MH 701: Module 4, Mood Stabilizers Exam Questions and Answers Best rated A+ Guaranteed Success Latest Update

Which disorder has at least one full manic episode, lasting at least one week? Hypomanic or depressive episodes may also occur but are not required for diagnosis. - Bipolar 1 disorder What is DIGFAST? - A mnemonic for the signs of mania: Distractibility Impulsivity/Indiscretion Grandiosity Flight of ideas Activity increase Sleep decrease Talkativeness How many DSM V criteria for mania must be present to diagnose a manic episode? - Three or more How long must symptoms be present to diagnose a manic episode? - At least one week, present every day, for most of the day. Mania onset after age 40, what other etiologies should be considered? - Other etiologies: Medical (eg. dementia, delirium) or substance use Newly diagnosed mania is uncommon in which populations? - Children and adults over age 65 Which disorder is characterized by at least one major depressive episode and at least one hypomanic episode (lasts at least 4 days, but not over 7 days), but no marked functional impairment? - Bipolar IIHow long must depressive symptoms occur to diagnose bipolar depression? - "Two blue weeks" Of 5 or more of the qualifying criteria Which disorder consists of persistent mood swings from moderate depression to hypomania and lasts two years or more? - Cyclothymia What is the Kindling Theory of bipolar disorder? - Repeated intermittent subthreshold stimulation eventually leads to an amplified response (amygdala seizures) What are common psychiatric comorbidities with bipolar disorder? - Anxiety disorders (50- 75% lifetime comorbidity) Substance use disorders (49-61%) Personality disorders (esp cluster B) Suicide (15x greater than the general population) What is the priority of treatment in bipolar disorder? - Safety Mood stabilizers are first-line agents Which classes of medications are used in an ACUTE bipolar manic episode? - Mood Stabilizers (FDA: Carbamazepine, Lithium, Valproate) Atypical Antipsychotics (Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone) Benzodiazepines Which mood stabilizer is the most effective for bipolar mania? - Lithium In early-onset bipolar disorder which class of medications works faster and has a more robust response? - Atypical antipsychotics (Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone) In bipolar mania, what is a typical pattern of treatment using antipsychotics and mood stabilizers? - Often an antipsychotic medication is combined with a mood stabilizer. The mood stabilizers tend to have a slower onset.Once the mood stabilzer has taken effect, then the antipsychotic may be withdrawn. Are acute mania and severe depressive episodes managed with monotherapy? - No, acute mania and severe depressive episodes often require 2-3 medications. What is rapid cycling bipolar disorder? - When a person has four or more cycles of mania and depression within 1 year Which mood stabilizer may be effective in bipolar disorder with rapid cycling? - Valproic Acid (Depakote) Which classes of medications are used for bipolar MAINTENANCE? - Mood stabilizers (FDA: Lamictal, Lithium) Atypical antipsychotics (Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone) Why are antidepressants as monotherapy not indicated in bipolar 1 disorder? - Not only are they ineffective, but they may also trigger a shift into mania or rapid-cycling. Which calcium-channel blocker may reduce the risk of antidepressant-induced mania? - Verapamil Which 2 classes of medications are used in the DEPRESSED phase of bipolar illness? - Mood stabilizers (No FDA approved, all off-label) SGAs: Quetiapine, Olanzapine-Fluoxetine in combination (Symbyax), Lurasidone How is borderline personality disorder (BPD) differentiated from bipolar disorder? - 1. Timing: BPD = mood changes occur within seconds to hours Bipolar = mood changes typically take weeks to months 2. Mood: BPD: Highly dependent on life events Bipolar: Often independent of life's events 3. Incidence: BPD: Common (6-10%)Bipolar: Rare (1-3%) Can bipolar disorders co-occur with borderline personality disorder (BPD)? - Yes Why is it important to differentiate between bipolar disorders and borderline personality disorder (BPD)? - Bipolar disorders: Mainstay of treatment is pharmacology (although therapy may also be helpful) BPD: Medications tend to be ineffective. Therapy (e.g. DBT) is the most effective treatment. What environmental trigger has been associated with manic episodes? - Sleep deprivation What role do genetic factors play in Bipolar disorder? - Increased risk by up to 24x that first degree relatives of people with bipolar 1 will also have bipolar 1 Which neurotransmitters are theorized to play a role in mania and depression? - Norepinephrine (NE) and serotonin (5HT) True or false. The mechanism of action of Lithium is clearly understood. - False Is lithium more effective in treating the manic phase or the depressive phase of bipolar illness? - More effective in mania "Treats from above better than it treats from below" Lithium is FDA approved for which phases of bipolar illness? - Bipolar mania Bipolar maintenance Used off-label for bipolar depression Why are atypical antipsychotics, benzodiazepines, and/or valproate (Depakote) initially used in addition to lithium for acute mania? - Due to lithium's delayed onset of action In an acute manic episode, how long does it take to see a response to lithium (with adequate plasma levels)? - May take up to 1-3 weeksLithium may decrease the risk of__________________ in bipolar I, bipolar II, and unipolar depression. - Suicide, by 13 fold If lithium (in therapeutic levels) is to be stopped, how is this done and why? - Taper gradually to avoid relapse and possible suicide What does this statement mean? Lithium has a narrow therapeutic index. - Lithium has a narrow window between its therapeutic level and its toxic level. The dose needed for therapy is uncomfortably close to the dose that will hurt or kill the patient. What are lithium's side effects? - "LMNOP" Lithium side effects: Movement (tremors) Nephrotoxicity/diabetes incipitus hypOthyroidism Pregnancy problems (teratogenic)