Bipolar - Chan

Question 1

What is the Kraepelinian Triad for Mania?

Answer 1

• Elation
• Flight of ideas
• Increased psychomotor activity

Question 2

Name (7) distinct features that may present in a manic episode. How many of them are required for a diagnosis?

Answer 2

• Gradiosity
• Decreased need for sleep
• Hyperverbal or pressured speech
• Flight of ideas or racing thoughts
• Distractibility
• Increased goal-directed activity, psychomotor agitation
• More pleasureable activity with painful consequences

3 are needed to make a diagnosis, 4 if the patient is irritable

Question 3

Describe Stage I Mania

Answer 3

• Increased psychomotor activity
• Increased rate of speech
• Labile, euphoric mood
• Expansiveness and gradiosity
• Increased sexual preoccupation, religiousness, spending, letter-writing

Generally “high”, but not out of control

Question 4

Describe Stage II Mania

Answer 4

• Increased pressured speech and psychmotor activity
• Increased dysphoria, depression
• Open hostility and anger
• Explosive, possibly assaultive behavior
• Flight of ideas
• Proccupations with frank delusions

Question 5

Describe Stage III Mania

Answer 5

• Desperate, panic-stricken state
• Frenzied and bizarre psychomotor activity
• Loose associations
• Bizarre, idiosyncratic delusions
• Hallucinations
• Disorientation
• Ideas of reference (wiki: phenomenon of experiencing everyday occurrances or coincidences as somehow having strong personal significance - i.e. destiny)

Question 6

In addition to Lithium, what four other broad drug categories might be helpful in treatment of bipolar disorder?

Answer 6

• Anti-seizure
• Neuroleptics (antipsychotics)
• Antidepressants
• Omega-3 Fatty acids

Question 7

Give (5) anti-seizure meds that might be useful in the treatment of bipolar disorder

Answer 7

• Carbamazepine
• Valproate
• Lamictal
• Clonazepam
• Gabapentin

Question 8

Give (6) anti-psychotic meds that may be useful in the treatment of bipolar disorder

Answer 8

• Aripiprazole
• Chlorpromazine
• Olanzapine
• Quetiapine
• Risperidone
• Ziprasidone

Question 9

Lithium and Carbamazepine have nasty side-effect profiles and several newer drugs are readily available. What’s one big reason these are still extensively used?

Answer 9

$$$

Lithium ($0.17/pill) and carbamazepine ($0.59/pill) are crazy-cheap compared to newer alternatives (several $ per pill)

Question 10

What is a hypomanic episode?

Answer 10

Similar to a manic episode, except the mood disturbance is not significant enough to cause marked impairment in social and/or occupational functioning. No psychotic features are present. The episode lasts at least 4 days.

Question 11

Compare Bipolar I to Bipolar II

Answer 11

Bipolar I

• presence of at least 1 manic episode
• With or without hypomanic or depressive episode

Bipolar II

• Presence of hypomanic and depressive episodes
• Mood and functioning usually returns to normal between episodes
• Relatively high suicide risk

Question 12

What is cyclothymic disorder?

Answer 12

A milder form of bipolar disorder lasting at least two years

Features: hypomania and dysthymia