Podcast
Questions and Answers
Quetiapine is recognized for its efficacy in treating both manic and depressive phases of bipolar disorder. Which of the following best describes its role in bipolar I disorder treatment?
Quetiapine is recognized for its efficacy in treating both manic and depressive phases of bipolar disorder. Which of the following best describes its role in bipolar I disorder treatment?
- An effective treatment for rapid cycling bipolar disorder, particularly when other mood stabilizers are contraindicated.
- An adjunctive therapy specifically designed to enhance the effects of mood stabilizers during depressive episodes.
- A monotherapy suitable for managing both manic and depressive episodes, and is one of the few FDA-approved medications for bipolar disorder. (correct)
- Primarily used to manage the acute depressive episodes while a separate medication is used to manage the manic phases.
A patient presents with a 2-year history of mood disturbances characterized by dysthymia and intermittent hypomanic symptoms. These symptoms do not meet the full criteria for a hypomanic episode, and the patient reports never being symptom-free for more than two months at a time. Which of the following conditions is most consistent with this presentation?
A patient presents with a 2-year history of mood disturbances characterized by dysthymia and intermittent hypomanic symptoms. These symptoms do not meet the full criteria for a hypomanic episode, and the patient reports never being symptom-free for more than two months at a time. Which of the following conditions is most consistent with this presentation?
- Bipolar II disorder
- Major depressive disorder with atypical features
- Cyclothymic disorder (correct)
- Bipolar I disorder
When distinguishing between Bipolar I and Bipolar II disorders, which criterion is MOST indicative of Bipolar I?
When distinguishing between Bipolar I and Bipolar II disorders, which criterion is MOST indicative of Bipolar I?
- The occurrence of hypomanic episodes that do not cause significant social or occupational impairment.
- The manifestations of at least one manic episode that lasts for a week and includes psychotic features. (correct)
- The presence of at least one major depressive episode lasting two weeks.
- The experience of rapid cycling between depressive and hypomanic states over a year.
A 30-year-old female diagnosed with bipolar disorder is concerned about weight gain associated with mood stabilizers. Considering her concerns, which of the following anticonvulsant medications is MOST suitable due to its lower incidence of causing weight gain?
A 30-year-old female diagnosed with bipolar disorder is concerned about weight gain associated with mood stabilizers. Considering her concerns, which of the following anticonvulsant medications is MOST suitable due to its lower incidence of causing weight gain?
A psychiatrist is explaining the concept of 'kindling' in the context of bipolar disorder to a newly diagnosed patient. Which of the following statements BEST describes the kindling phenomenon and its implications for treatment?
A psychiatrist is explaining the concept of 'kindling' in the context of bipolar disorder to a newly diagnosed patient. Which of the following statements BEST describes the kindling phenomenon and its implications for treatment?
Which age range represents the most common period for the onset of bipolar disorder symptoms?
Which age range represents the most common period for the onset of bipolar disorder symptoms?
A patient being evaluated for bipolar disorder admits to regular recreational drug use. Why is a 'drug wash out' period important in this scenario?
A patient being evaluated for bipolar disorder admits to regular recreational drug use. Why is a 'drug wash out' period important in this scenario?
In the context of psychodynamic factors contributing to bipolar disorder, what might mania serve as a defense against?
In the context of psychodynamic factors contributing to bipolar disorder, what might mania serve as a defense against?
What is the most critical immediate concern when assessing a patient with bipolar disorder?
What is the most critical immediate concern when assessing a patient with bipolar disorder?
In Bipolar I disorder, what commonly triggers the first affective episode?
In Bipolar I disorder, what commonly triggers the first affective episode?
A patient with Bipolar II disorder is prescribed medication but reports discontinuing it because they 'feel good' during hypomanic phases. What concept does this scenario exemplify?
A patient with Bipolar II disorder is prescribed medication but reports discontinuing it because they 'feel good' during hypomanic phases. What concept does this scenario exemplify?
A patient has a history of major depressive episodes interspersed with periods of hypomania where their mood is elevated, they have increased energy, but they do not experience any significant impairment in social or occupational functioning, nor any psychotic symptoms. Which disorder is most likely?
A patient has a history of major depressive episodes interspersed with periods of hypomania where their mood is elevated, they have increased energy, but they do not experience any significant impairment in social or occupational functioning, nor any psychotic symptoms. Which disorder is most likely?
A researcher is investigating the biochemical underpinnings of bipolar disorder. Which of the following best characterizes the primary focus of this investigation?
A researcher is investigating the biochemical underpinnings of bipolar disorder. Which of the following best characterizes the primary focus of this investigation?
What is the most common reason a person with Bipolar I disorder is first diagnosed?
What is the most common reason a person with Bipolar I disorder is first diagnosed?
Which of the following BEST describes the nature of the 'cycles' experienced by individuals with Bipolar I disorder?
Which of the following BEST describes the nature of the 'cycles' experienced by individuals with Bipolar I disorder?
According to DSM-5 criteria, what is the minimum duration of persistently elevated mood required for a diagnosis of hypomanic episode?
According to DSM-5 criteria, what is the minimum duration of persistently elevated mood required for a diagnosis of hypomanic episode?
A patient with a history of depressive episodes experiences a period of elevated mood, increased energy, and decreased need for sleep lasting for 5 days. During this time, they remain highly functional at work and maintain their social engagements without impairment. Which of the following is the most likely classification of this mood episode?
A patient with a history of depressive episodes experiences a period of elevated mood, increased energy, and decreased need for sleep lasting for 5 days. During this time, they remain highly functional at work and maintain their social engagements without impairment. Which of the following is the most likely classification of this mood episode?
The 'kindling' phenomenon in bipolar disorder suggests that recurrent mood episodes can lead to:
The 'kindling' phenomenon in bipolar disorder suggests that recurrent mood episodes can lead to:
Which element of the 'DIG FAST' mnemonic for manic episodes is primarily associated with racing thoughts and a stream of disconnected ideas?
Which element of the 'DIG FAST' mnemonic for manic episodes is primarily associated with racing thoughts and a stream of disconnected ideas?
A patient in a manic state exhibits pressured speech, impulsivity, and grandiose delusions, requiring hospitalization for safety. According to DSM-5 criteria, how many manic episodes are required to diagnose Bipolar I disorder?
A patient in a manic state exhibits pressured speech, impulsivity, and grandiose delusions, requiring hospitalization for safety. According to DSM-5 criteria, how many manic episodes are required to diagnose Bipolar I disorder?
A patient presents with a chronic, fluctuating mood disturbance characterized by dysthymic symptoms and brief periods of hypomanic symptoms that do not meet the full criteria for a hypomanic episode. These symptoms have been present for over two years, and the patient reports rarely feeling symptom-free for more than a month at a time. Which condition is MOST consistent with this clinical picture?
A patient presents with a chronic, fluctuating mood disturbance characterized by dysthymic symptoms and brief periods of hypomanic symptoms that do not meet the full criteria for a hypomanic episode. These symptoms have been present for over two years, and the patient reports rarely feeling symptom-free for more than a month at a time. Which condition is MOST consistent with this clinical picture?
Which of the following is a recognized risk factor for the development of rapid cycling in bipolar disorder?
Which of the following is a recognized risk factor for the development of rapid cycling in bipolar disorder?
In the management of rapid cycling bipolar disorder, the combination of lithium and lamotrigine is considered superior to either medication alone, primarily due to:
In the management of rapid cycling bipolar disorder, the combination of lithium and lamotrigine is considered superior to either medication alone, primarily due to:
Which of the following best describes the mechanism of action of lithium in treating bipolar disorder?
Which of the following best describes the mechanism of action of lithium in treating bipolar disorder?
A patient is started on lithium for bipolar disorder. Two weeks later, they develop muscle twitching, nausea, diarrhea, and increased thirst. Which of the following initial laboratory tests is MOST critical to evaluate in this scenario?
A patient is started on lithium for bipolar disorder. Two weeks later, they develop muscle twitching, nausea, diarrhea, and increased thirst. Which of the following initial laboratory tests is MOST critical to evaluate in this scenario?
Which of the following medications used in bipolar disorder treatment is known for its potential weight loss properties?
Which of the following medications used in bipolar disorder treatment is known for its potential weight loss properties?
A patient with bipolar disorder is experiencing acute agitation and insomnia. Which of the following medications would be MOST appropriate for initial management?
A patient with bipolar disorder is experiencing acute agitation and insomnia. Which of the following medications would be MOST appropriate for initial management?
Electroconvulsive therapy (ECT) is considered for bipolar disorder treatment in which of the following scenarios?
Electroconvulsive therapy (ECT) is considered for bipolar disorder treatment in which of the following scenarios?
A pregnant patient with bipolar disorder requires mood stabilization. Which of the following medications carries the HIGHEST risk of teratogenicity, particularly during the first trimester?
A pregnant patient with bipolar disorder requires mood stabilization. Which of the following medications carries the HIGHEST risk of teratogenicity, particularly during the first trimester?
Antidepressants are generally avoided as monotherapy in bipolar disorder due to the risk of:
Antidepressants are generally avoided as monotherapy in bipolar disorder due to the risk of:
A patient on a stable dose of lithium experiences breakthrough depressive symptoms. Which of the following is the MOST appropriate next step in management?
A patient on a stable dose of lithium experiences breakthrough depressive symptoms. Which of the following is the MOST appropriate next step in management?
Approximately what percentage of patients with bipolar disorder are estimated to discontinue their medication against medical advice?
Approximately what percentage of patients with bipolar disorder are estimated to discontinue their medication against medical advice?
Abrupt withdrawal of lithium in a patient with bipolar disorder is associated with a relapse rate of approximately 50% within what timeframe?
Abrupt withdrawal of lithium in a patient with bipolar disorder is associated with a relapse rate of approximately 50% within what timeframe?
Which of the following lifestyle modifications is LEAST likely to be recommended as an adjunct to pharmacological treatment for bipolar disorder?
Which of the following lifestyle modifications is LEAST likely to be recommended as an adjunct to pharmacological treatment for bipolar disorder?
A patient presents with chronic pain and a comorbid diagnosis of bipolar II disorder primarily characterized by depressive symptoms. Considering potential off-label uses, which of the following medications might be considered, while also weighing its limited evidence for bipolar depression?
A patient presents with chronic pain and a comorbid diagnosis of bipolar II disorder primarily characterized by depressive symptoms. Considering potential off-label uses, which of the following medications might be considered, while also weighing its limited evidence for bipolar depression?
A patient experiencing a first manic episode reports elevated mood, increased energy, and decreased need for sleep for the past 8 days. They also display impaired judgment leading to impulsive decisions. According to the diagnostic criteria, which condition is most likely?
A patient experiencing a first manic episode reports elevated mood, increased energy, and decreased need for sleep for the past 8 days. They also display impaired judgment leading to impulsive decisions. According to the diagnostic criteria, which condition is most likely?
Which of the following scenarios best illustrates the potential risks associated with prescribing an antidepressant as a monotherapy to a patient with undiagnosed bipolar I disorder?
Which of the following scenarios best illustrates the potential risks associated with prescribing an antidepressant as a monotherapy to a patient with undiagnosed bipolar I disorder?
How does Bipolar II disorder differ from Bipolar I disorder in terms of manic symptoms?
How does Bipolar II disorder differ from Bipolar I disorder in terms of manic symptoms?
A patient is diagnosed with Bipolar II disorder. Which mood pattern would you expect to observe in this patient's history?
A patient is diagnosed with Bipolar II disorder. Which mood pattern would you expect to observe in this patient's history?
What is the primary rationale for avoiding antidepressant monotherapy in patients with Bipolar I disorder?
What is the primary rationale for avoiding antidepressant monotherapy in patients with Bipolar I disorder?
Which of the following is an accurate description of the 'kindling' phenomenon in the context of bipolar disorder?
Which of the following is an accurate description of the 'kindling' phenomenon in the context of bipolar disorder?
Which of the following best describes the MOST effective strategy for preventing the 'kindling' phenomenon in bipolar disorder?
Which of the following best describes the MOST effective strategy for preventing the 'kindling' phenomenon in bipolar disorder?
A patient with bipolar disorder is concerned about weight gain. Which anticonvulsant medication would be MOST appropriate to consider, given its lower association with weight gain?
A patient with bipolar disorder is concerned about weight gain. Which anticonvulsant medication would be MOST appropriate to consider, given its lower association with weight gain?
A distinguishing factor between hypomania and mania lies in the:
A distinguishing factor between hypomania and mania lies in the:
A patient presents with a mix of depressive and hypomanic symptoms that have occurred over the past year. They report that these fluctuating symptoms are impacting their ability to maintain stable relationships and consistent work schedule, but they are not severe enough to warrant hospitalization. Which of the following interventions should be prioritized FIRST?
A patient presents with a mix of depressive and hypomanic symptoms that have occurred over the past year. They report that these fluctuating symptoms are impacting their ability to maintain stable relationships and consistent work schedule, but they are not severe enough to warrant hospitalization. Which of the following interventions should be prioritized FIRST?
A patient's family history reveals several first-degree relatives diagnosed with bipolar disorder. Based on the information provided, what is the approximate increased likelihood that this patient will develop bipolar disorder compared to the general population?
A patient's family history reveals several first-degree relatives diagnosed with bipolar disorder. Based on the information provided, what is the approximate increased likelihood that this patient will develop bipolar disorder compared to the general population?
Which of the following BEST describes the primary characteristic of bipolar disorder?
Which of the following BEST describes the primary characteristic of bipolar disorder?
A researcher is investigating potential biological underpinnings of bipolar disorder. According to the information, which factor would be MOST relevant to their investigation?
A researcher is investigating potential biological underpinnings of bipolar disorder. According to the information, which factor would be MOST relevant to their investigation?
Which of the following age ranges represents the second most common period for the onset of bipolar disorder symptoms, as indicated in the material?
Which of the following age ranges represents the second most common period for the onset of bipolar disorder symptoms, as indicated in the material?
In a patient presenting with symptoms suggestive of bipolar disorder, which of the following factors would necessitate immediate and thorough evaluation due to the elevated risk associated with the condition?
In a patient presenting with symptoms suggestive of bipolar disorder, which of the following factors would necessitate immediate and thorough evaluation due to the elevated risk associated with the condition?
Which concept related to bipolar disorder remains a prominent area of ongoing investigation, with implications for understanding the disorder's pathophysiology?
Which concept related to bipolar disorder remains a prominent area of ongoing investigation, with implications for understanding the disorder's pathophysiology?
A 48-year-old patient is suspected of having bipolar disorder, despite the typical onset being in late adolescence or early adulthood. Which of the following considerations is MOST important in confirming the diagnosis at this later age?
A 48-year-old patient is suspected of having bipolar disorder, despite the typical onset being in late adolescence or early adulthood. Which of the following considerations is MOST important in confirming the diagnosis at this later age?
A patient taking lithium is newly prescribed a thiazide diuretic for hypertension. What is the MOST important potential drug interaction to monitor for in this patient?
A patient taking lithium is newly prescribed a thiazide diuretic for hypertension. What is the MOST important potential drug interaction to monitor for in this patient?
Anticonvulsant medications are utilized in bipolar disorder treatment to stabilize mood. Which of the following mechanisms of action is associated with the therapeutic effects of anticonvulsants in this context?
Anticonvulsant medications are utilized in bipolar disorder treatment to stabilize mood. Which of the following mechanisms of action is associated with the therapeutic effects of anticonvulsants in this context?
In which of the following clinical scenarios would the use of anticonvulsants be MOST considered as a first-line treatment alternative to lithium for bipolar disorder?
In which of the following clinical scenarios would the use of anticonvulsants be MOST considered as a first-line treatment alternative to lithium for bipolar disorder?
A patient taking valproic acid (Depakote) for bipolar disorder presents with new onset of abdominal pain, nausea, and vomiting. Which of the following laboratory tests is MOST pertinent to immediately evaluate, considering the potential 'PATHological' side effects of valproic acid?
A patient taking valproic acid (Depakote) for bipolar disorder presents with new onset of abdominal pain, nausea, and vomiting. Which of the following laboratory tests is MOST pertinent to immediately evaluate, considering the potential 'PATHological' side effects of valproic acid?
A female patient of childbearing potential is being started on valproic acid for rapid cycling bipolar disorder. Beyond the established monitoring of liver enzymes and CBC, what is the MOST critical counseling point regarding the 'PATHological' side effects of valproic acid that needs to be emphasized before initiating treatment?
A female patient of childbearing potential is being started on valproic acid for rapid cycling bipolar disorder. Beyond the established monitoring of liver enzymes and CBC, what is the MOST critical counseling point regarding the 'PATHological' side effects of valproic acid that needs to be emphasized before initiating treatment?
According to DSM-5-TR criteria, what is the minimum duration of manic symptoms required to classify an episode as manic?
According to DSM-5-TR criteria, what is the minimum duration of manic symptoms required to classify an episode as manic?
Which of the following is NOT explicitly listed as a symptom of mania?
Which of the following is NOT explicitly listed as a symptom of mania?
Why might a patient with Bipolar II disorder discontinue their medication, according to the information?
Why might a patient with Bipolar II disorder discontinue their medication, according to the information?
According to the DSM-5-TR, what is the minimum duration of abnormally elevated or irritable mood required for a hypomanic episode in Bipolar II disorder?
According to the DSM-5-TR, what is the minimum duration of abnormally elevated or irritable mood required for a hypomanic episode in Bipolar II disorder?
Which criterion differentiates Bipolar II disorder from Bipolar I disorder?
Which criterion differentiates Bipolar II disorder from Bipolar I disorder?
To ensure accurate therapeutic monitoring of lithium, at what point in relation to the next scheduled dose should serum trough levels be checked?
To ensure accurate therapeutic monitoring of lithium, at what point in relation to the next scheduled dose should serum trough levels be checked?
Which of the following conditions is NOT a contraindication for lithium use due to the potential for adverse interactions or exacerbation of the condition?
Which of the following conditions is NOT a contraindication for lithium use due to the potential for adverse interactions or exacerbation of the condition?
A patient has experienced dysthymia with hypomanic symptoms for over two years, but has never met the full criteria for a hypomanic episode. According to the provided information, which condition is most likely?
A patient has experienced dysthymia with hypomanic symptoms for over two years, but has never met the full criteria for a hypomanic episode. According to the provided information, which condition is most likely?
According to the information, which of the following specifiers does NOT apply to cyclothymia?
According to the information, which of the following specifiers does NOT apply to cyclothymia?
According to the 'LMNOP' mnemonic for lithium side effects, 'N' stands for Nephrotoxicity. Which of the following is a potential renal-related side effect associated with lithium?
According to the 'LMNOP' mnemonic for lithium side effects, 'N' stands for Nephrotoxicity. Which of the following is a potential renal-related side effect associated with lithium?
What is the primary criterion for diagnosing rapid cycling in bipolar disorder?
What is the primary criterion for diagnosing rapid cycling in bipolar disorder?
A patient taking lithium presents with increased thirst and frequent urination. Which of the following factors would be LEAST likely to exacerbate these symptoms?
A patient taking lithium presents with increased thirst and frequent urination. Which of the following factors would be LEAST likely to exacerbate these symptoms?
What distinguishes rapid cycling bipolar disorder from other forms of bipolar disorder in terms of its clinical course?
What distinguishes rapid cycling bipolar disorder from other forms of bipolar disorder in terms of its clinical course?
Which of the following laboratory tests is specifically recommended prior to initiating lithium therapy for all patients, regardless of age or pre-existing conditions?
Which of the following laboratory tests is specifically recommended prior to initiating lithium therapy for all patients, regardless of age or pre-existing conditions?
A 50-year-old patient with bipolar disorder and a history of controlled hypertension is about to start lithium. An ECG is recommended prior to initiation due to:
A 50-year-old patient with bipolar disorder and a history of controlled hypertension is about to start lithium. An ECG is recommended prior to initiation due to:
A patient on lithium develops mild nausea and a fine tremor shortly after starting treatment. Which of the following is the MOST appropriate initial management strategy?
A patient on lithium develops mild nausea and a fine tremor shortly after starting treatment. Which of the following is the MOST appropriate initial management strategy?
Which of the following dietary changes would be MOST likely to lead to an increase in serum lithium levels, potentially approaching toxic levels?
Which of the following dietary changes would be MOST likely to lead to an increase in serum lithium levels, potentially approaching toxic levels?
A patient with bipolar disorder is taking lithium and reports experiencing cognitive impairment, including difficulty concentrating and memory problems. Which of the following management strategies is LEAST likely to be helpful for this specific side effect?
A patient with bipolar disorder is taking lithium and reports experiencing cognitive impairment, including difficulty concentrating and memory problems. Which of the following management strategies is LEAST likely to be helpful for this specific side effect?
The teratogenic effect of lithium is most notably associated with an increased risk of which specific congenital anomaly?
The teratogenic effect of lithium is most notably associated with an increased risk of which specific congenital anomaly?
Which of the following best describes the utility of lithium in treating bipolar disorder?
Which of the following best describes the utility of lithium in treating bipolar disorder?
A patient presents with suspected rapid cycling bipolar disorder. What is the MOST likely demographic profile of this patient?
A patient presents with suspected rapid cycling bipolar disorder. What is the MOST likely demographic profile of this patient?
Which condition MUST be present to diagnose Bipolar I or II disorder 'with anxious distress'?
Which condition MUST be present to diagnose Bipolar I or II disorder 'with anxious distress'?
Which of the following medical conditions can induce bipolar disorder symptoms?
Which of the following medical conditions can induce bipolar disorder symptoms?
A patient presents with symptoms suggestive of bipolar disorder. To rule out secondary causes, the physician assistant should consider medications known to induce bipolar symptoms, including:
A patient presents with symptoms suggestive of bipolar disorder. To rule out secondary causes, the physician assistant should consider medications known to induce bipolar symptoms, including:
What is the rationale behind using an antipsychotic or benzodiazepine concurrently with lithium at the start of bipolar disorder treatment?
What is the rationale behind using an antipsychotic or benzodiazepine concurrently with lithium at the start of bipolar disorder treatment?
Beyond mood stabilization, what additional neurological benefit has been observed in patients undergoing lithium treatment?
Beyond mood stabilization, what additional neurological benefit has been observed in patients undergoing lithium treatment?
You are evaluating a patient with suspected bipolar disorder. Which of the following presentations would MOST strongly suggest the need to broaden the differential to include neurological etiologies?
You are evaluating a patient with suspected bipolar disorder. Which of the following presentations would MOST strongly suggest the need to broaden the differential to include neurological etiologies?
A patient with no prior psychiatric history presents with a first episode suggestive of mania after being prescribed corticosteroids for a severe asthma exacerbation. Which of the following best explains this presentation?
A patient with no prior psychiatric history presents with a first episode suggestive of mania after being prescribed corticosteroids for a severe asthma exacerbation. Which of the following best explains this presentation?
A clinician is considering different pharmacological strategies for a patient with treatment-resistant rapid cycling bipolar disorder. According to the provided information, what combination demonstrates superior efficacy in managing this specific presentation?
A clinician is considering different pharmacological strategies for a patient with treatment-resistant rapid cycling bipolar disorder. According to the provided information, what combination demonstrates superior efficacy in managing this specific presentation?
Flashcards
Quetiapine for Bipolar I Mania
Quetiapine for Bipolar I Mania
Quetiapine is an antipsychotic medication used as a single treatment for both the manic and depressive phases of bipolar I disorder. It is one of the five FDA-approved medications for this condition.
Cyclothymia
Cyclothymia
Cyclothymia involves dysthymia with hypomanic symptoms that don't meet full hypomanic criteria, present for 2 years in adults or 1 year in children/adolescents, with symptom-free periods lasting no more than 2 months.
Bipolar I Disorder
Bipolar I Disorder
Bipolar I involves a combination of manic and euphoric highs, often followed by severe depression/suicide, interfering with work or social life, and may include psychotic features. A single manic episode lasting at least 1 week with 3+ manic symptoms is sufficient for diagnosis.
Bipolar II Disorder
Bipolar II Disorder
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Kindling in Bipolar Disorder
Kindling in Bipolar Disorder
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What is Bipolar Disorder?
What is Bipolar Disorder?
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Causes of Bipolar Disorder
Causes of Bipolar Disorder
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Suicide Risk in Bipolar Disorder
Suicide Risk in Bipolar Disorder
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Bipolar Disorder and Substance Abuse
Bipolar Disorder and Substance Abuse
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Why a 'Drug Wash Out'?
Why a 'Drug Wash Out'?
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Bipolar I characteristics
Bipolar I characteristics
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Common Bipolar I Triggers
Common Bipolar I Triggers
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Cycle (Bipolar Disorder)
Cycle (Bipolar Disorder)
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Affective Episode
Affective Episode
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Bipolar II characteristics
Bipolar II characteristics
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Lamotrigine (Lamictal)
Lamotrigine (Lamictal)
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Topiramate
Topiramate
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Gabapentin
Gabapentin
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Pregabalin
Pregabalin
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FDA-Approved BPD Meds
FDA-Approved BPD Meds
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BPD Agitation Treatment
BPD Agitation Treatment
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ECT for BPD
ECT for BPD
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Haldol in Pregnancy
Haldol in Pregnancy
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BPD Breakthrough Symptoms
BPD Breakthrough Symptoms
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BPD Lifestyle Changes
BPD Lifestyle Changes
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Hypomanic Episode
Hypomanic Episode
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Bipolar Disorder Triggers
Bipolar Disorder Triggers
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Manic Episode (DSM-5)
Manic Episode (DSM-5)
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DIG FAST (Mania Symptoms)
DIG FAST (Mania Symptoms)
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Cyclothymic Disorder
Cyclothymic Disorder
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BPD with Rapid Cycling
BPD with Rapid Cycling
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BPD with Psychotic Features
BPD with Psychotic Features
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BPD with Anxious Distress
BPD with Anxious Distress
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Lithium in BPD Treatment
Lithium in BPD Treatment
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LMNOP (Lithium Side Effects)
LMNOP (Lithium Side Effects)
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Mania Definition
Mania Definition
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Diagnostic Criteria: Bipolar I
Diagnostic Criteria: Bipolar I
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Bipolar I: Triggering events
Bipolar I: Triggering events
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Diagnostic Criteria: Bipolar II
Diagnostic Criteria: Bipolar II
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Hypomania Definition
Hypomania Definition
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Anticonvulsant with least weight gain
Anticonvulsant with least weight gain
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Kindling Definition
Kindling Definition
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Kindling Prevention
Kindling Prevention
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Antidepressants and Bipolar I
Antidepressants and Bipolar I
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Psychotic Features in Bipolar
Psychotic Features in Bipolar
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Bipolar disorder: severe episodes
Bipolar disorder: severe episodes
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Bipolar disorder: onset age
Bipolar disorder: onset age
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Bipolar disorder: biochemical cause
Bipolar disorder: biochemical cause
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Bipolar disorder: multiple pathways
Bipolar disorder: multiple pathways
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Bipolar disorder: genetic risk
Bipolar disorder: genetic risk
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Bipolar disorder: suicide risk
Bipolar disorder: suicide risk
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Anticonvulsant Discontinuation/Switching
Anticonvulsant Discontinuation/Switching
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Anticonvulsants Mechanism
Anticonvulsants Mechanism
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Anticonvulsants Uses
Anticonvulsants Uses
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Divaproex Use
Divaproex Use
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Divalproex Pathological SE
Divalproex Pathological SE
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Impaired Judgment (Mania)
Impaired Judgment (Mania)
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Manic Episode Duration (DSM-5)
Manic Episode Duration (DSM-5)
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Three Symptoms of Mania
Three Symptoms of Mania
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Hypomania
Hypomania
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Hypomanic Episode Criteria
Hypomanic Episode Criteria
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Bipolar II: Diagnostic Criteria
Bipolar II: Diagnostic Criteria
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Rapid Cycling Definition
Rapid Cycling Definition
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Rapid Cycling
Rapid Cycling
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Substance Mimicry
Substance Mimicry
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Lithium and Lamotrigine
Lithium and Lamotrigine
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BPD Differential Diagnosis
BPD Differential Diagnosis
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Medication-Induced BPD Symptoms
Medication-Induced BPD Symptoms
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Endocrine/Nutritional BPD Causes
Endocrine/Nutritional BPD Causes
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Neurologic BPD Causes
Neurologic BPD Causes
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Infectious BPD Causes
Infectious BPD Causes
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Lithium Trough Level
Lithium Trough Level
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Lithium Contraindications
Lithium Contraindications
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Lithium: Side Effects (LMNOP)
Lithium: Side Effects (LMNOP)
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Common Lithium Side Effects
Common Lithium Side Effects
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Factors Affecting Lithium Levels
Factors Affecting Lithium Levels
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Lithium-Sodium Relationship
Lithium-Sodium Relationship
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Pre-Lithium Labs
Pre-Lithium Labs
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Managing Lithium Side Effects
Managing Lithium Side Effects
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Lithium Side Effect Tolerance
Lithium Side Effect Tolerance
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Dividing daily dose
Dividing daily dose
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Study Notes
- Study notes on bipolar disorder
What is Bipolar Disorder (BPD)?
- Bipolar disorder is characterized by alternating cycles of depression and mania.
- Severe episodes of bipolar disorder can be accompanied by hallucinations or delusions.
- The most common onset of symptoms occurs between the ages of 15 and 19, with a secondary peak between 20 and 24.
Causes of Bipolar Disorder
- Bipolar disorder is associated with a biochemical instability affecting nerve impulse transmission in the brain.
- Psychodynamic factors suggest that mania serves as a defense mechanism against depression or loss.
- Pharmacological factors indicate that antidepressants may unmask a predisposition to mania.
- The risk of suicide in individuals with BPD is very high, with a mortality rate 2-3 times higher than the general population.
- A significant percentage (61%) of individuals with BPD have a lifetime history of drug or alcohol use disorder.
- Detoxification ("drug wash out") is necessary to differentiate between bipolar symptoms and drug effects.
- It is important to consistently inquire about drug use during patient visits.
Medication Treatment for Bipolar I with Acute Mania
- Quetiapine is an antipsychotic used as a single treatment for both mania and depression in bipolar disorder.
- It's one of the 5 FDA-approved medications for bipolar disorder.
Differences between Cyclothymia, Bipolar I, and Bipolar II
- Cyclothymia is characterized by dysthymia with hypomanic symptoms that do not meet the full criteria for a hypomanic episode.
- Adults must exhibit symptoms for two years, while children and adolescents must show them for one year.
- Individuals with cyclothymia will not be symptom-free for more than two months at a time.
- Bipolar I involves a combination of mania and euphoric highs, potentially followed by severe depression or suicidal ideation.
- Bipolar I can disrupt work or social life, and psychotic features might be present.
- The initial episode may be triggered by a stressful life event.
- To be diagnosed, a full manic episode must last one week and include at least three manic symptoms.
- Bipolar II includes hypomania with major depression; the mania is less intense, and psychotic symptoms are absent.
- It does not interfere with work or social life and includes one or more major depressive episodes and at least one hypomanic episode.
- Exhibits persistent elevated or irritable mood for a minimum of four days, along with at least three manic symptoms.
- Cyclothymia is a milder form of bipolar disorder, often referred to as "bipolar light".
- Symptoms must be present for 2 years in adults and 1 year in children/adolescents
- Defined by dysthymia with hypomanic symptoms that never meet full hypomanic criteria
- Individuals with cyclothymia will not be symptom-free for longer than 2 months
- Cyclothymia can progress to Bipolar I or II
Defining Characteristics of Bipolar I Disorder
- Bipolar I is characterized by a combination of mania and euphoric highs, often followed by severe depression or suicidal thoughts.
- Diagnosis often occurs after hospitalization, arrest, or at the insistence of family members.
- The initial episode is commonly triggered by a stressful life event, such as a new job, school, marriage, or excessive stimulation.
- A cycle in Bipolar I equals one entire rotation from each extreme.
- Cycles may be widely spaced with extended periods of wellness in between, or be short with seemingly continual illness
- An affective episode in Bipolar I is either a manic or a depressive episode
Defining Characteristics of Bipolar II Disorder
- Bipolar II is characterized by hypomania with major depression, often described as "low/mild mania."
- Shares some characteristics of mania, the highs do not interfere with a person's work or social life
- Individuals do not experience psychotic symptom
- Individuals may think they are fine, while family and friends recognize the hypomania.
- Individuals feel good and may stop taking their medication to continue experiencing the hypomania, which can result in severe mania or depression
- DSM 5 criteria for hypomanic episode: At least 4 continuous days of abnormally and persistently elevated/irritable mood
- There is no significant social or occupational dysfunction
- Includes one or more major depressive episodes and at least one hypomanic episode
- There is no history of mania or mixed episodes
- Bipolar II is treated like Bipolar I
Triggers for Bipolar Disorder
- Triggers include insufficient sleep, altercations with loved ones, alcohol and drug abuse, antidepressants, pregnancy, and seasonal changes.
Anticonvulsant Medication with Least Weight Gain
- Lamotrigine (Lamictal) is an anticonvulsant medication used for bipolar disorder that has the least incidence of weight gain.
Kindling and Prevention
- Kindling in bipolar disorder refers to the phenomenon where earlier, more frequent episodes can lead to more severe and persistent episodes over time.
- Managing kindling includes early and effective treatment. The goal is early and effective treatment
- The earlier and more frequent the bipolar episodes, the more severe and persistent they become.
- Early interventions are essential in preventing the escalation of the severity and persistence of bipolar episodes.
DSM 5 Criteria for Manic Episodes
- Abnormally and persistently elevated or irritable mood lasting at least one week or any duration if hospitalized
- Includes more than 3 manic symptoms
- Only one episode is needed for diagnosis of Bipolar I
- Results in social or occupational dysfunction
Mania Symptoms
- Mania can be remembered through the mnemonic DIG FAST: Distractibility, Insomnia, Grandiosity, Fast thoughts/Flight of ideas, Activities (increased/goal directed/pleasurable/high risk), Speech (over talkative/vulgar/clanging), and Thoughtlessness/reckless/impulsive
- Features of mania:
- Preoccupation with political, personal, religious, and sexual themes
- Impaired judgment
- Psychotic features
- Features of mania:
Antidepressants and Bipolar I Disorder
- Antidepressants are generally not recommended as a standalone treatment for bipolar I disorder because bipolar disorder involves cycling between depressive and manic episodes, and antidepressants may trigger manic episodes or rapid cycling in some individuals.
- Antidepressants are mostly ineffective for treating primarily depression in bipolar disorder and pose a risk of inducing a manic attack.
BPD I/II/III & Core Specifiers
- Characterized by four or more discrete, affective episodes/year
- Rapid cycling has faster or more often with shorter time periods in between episodes
- Rapid cycling tends to have longer duration and a more refractory course
- When rapid cycling occurs, count number of episodes rather than cycles
- Substance abuse can mimic rapid cycling
- Risk factors include:
- Treatment with antidepressants alone, without a mood stabilizer
- Development of clinical or subclinical hypothyroidism
- Lithium and Lamotrigine combination is superior to either alone in treatment sensitive rapid cycling bipolar
- Bipolar disorder with psychotic features: includes delusions, extreme paranoia, grandiose thoughts, hallucinations, catatonia, small % of patients
- Bipolar disorder with anxious distress: Must have 2+ of the following symptoms the majority of days during an episode: Irritable, short fused, Restlessness, Difficulty concentrating due to worry, Feeling of dread/impending doom, Fear of "losing control"
Medications that Cause BPD Symptoms
- Decongestants, street drugs, corticosteroids, sympathomimetic amines, barbiturates, caffeine
Endocrine/Nutritional Causes of BPD Symptoms
- Hemodialysis, Vitamin B12/folate deficiency, Hyper/hypothyroidism
Neurologic Causes of BPD Symptoms
- MS, damage to the Right hemisphere, Seizure disorders, Huntington's disease, Post stroke, Benign/malignant brain neoplasms
Infectious Causes of BPD Symptoms
- Neurosyphilis, herpes simplex encephalitis, HIV infection
BPD Treatment - Lithium
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The most efficacious treatment in a classic presentation.
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Lithium's MOA is unknown, but it "strengthens the calm, and calms the excited neurons."
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Takes 5-10 days to take effect
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Prevents Relapse, Reduces risk of suicide, reduces aggression/impulsivity, reduces risk of developing neurocognitive disorders, and increases gray matter and hippocampus in patients taking lithium
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When treating and monitoring you should:
- Maintain the trough blood level between 0.6-1.2 mmol/L and check the serum level before the next dose.
- Recognize it has a narrow therapeutic index
- Be aware that it is contraindicated with significant renal impairment, sodium depletion, dehydration, significant cardiovascular disease, hypothyroidism, and pregnancy.
-Side effects:
- LMNOP: Lithium, Movement, Nephrotoxicity, and Hypothyroidism
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Other side effects also include being "twitchy and pissy", Pregnancy issues, Nausea, Vomiting & Diarrhea, Polyuria, Thirst Weight gain, Oedema/Swelling, Worsening Psoriasis & Cognitive Impairment.
Lithium requires ongoing testing for:
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liver function, CBC w/ diff, glucose, weight, valproate levels & lipase
- Circumstances that can change lithium serum levels: Medical illness, Surgery, Severely restrictive dieting/sodium restriction, & Pregnancy Labs before starting: - Hemodialysis, Vitamin B12/folate deficiency, Hyper/hypothyroidism
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BPD Treatment - Anticonvulsant Drugs
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Decreases Firing of the CNS nerves
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Increases GABA
- which provides a calming, mechanism of action (MOA) similar to hypnotics/tranquilizers.
- Indications for anticonvulsants: Alternative to (or previous poor response to) Lithium, Recurrent substance abuse, and is important to remember All are teratogenic
- BPD Treatment - Valproic Acid/Divalproex (Depakote)
- Some sources consider this the DOC. It is used for rapid cyclers. Monitor levels for therapeutic effects for side effects ### ADE's: - Weight Gain, Drowsiness, Fatigue & Gait Disturbance. - Pathological side effects include Pancreatitis, Aplastic Anaemia Risk Teratogenic & Hepatic Toxicity Potential. - Liver enzymes, CBC w/ diff, glucose, weight, valproate levels & lipase need to be monitored in the lab. - Carbamazepine (Tegretol) is indicated for mixed features or as an alternative medication. - Side effects include diplopia, ataxia, weight gain, hyponatremia elevated liver enzymes photosensitivity & blood dyscrasias (aplastic anaemia & leukopenia) -It's very importanat to rule out SJS/TEN due to effects on asian patients.- BPD Treatment - Lamotrigine (Lamictal)
- Used for predominately depressive BP I or II for rapid cycling can cause SJS/TEN and causes Weight Loss. - The only 5 FDA approved meds that should be prescribed are Cariprazine, Lurasidone, Symbyax, Quetiapine & Lumateperone. ### BPD Agitation/Insomnia Treatment - Benzodiazepines are also a good option. Particularly Clonazepam or Lorazepam with the caveat that Insomnia is a risk factor. ### PBD Treatment in Preganancy - Haldol is safe, but look out for Extrapyramidal side and uncomfortable side effects. Second generation anti-psychotics can be used carefully and ECTs are considered safe. Do not prescribe Lithium in the 1st trimester as it is Teratogenic. Patients will sometimes ask for prescription for breakthrough symptoms. For that the recommendation is, if on lithium or mood stabiliser, add SQA Quetiapine. On treatment of Adherence/Compliance. Aproximately 50% of patients stop meds completely and average time to non-adherence is 9 months with side effects. Emotional blunting with medication is a main side effect is lithium is withdrawn abruptly, this increased the risk of relapse to aproxx 50% within 5 months. Therefore for lifestyle changes we will implement NO: Drugs, Restrictive/Alcohol & Caffeine, but we will impliment: Exercise, Regular sleep, Therapy and Symptom Monitoring (To identify highs lows fast) - which provides a calming, mechanism of action (MOA) similar to hypnotics/tranquilizers.
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Study notes cover medication treatments such as Quetiapine for Bipolar I and the differences between Cyclothymia, Bipolar I, and Bipolar II. Cyclothymia involves dysthymia with hypomanic symptoms. Bipolar I includes mania and euphoric highs followed by severe depression.
