Bipolar Disorder for the Physician Assistant (PA) Licensing Exam
Bipolar Disorder Overview
- Types:
- Bipolar I Disorder: Characterized by one or more manic episodes, often with major depressive episodes.
- Bipolar II Disorder: Features at least one hypomanic episode and one major depressive episode, with no full manic episodes.
- Cyclothymic Disorder: Chronic, fluctuating mood elevation involving numerous periods of hypomanic symptoms and depressive symptoms that do not meet criteria for a major depressive episode.
Clinical Features
- Manic Episode:
- Elevated or irritable mood for at least one week, with increased energy or activity.
- Symptoms include grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed activity or agitation, and risky behavior.
- Hypomanic Episode:
- Similar to manic episodes but less severe and without significant social or occupational impairment, lasting at least four consecutive days.
- Major Depressive Episode:
- Depressive mood or loss of interest in almost all activities for at least two weeks, accompanied by symptoms such as significant weight change, sleep disturbances, fatigue, feelings of worthlessness, diminished ability to think, and recurrent thoughts of death or suicide.
Diagnosis and Assessment
- Diagnostic Criteria: Based on the DSM-5, essential for accurate diagnosis and differentiation from other mood disorders.
- Tools: Use of standardized screening tools like the Mood Disorder Questionnaire (MDQ) can aid in identifying symptoms indicative of bipolar disorder.
Management
- Pharmacological Treatment:
- Mood Stabilizers: Lithium, valproate, and lamotrigine are foundational in managing both manic and depressive episodes.
- Antipsychotics: Often used in acute manic episodes and for maintenance; examples include olanzapine and risperidone.
- Antidepressants: Used cautiously in combination with mood stabilizers to manage depressive episodes to prevent switching to mania.
- Psychotherapy:
- Cognitive Behavioral Therapy (CBT) and psychoeducation are effective adjuncts to medication management.
- Monitoring and Follow-Up:
- Regular monitoring for efficacy and side effects of treatments. Lithium levels and renal function need careful monitoring due to toxicity potential.
Special Considerations
- Risk Management:
- Assess for suicide risk, particularly during depressive episodes or when treatment is being initiated or changed.
- Patient Education:
- Educating patients about the chronic nature of bipolar disorder, the importance of medication adherence, and recognition of early signs of mood swings.
- Interdisciplinary Approach:
- Collaboration with psychiatrists, psychologists, and social workers to provide comprehensive care.
High-Yield Topics
- Management of Acute Mania and Depression: Strategies including pharmacological and non-pharmacological interventions.
- Long-Term Care: Approaches to prevent relapses and manage chronic symptoms effectively.
- Ethical and Legal Issues: Managing treatment compliance and decision-making capacity, particularly in severe cases.