Bipolar Disorder for the American Board of Psychiatry & Neurology (ABPN) Exam
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Bipolar Disorder Overview
- Types:
- Bipolar I Disorder: Characterized by one or more manic episodes, often 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: A chronic disorder involving numerous periods of hypomanic and depressive symptoms that do not meet the criteria for a major depressive episode, lasting for at least 2 years.
Diagnostic Criteria
- Manic Episode:
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least one week.
- Symptoms include inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure to keep talking, flight of ideas, distractibility, increase in goal-directed activities, excessive involvement in activities that have a high potential for painful consequences.
- Hypomanic Episode:
- Similar to a manic episode but lasts at least four consecutive days, with symptoms that are noticeable to others but not severe enough to cause marked impairment in social or occupational functioning.
- Major Depressive Episode:
- Depressed mood or loss of interest or pleasure in almost all activities, along with four or more additional symptoms such as significant weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, diminished ability to think or concentrate, or recurrent thoughts of death or suicide.
Treatment Strategies
- Pharmacological Treatment:
- Mood Stabilizers: Lithium, valproate, and lamotrigine are standard treatments.
- Antipsychotics: Often used during acute manic or mixed episodes and for maintenance (e.g., olanzapine, quetiapine).
- Antidepressants: Used cautiously and typically in combination with mood stabilizers to manage depressive episodes.
- Psychotherapy:
- Cognitive Behavioral Therapy (CBT), psychoeducation, and family therapy are important adjuncts to medication.
- Advanced Interventions:
- Electroconvulsive Therapy (ECT) for refractory cases or when rapid symptom control is needed.
Monitoring and Long-Term Care
- Regular Monitoring: Essential for assessing medication effectiveness and managing side effects. This includes blood level monitoring for lithium and valproate.
- Relapse Prevention: Long-term medication adherence is crucial. Educate patients about the importance of maintaining medication regimens even when feeling well.
Special Considerations
- Co-occurring Conditions: Many patients with bipolar disorder have comorbid conditions such as anxiety disorders, substance use disorders, or other medical conditions that may complicate treatment.
- Suicide Risk Assessment: Bipolar disorder carries a significant risk of suicide, requiring vigilance and proactive management.
High-Yield Topics for the ABPN Exam
- Differential Diagnosis: Distinguishing bipolar disorder from other psychiatric disorders such as major depressive disorder, borderline personality disorder, and schizophrenia.
- Pharmacokinetics and Pharmacodynamics: Understanding the mechanisms and side effects of mood stabilizers and antipsychotics.
- Legal and Ethical Issues: Managing issues related to consent, capacity, and involuntary treatment in acutely manic patients.