``` Mania vs. Hypomania: Mood and activity level: For both 1. Mood is ______, _____ OR ___________ ``` 2. Increased goal directed _____ or ______

Abnormally and Persistently Elevated, expansive OR Irritable 2. Activity or energy

Mania vs. Hypomania: Sxs for both: 3 additional symptoms (need 4 if mood is only irritable) 1. Inflated ___ or ____ 2. Decreased need for _____ 3. Increased ______ or pressured ______ 4. ______ideas or thoughts _______ 5. Distra______ 6. Increased goal ______ activity or psychomotor ______ 7. Excessive involvement in _______ activities that have ______ potential for painful consequences.

1. Self esteem or grandiosity 2. sleep 3. talkativeness; pressured speech 4. Flight of ideas; thoughts racing 5. Distractibility 6. goal directed activity; psychomotor agitation 7. pleasurable activities; high potential

Bipolar Flashcards by Wesley Rubbin

Mania vs. Hypomania:
Mood and activity level:
For both
1. Mood is \_\_\_\_\_\_, \_\_\_\_\_
OR
\_\_\_\_\_\_\_\_\_\_\_

Increased goal directed _____ or ______

Abnormally and Persistently

Elevated, expansive
OR
Irritable

Activity or energy

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Mania vs. Hypomania:

Duration for mania

1 week (any duration if hospitalization necessary - even only one day)
Most days, nearly every day

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Mania vs. Hypomania:

Duration for hypomania

4 days

- most days, nearly every day

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Mania vs. Hypomania:
Functional Impairment for Mania:
Sxs lead to....
1. 
OR
2. 
OR
3.

Functional impairment
OR
Psychotic features
OR
Hospitalization to prevent harm to self or others

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Mania vs. Hypomania:
Functional Impairment for Hypomania:
Sxs do not lead to....
1. 
OR
2. 
OR
3.

Functional impairment
OR
Psychotic features
OR
Hospitalization to prevent harm to self or others

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Mania vs. Hypomania:
Sxs for both:
3 additional symptoms (need 4 if mood is only irritable)

Inflated ___ or ____
Decreased need for _____
Increased ______ or pressured ______
______ideas or thoughts _______
Distra______
Increased goal ______ activity or psychomotor ______
Excessive involvement in _______ activities that have ______ potential for painful consequences.

Self esteem or grandiosity
sleep
talkativeness; pressured speech
Flight of ideas; thoughts racing
Distractibility
goal directed activity; psychomotor agitation
pleasurable activities; high potential

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Mania vs. Hypomania:
Substance:
For both:

Sxs not attributable to _______
Sxs caused by _______ Tx (med or ECT) count if they continue ______ after Tx stops
Hypomania exception: if only _____ or ____ Sx (esp. irritability, edginess, agitation) due to antidepressant Tx then they do not count.

substance

antidepressant

continue on at full level

1 or 2 Sxs

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BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
BP-I
Need more than 1 \_\_\_\_\_\_ episode
Do not need a \_\_\_\_\_ episode for BP-I

manic; depressive

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BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
BP-II
Need more than 1 \_\_\_\_\_\_ episode 
AND
More than 1 \_\_\_\_\_\_ episodes

hypomanic; depressive

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BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Cyclothymia
More than 2 year period of subclinical Sxs of _______ and ________

hypomania; depression

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BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous BP-I
Can be ______ only

mania

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BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous BP-II
No ______ episode

manic

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BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Miscellaneous Cyclothymia
No _______, _______, or _________

major depressive, manic, or hypomanic episodes

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BP-I vs. BP-II vs. Cyclothymia
Requirements for Dx:
Timing for Cyclothymia:
Sxs present at least \_\_\_\_\_\_ time 
AND 
Not without Sxs for more than \_\_\_\_\_\_ at a time

half; two months

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BP-I vs. BP-II vs. Cyclothymia
Impairment:
BP-I
Due to _____ (or _____ if present) episodes

manic; or depressive

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BP-I vs. BP-II vs. Cyclothymia
Impairment:
BP-II
Due to \_\_\_\_\_\_ episode 
OR unpredictability of \_\_\_\_\_\_

depressive; mood swings

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BP-I vs. BP-II vs. Cyclothymia
Impairment:
Cyclothymia
Sxs cause significant ______ or ______ in functioning

distress; impairment

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BP-I vs. BP-II vs. Cyclothymia
Exclusion Criteria:
BP-I, BP-II, & Cyclothymia
Not better explained by…(5 choices)

Schizoaffective
Schizophrenia,
Schizophreniform
Specified or Unspecified Psychotic Dx
Delusional Dx

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BP-I vs. BP-II vs. Cyclothymia
Children and Adolescents:
BP-I & BP-II
Children and adolescents _______

not mentioned

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BP-I vs. BP-II vs. Cyclothymia
Cyclothymia:
Children and Adolescents:
_____ period for children and adolescents versus ____ period for adults

1 year; 2 year

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BP-I vs. BP-II vs. Cyclothymia
Specifier-All
With _______ distress

anxious

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BP-I vs. BP-II vs. Cyclothymia
Severity Specifiers:
BP-I and BP-II
Severity ______, ______, ______, or with _______

mild, moderate, severe, or with psychotic features

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BP-I vs. BP-II vs. Cyclothymia
Course Specifiers:
BP-I and BP-II
______ or _______ remission

Full or partial remission

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BP-I vs. BP-II vs. Cyclothymia
Feature Specifiers: 
BP-I and BP-II
1. Mixed \_\_\_\_\_\_
2. Rapid \_\_\_\_\_\_
3. With mood-\_\_\_\_\_\_\_ or mood-\_\_\_\_\_\_\_ psychotic features
4. With cata\_\_\_\_\_
5. With peri\_\_\_\_\_\_ \_\_\_\_\_
6. With seasonal \_\_\_\_\_\_
7. With mela\_\_\_\_\_\_ \_\_\_\_\_
8. With aty\_\_\_\_\_ \_\_\_\_\_

features
cycling
mood-congruent; mood-incongruent
catatonia
peripartum onset
seasonal pattern
melancholic features
atypical features

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BP-I vs. BP-II vs. Cyclothymia | All cannot be attributable to _______

substance

Mixed Features Specifier for Bipolar: If meeting criteria for manic or hypomanic, plus three of the following: 1. Prominent ______ or ________ mood 2. Anh_____ 3. Psychomotor _______ (observable by others) 4. Fatigue or _______ 5. Feeling ______ or inappropriate _______ 6. Recurrent thoughts of _____, ______/______/or ______

1. dysphoria; depressed 2. anhedonia 3. retardation 4. loss of energy 5. worthless; guilt 6. death, suicidal ideation, plan, or attempt

Mixed Features Specifier for Bipolar: If meeting criteria for Major Depressive Disorder, plus three of the following: 1. Elevated or _______ mood 2. Inflated ______ or _______ 3. Increased _______ or pressured _______ 4. Flight of ______ or thoughts _______ 5. Increased goal _______ 6. Excessive involvement in _______ activities that have _____ potential for painful consequences 7. Decreased need for ______

1. expansive 2. self-esteem; grandiosity 3. talkativeness; speech 4. ideas; racing 5. directed activity 6. pleasurable; high 7. sleep

Mixed Features Specifier for Bipolar: | If criteria met for full episode of mania and depression simultaneously then Dx......

Manic Episode with Mixed Features

Rapid-Cycling Specifier for Bipolar: Can be applied to BP-I or BP-II: 1. More than ____ mood episodes in prior ____ months 2. Episodes = _____ or _____ remission for more than ____ months or _____ switch 3. Note: Substance induced episodes _______ 4. Note: Manic and hypomanic are counted as _________

1. 4; 12 2. Full or partial; 2; polarity 3. not counted 4. the same pole

``` With Psychotic Features Specifier: Mood Congruent = themes of: 1. 2. 3. ```

1. grandiosity 2. invulnerability 3. paranoia - especially doubts about other's capabilities

With Seasonal Pattern specifier: Only need ___ of the _____ poles (____/_____ or depressed) to occur with seasonal variation - not both. More common in BP-II than BP-I

1; 2 (manic/hypomanic or depressed)

Differential Dx Worse in BP-I, BP-II, or Unipolar: Impairment: Impairment level can be ________

similar across all types

Differential Dx Worse in BP-I, BP-II, or Unipolar: Suicide attempts: _____ data if any ______ in one BP subtype than the other

Mixed; higher

Differential Dx Worse in BP-I, BP-II, or Unipolar: Psychosis: Highest in ______

BP-I

Differential Dx BP-I and BP-II More _______ agitation in their depression than unipolar

psychomotor

Differential Dx BP-I and BP-II Depression _____ in morning and more early morning awakenings than unipolar

worst

Differential Dx BP-I and BP-II Greater ________ concentrating than unipolar

difficulty

Bipolar prevalence

~ 1%

Bipolar onset

Avg is 18-20 y.o. | 20% of cases onside is less than 13 years

Bipolar sex ratio: | In children

Males > Females

Bipolar sex ratio: | In adults

Males = Females

Bipolar comorbidity: 1. 2. 3.

1. Anxiety Dxs 2. Substance Dxs 3. Borderline PD

Bipolar Suicidality: | _____ higher in BP than general population

14x

Bipolar: Depressive/Manic Balance: | For majority of cases the number of depressive episodes ____ than the number of manic/hypomanic episodes

is greater

Kindling

As you get older the time between episodes tends to shorten Increased sensitivity model is best supported - idea is that you need less environmental stress to trigger an episode Shows importance of treating early and aggressively before getting into kindling cycle

Bipolar genetics | High or low heritability?

High heritability rate | .85 to .93

Bipolar neurotransmitters involved

Dopamine | Serotonin

Med Tx for Bipolar: | Lithium side effects

Toxic range is next to therapeutic range Hand tremors, weight gain, thirst

Med Tx for Bipolar: AEDs Anti-epileptic drugs Side effects

Potential teratogens Stevens-Johnson Syndrome

Meds - Acute Mania | Lithium is ______ at addressing mania than antipsychotic meds and there is ______ between among AEDs and Li.

slower; no noteworthy difference

Meds - Depressive phase Antipsychotics 1. AEDs 2.

1. Latuda | 2. Lamictal

Meds - Prophylactic/Maintenance: Lithium is an ______ Especially in preventing _______ phase. Lamictal has prophylactic efficacy for the ______ pole and may be better for _______

effective prophylaxis agent; manic; depressive; BP-II

``` Psychotherapy Tx: Acute phase: Very limited evidence to support use of: 1. 2. 3. ```

1. CBT 2. Interpersonal 3. Social Rhythm

``` Psychotherapy Tx: Maintenance phase: Psychoeducation effects are.... 1. Decrease in _____ 2. Increase in overall ______ Effects are likely due to... 1. Increased _____ adherence 2. Increase in _____ habits 3. Increase _____ for/recognition when _______ ```

1. relapse 2. overall functioning 1. medication 2. regular habits 3. planning; deteriorating

Peds BP: | Irritability is ______ found in Peds BP

frequently

Peds BP: Irritability is not unique to Peds BP. What other Dxs can express irritability? Name 6

``` MDD Persistent Depressive Dx Generalized Anxiety Dx PTSD Oppositional Defiant Dx Disruptive Mood Dysregulation Dx ```

Peds BP: Popularity of Dx ~ 60% of medical visits where the child received this Dx outpatient the Tx was....

polypharmacy

Peds BP: | ~ 48% of those visits the Tx included an _______

atypical antipsychotic

Peds BP: Increase in diagnosis occurred between _____ and _______ as a reason for psychiatric inpatient admit. BP increased ______ and adolescent _____ in this timeframe. Childhood unipolar depression only rose ______

1997 and 2004 438%; 296%; 17%

Peds BP: Narrow Phenotype Follows DSM-5 OR More _____ - Requires "______" Sx of _______ mood and/or _______

rigorous; "cardinal"; elated mood; grandiosity

Peds BP: Broad Phenotype Ultra-______ rapid _____ Comorbid _______ Rageful _______ Ir______

ultra; cycling ADHD reactions Irritability

Peds BP: DSM-5's Solution Disruptive Mood Dysregulation Dx is created to __________

decrease incidence of BP in youth

Peds BP: DSM-5's Solution Placed with unipolar because DSM says....

irritability associated with later unipolar (not BP)

DMDD Diagnostics: A. Severe, recurrent _______ _____, manifested verbally and/or ______ that are ______ out of proportion in _____ or ______ to the situation or _________

temper outbursts; behaviorally; grossly; intensity; duration; provocation

DMDD Diagnostics: | B. Outbursts are _______ with _______ level

inconsistent; developmental

DMDD Diagnostics: | C. Outbursts occur more than _______ times per week (average)

3 times per week

DMDD Diagnostics: D. The _____ between outbursts is persistently _______ or ______ most of the day, nearly ______ day, and observable ________

mood; irritable; angry; every; by others

DMDD Diagnostics: E. Criteria _____- _____ present more than _____ months with no period more than ______ months without all ______ in Criteria A-D

A-D; 12 months; 3 months; symptoms

DMDD Diagnostics: | F. Do not make diagnosis for 1st time before _____ and after ______.

age of 6; after age of 18

DMDD Diagnostics: | G. (By Hx or observation) age of onset for criteria A-E is less than _____ years

DMDD Diagnostics: | H. _____ been a distinct period of more than ____ where they met full Sx criteria for _____ or _______

Never; 1 day; mania or hypomania

DMDD Diagnostics: I. ______ do not occur exclusively during ______ and are not better explained by another mental Dx (Note: This Dx CANNOT co exist with ODD, Intermittent Explosive Dx, or Bipolar. If criteria for DMDD and ODD then only given DMDD)

Behaviors; MDD

DMDD Diagnostics: | J. Not attributable to _____ or other ______

substance; medical condition

DMDD Comorbidity: If could Dx with ODD then those with DMDD would be at 54 to 103x greater risk of having...

ODD

DMDD Comorbidity: ICD made DMDD a specifier of _____ for those with chronic _____

ODD; irritability

DMDD Course: Only ______ maintained a Dx 2-3 years later

14-19%

DMDD Genetics: Offspring whose parents had ______ are 5.4x more likely to have DMDD

DMDD Tx: 1. Parent ______ 2. IPT - for ____ and _____

1. training | 2. for mood and dysregulation

Bipolar Flashcards

(78 cards)