Mood Disorders: Bipolar Disorder Flashcards Preview

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Flashcards in Mood Disorders: Bipolar Disorder Deck (24)
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0
Q

What’s bipolar NOS?

A

Bipolar disorder not-otherwise-specified. (a little vague. Could be just a little hypomanic… could be just in response to medication)

1
Q

What’s the major difference between Bipolar Type 1 and Type 2?

A

Type 1: at least one manic episode

Type 2: hypomania and depression, no manic episodes.

2
Q

What’s schizoaffective disorder? How does it differ from bipolar disorder?

A

Like bipolar - can swing between mania and depression, but these patients don’t return to baseline between episodes.

3
Q

What are some non-psychiatric cause of mania?

A

Medication (esp. glucocorticoids)

Non-mental illness.

4
Q

How long must manic symptoms last for it to be considered a “manic episode”?

A

7 days (but this is admittedly somewhat arbitrary)

5
Q

What are 7 features of mania? How many must you have for it to be considered a manic episode?

A
Grandiosity
Decreased need for sleep
Pressured speech
Racing thoughts / flight of ideas
Distractibility
Increased goal-directed activity
Poor judgment/risky behaviors (sex, spending, gambling, etc.)
6
Q

About how common are psychotic in mania? Are hallucinations or delusions more common?

A

About 58% of patients have at least 1 psychotic symptom.

Delusions are much more common than hallucinations.

7
Q

4 reasons that you call something mania and not hypomania?

A

Psychotic symptoms (delusions/hallucinations)
Social / work impairment
Hospitalization
Longer duration (hypomanic episodes are shorter)

8
Q

What are 4 clinically important subforms of bipolar disorder? Why is classification important?

A

Rapid cycling
Mixed features (mania and depression at same time)
Seasonal (depression in fall/winter, mania in spring/summer)
With psychotic symptoms
Classification guides prognosis and treatment.

9
Q

What’s the major reason there’s a lot of variation in the estimates for prevalence of bipolar disorder?

A

Criteria for “hypomania” vary widely, and thus so do Bipolar II prevalence estimates. (Bipolar I prevalence is pretty consistently put at 0.5 - 1.0%)

10
Q

Of the time that bipolar patients are symptomatic, what’s the relative fraction of mania / depression? Does it vary between bipolar I and bipolar II?

A

Depression predominates in both.
Bipolar I patients spend more time manic (20% manic/hypomanic, 13% mixed) vs.
Bipolar I patients with only 2.5% hypomanic, 4.5% mixed.

11
Q

Median age of onset of bipolar disorders? 90% have onset before what age?

A

Median age of onset: 17.5 year
90% have onset before 30 years.
It’s a condition that begins in adolescents and young adults.

12
Q

How does age of onset relate to severity / co-morbidities?

A

The early the onset, the more severe it usually is.

13
Q

How heritable is bipolar disorder: MZ concordance? Risk for first degree relatives?

A

Very heritable.
50-70% concordance in MZ twins.
1st degree relatives have 10x risk of mania, 2x risk of depression.

14
Q

Common co-morbidities of bipolar disorder? (4 things)

A

Anxiety, substance abuse, antisocial behavior, conduct disorders.

15
Q

Why does it take so many people a long time (avg = 10 years) to get properly diagnosed with bipolar disorder? Effect on treatment?

A

It’s often initially misdiagnosed as depression. (which it can look like before the patient has a manic episode)
Treatment for depression tends not to work well for bipolar disorder.

16
Q

Does bipolar disorder or major depression have a higher societal burden? Which has a higher rate of completed suicide?

A

Bipolar causes more days of work lost, and more completed suicides.

17
Q

What’s the main instrument for screening for bipolar disorder?

A

Mood Disorder Questionnaire (MDQ)

18
Q

What’s the goal of treatment for bipolar disorders, especially bipolar I?

A

Mood stabilization.

19
Q

3 features that define a mood-stabilizing drug?

A

Treats acute mania and/or depression.
Reduces recurrence of mania and depression.
Do not make either mania or depression worse.

20
Q

5 mood stabilizing therapies? (4 are drugs)

A

Lithium salts
Divalproex
Carbamazapine
1st and 2nd Gen. Antipsychotics (but can be pro-depressive)
Electroconvulsive Therapy (ECT) -rarely used.

21
Q

What feature of Bipolar I is easiest to treat: Mania, depression, or mixed episodes?

A

Mania is the easiest to resolve with treatment. Mixed/cycling is the hardest.

22
Q

Is monotherapy or combination therapy preferred for bipolar disorder?

A

Combination therapy, but it comes with increased risk of side effects.

23
Q

Do people’s treatment regimen for bipolar disorder usually stay constant or have to be modified?

A

Usually must be modified.