Bipolar Disorders

What are bipolar disorders?

Mood disorders characterized by episodes of mania, hypomania, and depression.

What is bipolar I disorder?

Presence of at least one manic episode lasting ≥1 week or requiring hospitalization, with or without depressive episodes.

What is bipolar II disorder?

Presence of at least one hypomanic episode and one major depressive episode, with no history of full mania.

What is cyclothymic disorder?

Chronic fluctuating mood disturbances with hypomanic symptoms and depressive symptoms for ≥2 years without meeting full criteria for episodes.

What neurotransmitters are implicated in bipolar disorders?

• Serotonin

• Norepinephrine

• Dopamine

What medical conditions can mimic mania?

• Hyperthyroidism

• Substance intoxication

• Sleep deprivation

• Steroid use

• Neurologic disorders

What substances can cause manic symptoms?

• Stimulants

• Cocaine

• Amphetamines

• Antidepressant-induced mania

What is mania?

A distinct period of abnormally elevated, expansive, or irritable mood with increased energy lasting ≥1 week.

What are symptoms of mania?

• Elevated mood

• Decreased need for sleep

• Pressured speech

• Flight of ideas

• Distractibility

• Increased goal-directed activity

• Risky behaviors

What is hypomania?

A less severe form of mania lasting ≥4 days without marked impairment or hospitalization.

What differentiates mania from hypomania?

Mania causes significant impairment or requires hospitalization

What are symptoms of bipolar depression?

• Depressed mood

• Anhedonia

• Sleep changes

• Appetite changes

• Fatigue

• Poor concentration

• Psychomotor changes

• Suicidal ideation

What is the first-line treatment for acute mania?

Mood stabilizers or antipsychotics.

What mood stabilizers treat bipolar disorder?

• Lithium

• Valproate

• Carbamazepine

• Lamotrigine

What antipsychotics treat acute mania?

• Risperidone

• Olanzapine

• Quetiapine

• Aripiprazole

What is lithium used for?

Acute mania, maintenance therapy, and suicide risk reduction.

What labs are required before starting lithium?

• BMP

• TSH

• Pregnancy test

• ECG (if cardiac risk)

What monitoring is required for lithium therapy?

• Lithium levels

• Renal function

• Thyroid function

What are signs of lithium toxicity?

• Tremor

• Ataxia

• Confusion

• GI upset

• Seizures

What is valproate used for?

Acute mania and mixed episodes.

What labs are required before starting valproate?

• LFTs

• CBC

• Pregnancy test

What is lamotrigine used for?

Bipolar depression and maintenance therapy.

What is the major risk of lamotrigine?

Stevens-Johnson syndrome

What medications treat bipolar depression?

• Lamotrigine

• Quetiapine

• Lurasidone

• Olanzapine-fluoxetine combination

Why are antidepressants used cautiously in bipolar disorder?

Risk of inducing mania or rapid cycling.

What psychotherapy is helpful in bipolar disorder?

• CBT

• Psychoeducation

• Family-focused therapy

What lifestyle modifications help bipolar disorder?

• Sleep regulation

• Avoiding substances

• Stress management

• Routine scheduling

What medical workup may be needed for bipolar symptoms?

• Thyroid studies

• CBC

• CMP

• Toxicology screen

What differentiates bipolar I from bipolar II?

Bipolar I includes full mania

What differentiates bipolar disorder from borderline personality disorder?

Bipolar has episodic mood changes

What differentiates bipolar mania from ADHD?

Mania has decreased need for sleep, risky behaviors, and episodic course.

What differentiates bipolar depression from unipolar depression?

Bipolar depression often has hypersomnia, psychomotor retardation, and a history of hypomania.

What is rapid cycling bipolar disorder?

≥4 mood episodes per year.

What is mixed features bipolar disorder?

Symptoms of mania and depression occurring simultaneously.

What complications can occur from untreated bipolar disorder?

• Substance use

• Legal issues

• Financial problems

• Relationship instability

• Suicide risk

What is the prognosis of treated bipolar disorder?

Good with medication adherence and psychotherapy.

What is the prognosis of untreated bipolar disorder?

Chronic relapses, impaired functioning, increased suicide risk.

What is the classic triad of mania?

• Elevated mood

• Pressured speech

• Decreased need for sleep

What physical symptoms strongly suggest mania?

• Decreased need for sleep

• Increased energy

• Psychomotor agitation

What is the classic triad of bipolar depression?

• Depressed mood

• Anhedonia

• Sleep/appetite changes

What symptom cluster strongly suggests bipolar disorder over unipolar depression?

• History of hypomania

• Family history of bipolar disorder

• Antidepressant-induced mania