Bipolar Disorder (patho)

Patho

Define bipolar

common, chronic and often severe cyclic mood disorder

True or false: bipolar always presents with episodes of mania or hypomania

true

bipolar is formerly called

manic-depression

bipolar is associated with high rates of

disability and suicide 

true or false: bipolar is usually diagnosed quickly and correctly

false

what is a key factor with bipolar disorder

medication adherence

do women or men have more likelihood of having bipolar II

women

true or false: The first mood episode at initial presentation varies

true 

what percent of patients have a family history of the disorder

50%

what are some neuroanatomical factors

• increased volume of ventricles and amygdala

• decreased cortical volume

• decreased grey matter in prefrontal

what are some neurochemical factors

• monoamine dysregulation

• GABA/Glutamate imbalance 

dysregulation of glutamate and GABA can affect

mania

define kindling

with each subsequent episode, their mania or depression, the episode acceleration becomes more difficult and symptoms become more difficult to treat —> structural changes in brain

kindling lowers the ______  (episode sensitization)

threshold

what characterizes a manic episode

• at least 1 week (or hospitalization required)

• abnormal and persistently elevated, expansive, or irritable mood

• at least 3 of the following (on the slides)

true or false: acute mania is not a medical emergency

false

define hypomania

• less severe but same criteria

• at least 4 days

• no psychotic features associated

Drugs that induce mania

• dopamine agonists

• thyroid stimulating 

• corticosteroids

• stimulants 

What does DIG FAST stand for

• Distractible

• insomnia

• grandiosity/superhero mentality

• flight of ideas/racing thoughts

• activity increased

• speech increased

• taking risks

Characterize major depressive episode

• 5 or more symptoms for 2 or more weeks 

• one symptom must be depressed mood or loss of interest or pleasure 

Hypothyroidism induces ______ whereas hyperthyroidism induces _____

depression, mania

What does SIG E CAPS stand for

• Sleep is altered

• Interest mood is decreased

• guilt 

• energy decreased

• concentration decreased 

• appetite is altered

• psychomotor retardation/agitation

• suicidality 

generally ______ of patients spend their life in the depressed state

1/3

what term do we use to describe “your normal mood”

euthymia

Characterize bipolar 1

• one or more (or mixed) episodes, ± major depressive episode

• manic episode lasts for 7 or more days or any duration is hospitalization is required and/or psychotic features are present 

• manic episode includes 3 or more symptoms 

characterize bipolar 2

• one or more hypomanic episode + more than 1 major depressive episode 

• hypomania episode includes 3 or more mania/hypomania symptoms

• hypomanic episode lasts 4 or more days

• depressive episode lasts 2 or more weeks 

• depressive episode has 5 or more symptoms 

what is cyclothymic disorder

• chronic fluctuations between subsyndromal depression and hypomania lasting more than 2 years

• does not meet full criteria for depression or mania

Major depressive episode + hypomanic episode

bipolar 2

manic episode ± major depressive episode or mixed episode

bipolar 1

chronic fluctuation between subsyndromal depressive and hypomanic episodes 

cyclothymic 

define rapid cycling

• >4 mood episodes in past 12 months 

• valproic acid (DOC)

what defines psychotic features

hallucinations or delusions that are present at any time during the episode