Updated: 9/3/2020

Bipolar Disorder

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
7
0
0
0%
0%
Evidence
10
0
0
Topic
Snapshot
  • A 25-year-old man seeks help from his psychiatrist. He has a history of bipolar I disease and had been on lithium for many years. He has had primarily manic episodes in the past which required mood stabilization. Lately, he reports he has been feeling depressed. He is preoccupied about thoughts of hurting himself. He stopped taking his lithium medication consistently, taking it only when he feels it may be beneficial. He also reports sleeping excessively and feeling very fatigued. He felt a huge amount of guilt towards his parents who had high hopes for him to become a doctor. His psychiatrist contemplates switching mood stabilizers.
Introduction
  • Overview
    • bipolar disorder is characterized by episodes of mania and depression
      • treatment is mood stabilizers or atypical antipsychotics
      • bipolar I
        • at least 1 manic episode, with or without a hypomanic or depressive episode
      • bipolar II
        • hypomanic episode and depressive episode
  • Epidemiology
    • incidence
      • lifelong prevalence range from 0.9-2.1%
    • demographics
      • mean age of onset is 21 years
      • women often cycle through manic and depressive episodes more frequently
    • risk factors
      • other mood disorders
  • Pathogenesis
    • mechanism
      • may be a genetic susceptibility for bipolar disorder
      • may be atrophy in the brain
Presentation
  • Symptoms
    • mood may normalize between episodes, and patient may be fully functional during this time
    • using antidepressants may destabilize mood and trigger an episode
    • manic episodes (at least 1 week duration and causes marked impairment in function) or hypomanic episodes (at least 4 days duration and may not be severe enough to cause dysfunction) with 3 or more of the following
      • grandiosity
      • decreased sleeping
      • excessive talking and pressures speech
      • racing thoughts and ideas
      • distractibility
      • increased level of goal-focused activity at home, work, or sexually
      • excessive pleasurable activities
    • depressive episodes (2 weeks duration) with 5 or more of the following, including either depressed mood or loss of pleasure or interest in activities
      • depressed mood
      • loss of pleasure or interest in activities
      • weight loss or gain or appetite loss or gain
      • hypersomnia or insomnia
      • psychomotor retardation or agitation
      • loss of energy or fatigue
      • feelings of worthlessness or excessive guilt
      • decreased ability to concentrate or make decisions
      • preoccupation with death or suicide
    • either phase may have psychotic features
  • Physical exam
    • psychomotor agitation or depression
Differential
  • Cyclothymic disorder
    • key distinguishing factor
      • presents similarly but with milder symptoms and lasts 2 years or longer
Treatment
  • Non-medical
    • psychotherapy
      • indications
        • may help decrease recurrence rates or help improve quality of life
    • inpatient admission
      • indications
        • suicidal behavior or psychosis
    • electroconvulsive therapy (ECT)
      • indications
        • refractory to medications
  • Medical
    • mood stabilizers
      • indications
        • first-line
      • drugs
        • lithium    
          • renal failure, hyponatremia, and dehydration increase the likelihood of lithium toxicities
        • valproic acid  
        • carbamazepine
        • lamotrigine
    • atypical antipsychotics or typical antipsychotics  
      • indications
        • if there are features of psychosis
      • drugs
        • ziprasidone
        • quetiapine
        • risperidone
        • aripiprazole
        • haloperidol
          • used in pregnant women
Complications
  • Increased risk of suicide

Please rate topic.

Average 4.9 of 9 Ratings

Questions (7)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK

(M3.PY.16.8) A 35-year-old female presents to her PCP at the request of her husband after 3 weeks of erratic behavior. The patient has been staying up all night online shopping on eBay. Despite a lack of sleep, she is "full of energy" during the day at her teaching job, which she believes is "beneath [her], anyway." She has not sought psychiatric treatment in the past, but reports an episode of self-diagnosed depression 2 years ago. The patient denies thoughts of suicide. Pregnancy test is negative. Which of the following is the best initial treatment? Tested Concept

QID: 105825
1

Valproate

40%

(2/5)

2

Valproate and venlafaxine

20%

(1/5)

3

Valproate and olanzapine

0%

(0/5)

4

Haloperidol

20%

(1/5)

5

Electroconvulsive therapy

20%

(1/5)

M 11 E

Select Answer to see Preferred Response

(M3.PY.12.3) A 20-year-old woman is brought in by police for trying to break into a museum after hours. The patient states that she is a detective on the trail of a master collusion scheme and needs the artifacts from the museum to prove her case. Her family reports that she has been acting strangely for the past week. She has been up perusing the internet all night without taking breaks. Her husband states that she has had increased sexual interest for the past week; however, he did not report this to the physician when he first noticed it. The patient is unable to offer a history as she cannot be redirected from her current theory. Her temperature is 99.0°F (37.2°C), blood pressure is 122/81 mmHg, pulse is 97/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable only for a highly-energized patient. Laboratory studies are ordered as seen below.

Urine:
Color: Yellow
Nitrite: Negative
Bacteria: Negative
Leukocytes: Negative
hCG: Positive
Benzodiazepines: Negative
Barbiturate: Negative
Cocaine: Negative
Acetaminophen: Negative

Which of the following is the most appropriate next step in management?
Tested Concept

QID: 103738
1

Electroconvulsive therapy

67%

(6/9)

2

Fluoxetine

0%

(0/9)

3

Haloperidol

22%

(2/9)

4

Lithium

11%

(1/9)

5

Valproic acid

0%

(0/9)

M 11 E

Select Answer to see Preferred Response

Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
Evidence (13)
EXPERT COMMENTS (31)
Private Note