Bipolar Disorder for USMLE Step 2 / COMLEX-USA Level 2
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Bipolar Disorder Overview
- Types:
- Bipolar I Disorder: Defined by the occurrence of at least one manic episode, with or without major depressive episodes.
- Bipolar II Disorder: Characterized by at least one hypomanic episode and one major depressive episode, without full-blown manic episodes.
- Cyclothymic Disorder: Chronic mood disorder with numerous periods of hypomanic symptoms and depressive symptoms that do not meet criteria for a major depressive episode, lasting for at least 2 years.
Clinical Features
- Manic Episode:
- A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week.
- Symptoms: 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 activity, excessive involvement in risky behaviors.
- 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:
- Depressed mood or loss of interest or pleasure in almost all activities for a two-week period, along with significant weight change, sleep disturbances, fatigue, feelings of worthlessness, diminished ability to concentrate, suicidal ideation.
Diagnosis
- Assessment Tools: Use of standardized screening tools like the Mood Disorder Questionnaire (MDQ) can aid in diagnosis.
- Differential Diagnosis: Differentiate from other mood disorders, personality disorders, substance use disorders, and medical conditions that may mimic manic or depressive states.
Management
- Pharmacological Treatment:
- Mood Stabilizers: Lithium, valproate, and lamotrigine are commonly used to control mood swings.
- Antipsychotics: Olanzapine, quetiapine, and aripiprazole for manic episodes and for maintenance therapy.
- Antidepressants: Used cautiously and typically in combination with mood stabilizers to prevent switching to manic episodes.
- Psychotherapy:
- Cognitive Behavioral Therapy (CBT), psychoeducation, and family therapy are important adjuncts for long-term management.
- Acute Management:
- Hospitalization may be necessary for severe manic episodes or depressive episodes with suicidal risk.
- Monitoring for lithium toxicity is critical if lithium is used.
Monitoring and Follow-Up
- Regular Monitoring: For medication side effects, especially with lithium (e.g., renal function, thyroid function) and antipsychotics (e.g., metabolic syndrome).
- Long-Term Care: Regular follow-up to adjust medications as needed and to monitor for signs of relapse or mood destabilization.
High-Yield Points for Step 2
- Recognition of Mania: Key in differentiating bipolar disorder from major depressive disorder, which affects treatment choices.
- Management of Bipolar Depression: Specific considerations for using antidepressants in bipolar disorder to avoid inducing mania.
- Treatment Adherence: Challenges in managing bipolar disorder, particularly adherence to medication regimens and recognition of early signs of mood episodes.