bipolar
Terms
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- mean age of onset for bipolar disorder in men and women
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20 y/o
slightly younger in females - DSM IV criteria for manic episode:
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Criteria A: elevated, expansive, or irritable mood lasting at least 1 week (or any duration if hospitalization is necessary
Criteria B:
-Inflated self-esteem or grandiosity
-Decreased need for sleep
-More talkative than usual or pressure to keep talking
-Flight of ideas or the subjective feeling of racing thoughts
-Distractibility
-Increased goal-directed activity or psychomotor agitation
-Excessive involvement in pleasurable activities that have a high potential for painful consequence
CriteriaC:Not a Mixed Episode
Criteria D: impairment in functioning; necessity for hospitalization; presence of psychotic features
Criteria E: not due to drugs or medical condition -
Mania: epidemiology
bipolar I
bipolar II -
bipolar I
manic + depression
1-2% of adult pop.
bipolar II
hypomanic + depression
5% of adult pop. -
mania
what percent of mood disorders?
What percent go untreated?
What percent end in suicide? -
10-20%
40%
15-25% - Mania: Course
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Onset- early 20’s; adolescence, after 50
Frequently follow psychosocial stressors
Sudden onset with rapid escalation (days)
Last weeks to months
50% of episodes followed my MDEs
May be postpartum - Mania: Course Across lifetime
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Average of 8-10 episodes
4-6 years typically separates 1st and 2nd episodes
Inter-episode interval typically grows shorter between the 2nd and 5th episodes, with subsequent episodes lasting about 18 months - Mania: Predictors of poor response
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Highly loaded family history(especially first degree relatives)
Early age of onset
Severity of manic episode
History of past suicide attempts
Chronic course
Rapid-cycling course - Hypomania
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A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood
During the period of mood disturbance, 3 or more symptoms of mania persist (4 if the mood is only irritable) to a significant degree
Criteria C, D, and E of Mania Criteria - Cyclothymia
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For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a MDD
During the 2 year period (1 year in child and adolescents), the person has not been without the symptoms for more than 2 months
No MDD, Manic or Mixed Episode has been present during the first 2 years of the disturbance[afterwards these diagnoses may be superimposed] -
Mania: Treatment
Know this flashcard -
Start lithium, divalproex, psychotropic
If psychotic features add psychotropic
If agitated add psychotrophic or benzodiazepine
If poor response, add/change to another mood stabilizer, consider carbamazepine
Bilateral ECT -
Mania: Treatment
Lithium - acute & maintenance treatment
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Mania: Treatment
Divalproex - acute treatment
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Mania: Treatment
Olanzapine (in combination with lithium or valproate - acute mania
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Mania: Treatment
Lamotrigine - -“the maintenance treatment of BP I disorder to delay the time to occurrence of mood episode(depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapyâ€
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Mania: Treatment
Zyrexa (olanzapine) - - acute mania
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Mania: Treatment
Seroquel (quetiapine) - - acute bipolar mania and/or mixed state
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Mania: Treatment
Risperidal (risperidal) - - acute bipolar mania and/or mixed state
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Mania: Treatment
Abilify (aripiprazole - acute bipolar mania
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Mania: Treatment
Geodon (ziprasidone) - acute manic and/or mixed state
- Bipolar depression is less pervasive than mania T/F
- F
- Mean duration of the depressive episode in bipolar disorder is longer than manic episodes T/F
- T
- Depression is chronic in more than 20% of patients with bipolar disorder T/F
- T
- Recently introduced medications (anticonvulsants and atypical antipsychotics) have predominantly antimanic—rather than antidepressant—properties T/F
- T
- T/F patients with cyclical mood disorders typically take longer to get to a stable mood than unipolar patients
- T