTs

42

M surgeon who took baseball bat to car in his spot
pressure hyperverbal and very labile
agressive and gradiosity new
picking at own skin
labs to order?

BMP
CBC
urine drug screen
LFTs

43

M 2-3 years high and lows
stable employment
each type episode lasts 1-2 weeks

cyclothymic

44

Tx for cyclothymic

lithium

45

cyclothymic disorder assoc with +FMH for what

bipolar I

46

45 F with MDD recurrent
on venlafaxine
has increased energy, talking too much, dec sleep

medication induced bipolar disorder

47

important factors to address for non-adherence to meds in bipolar

potential side effects
goals and how difficult it is to achieve them
impact on family and friends

48

most effective psychotherpeutic intervention during non-adherence time of illness

psychoeducation and family therapy