Bipolar Disorders

What medication is the gold standard for classic bipolar disorder?

Lithium

What types of episodes does lithium help prevent in classic bipolar disorder?

Both manic and depressive episodes

What type of bipolar disorder is lithium best for?

Classic bipolar disorder with clear manic and depressive episodes, euphoric mania, and lower rates of rapid cycling

What serious precaution is needed with lithium treatment?

Blood level monitoring due to narrow therapeutic window and risk of toxicity

When are anticonvulsants and secondgeneration antipsychotics used in bipolar disorder?

For atypical bipolar disorder, rapid cycling, mixed states, or when lithium is ineffective or not tolerated

Name 3 anticonvulsants used in bipolar disorder.

Valproate (Depakote), Carbamazepine, Lamotrigine

Which anticonvulsant is especially good for mixed states and rapid cycling?

Valproate (Depakote)

Which anticonvulsant is often used for bipolar depression maintenance, not acute mania?

Lamotrigine

"Lamo the mellow llama"

"I don’t do drama (mania)... I just chill with the lows."

What symptoms are SGAs helpful for in bipolar disorder?

Acute mania, mixed features, and bipolar depression

What is the mnemonic for remembering medication choices for bipolar disorder?

“Li Classic, ACAs Atypical.” Lithium for Classic; Anticonvulsants and Atypical antipsychotics for Atypical bipolar

Does lithium reduce suicide risk in bipolar disorder?

Yes, lithium has evidence for reducing suicide risk.

What defines a manic episode in Bipolar Disorders?

• ≥ 1 week of abnormally and persistently elevated, expansive, or irritable mood

• Increased activity or energy

• ≥ 3 symptoms (e.g., inflated self-esteem/grandiosity, decreased need for sleep, flight of ideas)

• Marked impairment in functioning, hospitalization required, or psychotic features

• EPPP Highlight: Mania = ≥ 1 week, significant impairment, possible psychosis

What defines a hypomanic episode?

• ≥ 4 consecutive days of elevated, expansive, or irritable mood

• Increased activity or energy

• ≥ 3 symptoms of mania

• Symptoms do NOT cause marked impairment, hospitalization, or psychosis

• EPPP Highlight: Hypomania = ≥ 4 days, no major impairment, no psychosis

What defines a major depressive episode?

• ≥ 2 weeks of 5+ symptoms

• Must include either:

  • Depressed mood OR

  • Loss of interest/pleasure (anhedonia)

• Causes significant distress or functional impairment

• EPPP Highlight: Key = 2 weeks, 5+ symptoms, one must be depressed mood or anhedonia

What episodes are required for a Bipolar I Disorder diagnosis?

• At least 1 manic episode

• May or may not have major depressive or hypomanic episodes

• EPPP Highlight: Bipolar I = Mania required

What episodes are required for a Bipolar II Disorder diagnosis?

• At least 1 hypomanic episode AND

• At least 1 major depressive episode

• No history of mania

• EPPP Highlight: Bipolar II = Hypomania + Depression; NO Mania

What defines Cyclothymic Disorder?

• ≥ 2 years (adults) or ≥ 1 year (kids/teens)

• Periods of hypomanic symptoms not meeting full criteria for hypomania

• Periods of depressive symptoms not meeting full criteria for major depression

• Symptoms present at least half the time and never absent more than 2 months

• EPPP Highlight: Cyclothymia = chronic fluctuating low-grade highs/lows for 2 years (1 year kids)

How long must symptoms persist for a cyclothymic disorder diagnosis?

• ≥ 2 years in adults

• ≥ 1 year in children/adolescents