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1. The DSM-5 defines bipolar disorder by the experience manic or hypomanic
of a ____ or ____ episode.
2. Mania can be thought of as the affective opposite of depression
____. 1 week
A manic episode is characterized by at least _____ of
an abnormal and persistently elevated mood accom-
panied by an increased amount of activity.
3. Symptoms of ____ mania
inflated self-esteem
irritability
decreased need for sleep
pressured speech
flight of ideas
poor attention
increased hyperactivity or agitation
involvement in high-risk, pleasurable activities with-
out respect to the consequences.
4. A hypomanic episode is a_____. milder form of mania
It must exist for _____or longer. 4 days
Unlike mania, it is not severe enough to warrant _____, hospitalization
It does not impair ________, social or occupational
It is s not associated with ______. functioning
psychosis
5. _____: Chronic disorder marked by one or more manic Bipolar I
or mixed episodes and major depressive episodes
6. ______: Chronic disorder marked by one or more major Bipolar II
depressive episodes, accompanied by at least one hy-
pomanic episode
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7. ______: Several periods of hypomania and mild depres- Cyclothymic disorder
sion, none of which meet the criteria for mania or
major depressive episode
8. Rapid cycling is at least ____ episodes of mania or 4 episodes in 1 year
depression in _____
9. Bipolar disorder, particularly type II bipolar disorder, is major depression
often misdiagnosed as ___. treatment is different
The diagnosis is important because ______.
10. __________: elevated mood
3 symptoms (______) or 4 symptoms (______): (elation)
Decreased need for sleep (irritability)
Distractibility
Excessive involvement in high risk pleasurable activi-
ty
Flight of ideas
Grandiosity
Increase in energy, goal-directed activity or psy-
chomotor agitation
Pressured speech
11. A drug can be ________ and "treat from above" to "mania-minded"
reduce symptoms of mania, and/or "stabilize from "depression-minded"
above" to prevent relapse and recurrence of mania.
Or drugs can be _______ and "treat from below" to
reduce symptoms of bipolar depression, and/or "sta-
bilize from below" to prevent relapse and recurrence
of depression. Not all drugs proven to work in bipolar
disorder have all four therapeutic actions.
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12. Bipolar tx •Lithium
•Acute therapy: manic episode •Valproic acid
______, _______, (or _____, ______ if needed) (antipsychotic or benzo)
13. Bipolar tx •Mood stabilizer alone or
•Acute therapy: depressive phase with an antidepressant
______ alone or with _______
14. Bipolar tx •One or more mood sta-
Long-term prevention bilizers and other drugs
which are needed acutely
15. The exact mechanism of action for lithium is unknown, neuroprotective
but it appears to be ______.
16. ______ Lithium
-Continues to be the gold standard for treating type
I bipolar disorder. It is effective for the manic AND
depressive components.
-Although it is not a particularly good antidepressant
as monotherapy in unipolar depression, it is effective
in patients with bipolar disorder.
-It also has anti-suicidal effects when used to treat
bipolar disorder.
17. Lithium tx: 1-2 weeks
Antimanic effects can occur in ______. 6-8 weeks
Antidepressant effects can occur in ______. (antipsychotics or benzo-
(Most clinicians use ______ or ______ as adjunctive ther- diazepines)
apy during this period to cover the agitation and other
symptoms.)
18. Lithium
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_______:
-Its half-life is 20-24 hours.
-It is excreted 95% unchanged by glomerular filtra-
tion
-Anything that alters the glomerular filtration rate af-
fects its clearance.
19. Lithium tx: 5-6 days
Pharmacokinetic methods are available for early pre-
diction of doses, but waiting ______ for steady state
seems to work just as well.
20. Initial dosing of lithium is ______in divided doses and 600-900 mg/day
then titrated according to response and tolerability.
21. Maintenance doses of _____ are based on serum con- Lithium
centrations, symptom relief, and the occurrence of
adverse effects.
22. 6. A pre-_____ workup includes Lithium
-CBC,
-Electrolytes
-Renal function
-Thyroid function tests
-Urinalysis
-ECG
-Pregnancy test for women of childbearing age.
23. _____: Lithium
-Teratogenic, particularly in the first trimester.
-Women of childbearing age should be counseled on
its potential effects.
-Risks of discontinuing this drug must be weighed