in order to be qualified as mania
distinct, abnormal, elevated, expansive (or irritable mood) X 7 days minimum
in order to be qualified as mania at least what 3 symptoms must be present for at least 2 weeks?
- increased self esteem/grandiosity
- decreased sleep
- increased speech
- racing thoughts
- distractibility
- increased activity (and energy is key for DSM5)
- increased dangerous impulsivity
DTRHIGH
Distractible Talkative Racing thoughts Hyperactive Impulsive Grandiose Hyposomnic
what is hypomania?
- milder mania
- at least 4 days or more
- same symptoms as mania
- the symptoms provide an unequivocal change in function, personality… that is clearly noted by others
- not severe enough to cause marked impairment
what is major depressive episode?
pervasive sad, down, or irritable mood more than 2 weeks?
what is manic episode?
mania (abnormally elevated, expansive or irritable mood) plus 3 or 4 other symptoms
what is the affect range from the most exciting state to the lowest?
mania –> hypomania –> euthymia (normal mood) –> dysthymia –> depression
what is hypomanic episode?
hypomania (elevated, expansive, or irritable mood, less severe and shorter duration than mania) plus 3 or 4 other symptoms
what is mixed episode?
meets criteria for both a manic episode and a major depressive episode
what is bipolar 1?
mania + MDE (major depressive disorder)
to be qualified as bipolar 1 what do you need?
must have mania, do not need to have depression
what is bipolar 2?
hypomania + MDE
to be qualified as bipolar 2 what do you need?
must have hypoMANIA, do not need to have depression
what is cyclothymia?
more than 2 yrs of hypomania with minor depressions
Occurrence of biopolar?
1% Lifetime prevalence: Women = Men in Bipolar 1
Greater for Bipolar 2 where women > Men
Biological Factors of bipolar?
- Altered neurotransmitter activity (Increase of DA, SR, NE)
- Monoamine Receptor Deficiency theory (opposite of depression)
- Genetics (high association)
- Kindling Hypothesis
- Too much neuronal firing in the limbic system
Seizure and anti-epilepsy drug model via Na++ channel blockade
Antidepressants for Bipolar Depression?
- Try not to use them. Avoid antidepressants that increase multiple monoamine neurotransmitters and favor lower doses of much simpler mechanistic SSRI(selective serotonin reuptake inhibitors)
- If you have to use them, make sure a mood stabilizer is used first to help prevent antidepressant alone from causing increased mania and instability
Antipsychotics for Bipolar?
- Some atypical antipsychotics, initially approved for schizophrenia have now been approved for treating bipolar depression, why?
–> They block the dopamine-2 receptor which treats mania or helps prevent it
–> All block 5HT2a receptors which treats depression
Some stimulate 5HT1a receptors “ “ “ “
Some have SSRI properties
Some have NRI properties
Some block 5HT2c, 5HT3, 5HT7 all of which have antidepressant inklings - THEY ARE UNIQUELY SUITED TO TREAT BOTH SIDES OF BIPOLARITY
Liithium has less data but is also a good choice….
does psychotherapy does work bipolar?
no does not work, medication management is critical
bipolar used to be called
manic depression
in order to qualified as bipolar
At least 3 symptoms must be present for at least 2 weeks:
- Increased self esteem/grandiosity
- Decreased sleep
- Increased speech
- Racing thoughts
- Distractibility
- *Increased activity (and energy is key for DSM 5)
- Increased dangerous impulsivity
Bipolar I defined
by the presence of at least 1 manic episode with or without a hypomanic or depressive episode.
Bipolar II defined
by the presence of a hypomanic and a depressive episode.
Patient’s mood and functioning usually return to
normal between episodes. Use of antidepressants can lead to mania. High suicide risk. Treatment: mood stabilizers (e.g., lithium, valproic acid,
carbamazepine), atypical antipsychotics.
