BMED- bipolar/related disorders

What is another name for Bipolar Disorder?

Manic-depressive illness

What type of disorder is Bipolar Disorder?

Brain disorder

What does Bipolar Disorder cause changes in?

Mood, energy, activity levels, and ability to carry out daily tasks

What phases are seen in Bipolar Disorder?

Episodes of both mania and depression

Which phase usually occurs first in Bipolar Disorder?

Depression

Before what age does the first manic episode typically occur?

30 years old

How long must mania last to meet diagnostic criteria?

≥ 1 week

Is there such a thing as a pure manic disorder?

No

Is Bipolar Disorder chronic or acute?

Chronic with lifetime recurrence

What issue commonly affects treatment success in Bipolar Disorder?

Non-compliance

Why do some patients enjoy the manic state?

Feel productive, creative, on top of the world

What percentage of the general population has Bipolar Disorder?

1-2 %

Which gender is more affected by Bipolar Disorder?

Men = Women

What is the risk if a first-degree relative has Bipolar Disorder?

25 %

What is the risk if both parents have Bipolar Disorder?

60 %

What must a person experience to be diagnosed with Bipolar Disorder?

≥ 1 episode of mania or hypomania

How long must a manic episode last?

≥ 1 week

What mood changes characterize a manic episode?

Elevated, expansive, or irritable mood

Name one disorder that must be ruled out before diagnosing Bipolar Disorder.

Major depressive disorder

Name other differential diagnosis for Bipolar Disorder.

Cyclothymia, Anxiety disorder, Substance abuse, ADHD, Personality disorder, Schizophrenia

Is Bipolar Disorder diagnosed clinically or by lab test?

Clinical diagnosis only

What is the purpose of lab work in Bipolar Disorder?

Rule out other issues

Name lab tests used to rule out other causes of bipolar disorder.

CBC, ESR, Fasting glucose, Electrolytes, Protein levels, Thyroid hormone levels, Cr and BUN, Liver and lipid panel, Substance and alcohol screen

How does the prognosis of Bipolar Disorder compare with major depression?

Worse

What is the average time between manic episodes?

6-9 months

What happens to the wellness period between episodes as illness progresses?

Becomes shorter

Why should SSRIs not be used alone in Bipolar Disorder?

May trigger manic episode

What class of drugs is first-line treatment for Bipolar Disorder?

Mood stabilizers

What are mood stabilizers used for?

Treat acute mania and prevent manic & depressive episodes

Name one first-line mood stabilizer.

Lithium

Name another mood stabilizer.

Valproate

Name a drug used to manage depression and prevent episodes.

Lamotrigine

Name four 2nd-generation antipsychotic added to first-line therapy.

Quetiapine, Olanzapine, Risperidone, Aripiprazole

What is the name of the combo antipsychotic/SSRI used in Bipolar Disorder?

Olanzapine / fluoxetine (Symbyax)

Which drug is most effective in refractory Bipolar II?

Clozapine

What class of drugs is used in emergencies for sedation?

Benzodiazepines

What treatment is used for therapy-resistant Bipolar Disorder?

ECT or TMS

What forms of psychotherapy are necessary in Bipolar Disorder?

Psychoeducation and psychotherapy

Name two types of psychotherapy used.

CBT and Family-focused intervention

What type of mood defines mania?

Abnormally elevated, expansive, or irritable mood

How long must mania last?

At least 1 week (or any duration if hospitalized)

What is required for diagnosis of mania if mood is only irritable?

≥ 4 symptoms

List three hallmark symptoms of mania.

Inflated self-esteem, decreased need for sleep, pressured speech

Name three more symptoms of mania.

Racing thoughts, distractibility, increased goal-directed activity

Name one high-risk behavior seen in mania.

Excessive involvement in pleasurable but risky activities

When does mania require hospitalization?

When there is marked impairment or risk of harm

Is mania due to substances or medical conditions?

No

How long must hypomania last?

≥ 4 consecutive days

What is required for diagnosis of hypomania if mood is only irritable?

≥ 4 symptoms

≥ 3 symptoms if mood isn’t irritable

How does hypomania differ from mania in severity?

Not severe enough to cause marked impairment or hospitalization

If psychosis is present, what does the episode become by definition?

Manic

Is hypomania caused by a substance or medical condition?

No

What may occur in full-blown mania?

Delusions, psychosis, or inability to complete thoughts

How many symptoms are required for diagnosis of a depressive episode?

≥ 5

How long must depressive symptoms last?

2 weeks

At least one symptom must be which of the following?

Depressed mood or loss of interest / pleasure

List three common symptoms of depression.

Weight/appetite change, insomnia/hypersomnia, fatigue

List three more symptoms of depression.

Worthlessness/guilt, poor concentration, suicidal thoughts

How many manic episodes are required for Bipolar I diagnosis?

≥ 1

What disorder must be ruled out before diagnosing Bipolar I?

Schizoaffective or schizophrenia spectrum disorders

How many episodes per year define rapid cycling?

4 episodes / year

Which gender is more often affected by rapid cycling?

Females

What medical condition predisposes to Bipolar I?

Thyroid disorders

Describe the typical course of Bipolar I.

Euthymia → Depression → Mania → Subsyndromal Depression → Depression → Hypomania

Does Bipolar I include manic episodes?

Yes

Does Bipolar II include manic episodes?

No

Does Bipolar II include hypomanic episodes?

Yes

Do both Bipolar I and II include depressive episodes?

yes

Can both show mixed features, anxious distress, or rapid cycling?

Yes

Can both show psychotic features or catatonia?

Yes

What is the key distinguishing feature between Bipolar I and II?

Bipolar I = mania present; Bipolar II = no mania

What defines Cyclothymic Disorder?

Numerous hypomanic & depressive symptoms not meeting full criteria for either episode for ≥ 2 years

How long must symptoms persist for Cyclothymic Disorder?

At least 2 years

What are hypomanic phases like in Cyclothymia?

Energetic, optimistic, "moody," lasting ≈ 3 months

What is the prevalence of Cyclothymic Disorder?

1 % of population

What is the gender distribution of Cyclothymic Disorder?

Women = Men

What is the usual age of onset for Cyclothymic Disorder?

15 - 25 years

Name one differential diagnosis for Cyclothymic Disorder.

Adjustment disorder

Name another differential.

Substance abuse

Name another differential.

Bipolar disorder

Name one possible etiology for Cyclothymic Disorder.

Loss of a close relative

Name another etiology.

Chronic medical illness

What is the prognosis for Cyclothymic Disorder?

Chronic/lifelong; 35 % develop Bipolar Disorder

What is the treatment for Cyclothymic Disorder?

CBT and antimanic agents