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Flashcards in Lecture 5-Bipolar Deck (23):
1

Which best explains (D)ysthymia VS (C)yclothymia?

a. D is acute low level depression and C is acute low level mania

b. D is chronic low level depression and C is chronic low level mania

c. D is acute low level depression and C is chronic low level mania

d. D is chronic low level depression and C is acute low level mania

b. D is chronic low level depression and C is chronic low level mania

2

Which psychiatric disorder affects more of the general population?

a. Major Depression

b. Bipolar 1 Disorder

c. Bipolar 2 Disorder

d. Cyclothymia

a. Major Depression

3

What is psychomotor retardation?

a. Depression causes IQ to lower on IQ tests because depression causes poor concentration and the patient makes errors on the test

b. Depression causes a psychological thinking process that acts like a motor with pistons where thoughts speed up and slow down in alternating fashion

c. Depression causes the patient to feel and act slowed down

d. Depression causes the patient to feel and act psycho and be violent

c. Depression causes the patient to feel and act slowed down

4

What is mania? What is the minimum number of days for something to be mania?

Distinct, abnormal, elevated (happy), expansive (or irritable mood) x 7 days minimum.

At least 3 symptoms must be present for at least 2 weeks:

Increased self esteem/grandiosity (invincible & inflated)

Decreased sleep

Increased speech

Racing thoughts

Distractibility

*Increased activity (and energy is key for DSM 5)
Increased dangerous impulsivity

5

Mnemonic for mania?

Down The Rack HIGH

Distractible

Talkative

Racing thoughts

Hyperactive

Impulsive

Grandiose

hyposomnic ((low sleep))

6

What is hypomania? How many days must it be present for? Does it cause dysfuction like normal mania?

Milder mania: Same symptoms as mania

At least 4 days or more

Not severe enough to cause marked functional impairment

7

How long does a major depressive episode have to occur in bipolar?

More than 2 weeks

8

What is bipolar?

Bipolar disorder is characterized by transitions between depression and mania

9

Mixed episode =

mania with major depression

10

Bipolar 1 =

Mania +/- major depressive episode (MDE)

Bipolar 1 does not need to have depression.

11

Bipolar 2 =

hypomania +/- MDE

*MUST HAVE hypoMANIA, do not need to have depression

12

Cyclothymia? Time definitions?

Hypomania (2 yrs) + MINOR depression

Very succesfull businessmen and artists have this, never see a shrink

13

(T/F) Bipolar people are seductive, sexually active, more divorce, and job loss, and can become angry easily?

True

14

Biological basis of bipolar? Neurotransmitters? Genetics? Kindling hypothesis?

Altered neurotransmitter activity (Increase of DA, SR, NE)

Monoamine Receptor Deficiency theory (opposite of depression)

Genetics (high association)

Kindling Hypothesis (symptoms can grow)
- Too much neuronal firing in the limbic system
- Seizure and anti-epilepsy drug model via Na++ channel blockade

15

Women _ Men in Bipolar 1

Bipolar 2; women _ Men

=; >

16

Name psychosocial factors of bipolar.

Psychosocial Factors
Low self esteem, negative outlook, Learned helplessness, Catastrophic loss**, demeaning parents, peers can yield denial and fantasy defenses to occur = mania

Stress can increase mania despite what book says:
- Stress can lower compliance
- Disrupt sleep and circadian rhythm
- Increase substance abuse

17

Usually we do ___ give antidepressants for bipolar, but how would we give them to a bipolar patient?

not;

If you have to use antidepressants, make sure a mood stabilizer is used first to help prevent antidepressant alone from causing increased mania and instability

18

What are two major treatments for bipolar?

Antipsychotics & lithium- max

19

What do antipsychotics for bipolar block?

They block the dopamine-2 receptor which treats mania or helps prevent it

All block 5HT2a receptors which treats depression

20

_____ works during depressed phase, but not manic phase of bipolar.

Psychotherapy

21

What are some anti maniac agents?

Lithium- provides Ca++ membrane stability and promotes neuronal health and protective factors. Lithium hurts kidneys and thyroid. Increases WBC.

Divalproex- increases GABA activity/tone. Hurts pancreas, liver & platelets. So lifelong blood draws to make sure not hurting organs.

Carbamazepine- blocks Na+ channels and promotes neuronal health. Suppresses bone marrow.

Atypical Antipsychotics- All block D2 receptors and ? Increase neuronal health and connectivity:
Risperidone, Aripiprazole
Olanzapine, Asenapine
Quetiapine

22

A patient has mania and you want to prescribe a treatment. Which property below would you like to manipulate by way of prescribing?

a. Block Na++ channels to slow neuronal firing to slow limbic system

b. Stimulate D2 receptors to increase limbic activity

c. Increase NE release robustly into synapse

a. Block Na++ channels to slow neuronal firing to slow limbic system

23

A 40 yr old patient has had Bipolar 2 disorder for 15 years but comes to your office in a fully manic state that has lasted at least 14 days. What is the correct diagnosis?

Cyclothymia

Bipolar 2

Bipolar 1

Bipolar 3

Bipolar 1