Bipolar Disorder for the American Board of Internal Medicine (ABIM) Exam
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Bipolar Disorder Overview
- Types:
- Bipolar I Disorder: Characterized by one or more manic episodes, possibly interspersed with major depressive episodes.
- Bipolar II Disorder: Involves at least one hypomanic episode and one major depressive episode, without full-blown manic episodes.
- Cyclothymic Disorder: Less severe but more chronic form, involving numerous periods of hypomanic and depressive symptoms that do not meet the full criteria for a major depressive episode.
Clinical Features
- Manic Episode:
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week.
- Symptoms include increased self-esteem, decreased need for sleep, more talkative than usual, flight of ideas, distractibility, increased goal-directed activity, excessive involvement in risky behaviors.
- Hypomanic Episode:
- Similar to manic episodes but less severe, not causing marked impairment in social or occupational functioning, lasting at least four consecutive days.
- Major Depressive Episode:
- Features include depressed mood, markedly diminished interest or pleasure in all, or almost all, activities, significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness, diminished ability to think or concentrate, recurrent thoughts of death.
Diagnosis and Assessment
- Diagnostic Tools: Utilization of DSM-5 criteria to accurately diagnose and differentiate bipolar disorder from other mood disorders.
- Screening Instruments: Tools such as the Mood Disorder Questionnaire (MDQ) can help identify symptoms indicative of bipolar disorder.
Management Strategies
- Pharmacological Treatment:
- Mood Stabilizers: Lithium, valproate, and lamotrigine are commonly used to control mood swings.
- Antipsychotics: Often used during manic phases and for ongoing stabilization (e.g., olanzapine, quetiapine).
- Antidepressants: Used cautiously and typically in conjunction with mood stabilizers to manage depressive episodes.
- Psychotherapy:
- Cognitive Behavioral Therapy (CBT) and other supportive therapies are important adjuncts to medication.
Monitoring and Follow-Up
- Medication Side Effects: Monitoring for side effects, especially renal function and thyroid function with lithium, liver function with valproate, and metabolic profile with antipsychotics.
- Long-Term Management: Regular follow-up to assess effectiveness and adjust treatment plans as necessary.
Interprofessional Collaboration
- Coordinating Care: Collaborating with psychiatrists, psychologists, and other mental health professionals to provide comprehensive care.
- Patient and Family Education: Educating patients and families about the disorder, treatment options, and the importance of adherence to prevent relapse.
High-Yield Topics for ABIM Exam
- Clinical Decision-Making: Applying clinical guidelines and evidence-based practices in the treatment of bipolar disorder.
- Treatment Challenges: Addressing issues such as treatment resistance, managing comorbid conditions, and minimizing side effects.
- Legal and Ethical Considerations: Understanding the implications of involuntary treatment and ensuring appropriate care during acute and maintenance phases.