Bipolar

Question 1

What are the risk factors for bipolar disorder?

Answer 1

Genetics

Treatment-Induced
- Antidepressant-induced mania – by ↑NE or DA transmission
- ECT

Induced by General Medical Conditions

Hx of Trauma – Perinatal trauma, head trauma, physical abuse

Physical stressors

Seasonal changes

Question 2

What are some medications/drugs that can precipitate bipolar disorder?

Answer 2

• Drugs of abuse: alcohol, LSD, marijuana
• Drug withdrawal: alcohol, α2-agonists, antidepressants, barbiturates, BZDs, opiates
• Antidepressants
• DA-augmenting agents: CNS stimulants, amphetamines, cocaine, sympathomimetics, DA agonists, releasers, reuptake inhibitors
• St John’s wort
• NE-augmenting agents: α2-agonists, β-agonists, NE reuptake inhibitors
• Steroids: anabolic, ACTH, corticosteroids
• Thyroid preparations
• OTC weight-loss agents and decongestants – pseudoephedrine, ephedra
• Xanthines – caffeine, theophylline

Question 3

What are the depressive symptoms of bipolar disorder?

Answer 3

Depressed mood
Sleep increase/decrease
Interest in formerly pleasurable activities diminished
Guilt, low self-esteem
Energy decreased
Concentration poor
Appetite increase/decrease
Psychomotor agitation or retardation
Suicidal ideation

Question 4

What are the manic symptoms of bipolar disorder?

Answer 4

Distractibility and easily frustrated
Irresponsibility and erratic uninhibited behaviour
Grandiosity – inflated self-esteem
Flight of ideas – racing of thoughts
Activity incr – goal-directed activity/psychomotor agitation
Sleep needs decreased
Talkativeness

Manic episode – ≥3 Sx + elevated mood (or 4 Sx if mood is merely irritable)