Flashcards in Lecture 29 - Mood D/o: Bipolar D/o Deck (22):
5 categories of thought processes: which are normal, which are abn?
Flight of ideas -- patient doesn't answer the directed question, jumps from topic to topic, but topics are connected
Loose associations -- patient doesn't answer question and no connections between topics. Manic or psychotic patients
DSM Criteria for Manic Episode
at least 1 week
Elevated mood + 3 symptoms
Irritable mood + 4 symptoms
w/ increased activity or energy
Symptoms: DIG FAST
Irresponsbility -- risky behavior; hedonistic
Flight of ideas
Activity -- incresaed goal directed activity; agitation
Sleep -- decreased need for; only sleeps 2 hours/night
Talkative -- pressured speech
MAY BE PSYCHOTIC
DSM criteria for hypomanic episode
at least 4 days of symptoms
mood disturbance does not cause marked impairemnt in social/occupational function.
NO PSYCHOTIC FEATURES
BP with...Mixed features of mania/hypomania -- duration?
at least 1 week
what classisfies a rapid cycler?
Bipolar I or II disorder in which 4 or more mood episodes occur in a year
worse prognosis overall
Things to rule out before making BP diagnosis?
Substance use -- cocaine in the past month;
Heroin -- can look like depression
Heroin withdrawal -- anxiety, hypoamania
ETOH withdrawl -- anxiety, mania, hypomania, psychosis
co morbid conditions -- hyperthyroid, partial sz, MS, SLE, delirium, head trauma, cushing's
Medication side effects -- antidepresants (trigger mania), prednisone, stimulants, dopaminergic agents
BP 1 --
.6% of the population
18 yo = median age of onset (rare after 50 yo)
depression or mania first?
mean mood episodes per lifetime?
depression before mania for most patients
Untreated mania -- 3 months
Untreated depression - 6 to 12 months
9 mood episodes per lifetime
suicide attempts %?
Suicde completion %?
when is the highest risk for suicide?
36% of patients attempt suicide
10-19% suicide completion rate
Highest risk is transmission to dep
Substance use, anxiety, alcohol use
10-fold increased risk of BPAD in relatives of patients with BPAD I or II
50% of all Bipolar patients have at least one parent with a mood d/o
Main difference between BP 1 and BP 2 ?
BP1 -- manic episodes, euthymia +/- dysthemia
BP2 -- hypomanic episodes +/- dysthemia; no psychosis
EPI -- % of pop; age of onset compared to BP1
what's more common: hypomanic or depressive episodes?
8% of the US;
○ Age of onset 20 yo (slightly later than BP1)
• Clinical Course ---12% of patients initially dx with MDD; some may become BP1
○ Depressive episodes more common than hypomanics
• Co morbidities -- anxiety, substance use, eating d/o
Suicide in BP2:
lethality higher or lower than BP1
1/3 of patients attempt; lethality is HIGHER than BP1
Cyclothymic Disorder --
Patients with cyclothymia have hypomanic periods and dysthymic periods, but never have symptoms severe enough to meet criteria for either mania, hypomania, or major depression (cycling between the abn mood phases)
Sxs last for >2 yrs, without going for more than 2 months sx-free
Cyclothymic Disorder --
EPI -- gen pop?
.4-1% of the gen pop; males = females;
○ Co morbidities -- BPD, substance use;
Treatment of Acute mania --
methods of treatment:
Go to drug
Goals of treatment:
methods: Mood stabilizers (lithium, valproate)
Sleep, decrease disorganization, prevent dangerous behavior, education family and patient
Treatment of bp depression --
-- what must be considered in terms of drugs use to treat?
go to drug
If you treat the patient with only an antidepressant and no mood stabilizer, you may precipitate a manic episode
what is the treatment of choice for BP?
what % of patients repsond?
60-70% respond to this
Name 3 mood stabilizers?
other side effects
Pregnancy D -- can lead to Ebsteins anomaly (tricuspid valve malformation); However this may be over-reported and therefore still given to females
SE: Nausea, diarrhea, EKG Changes, Thyroid abn, Tremor, Poyldipsia/polyuria, Diabetes Insipidus,
Ibuprogen -- can increase the lithium level by interfering with renal clearance
== more effective for which type of BP?
-- birth considerations
more effective for rapid cyclers and mixed states
§ Teratogen: High risk for birth defects -- women need to be on documented birth control
§ Side effects -- Nausea, diarrhea, tremor, sedation, weight gain,
□ Rare -Thrombocytopenia, hepatotoxicity
§ Interactions/Metabolism -- p450s
-- birth considerations --
Not good for...
-- teratogen: patient must be on birth control
But also interactions with OCP and decreases this serum level
Interactions with other P450s
Not good for bp depression