Bipolar Disorder for USMLE Step 3 / COMLEX-USA Level 3
Bipolar Disorder Overview
- Types:
- Bipolar I Disorder: Characterized by one or more manic episodes, often accompanied by major depressive episodes.
- Bipolar II Disorder: Characterized by at least one hypomanic episode and one major depressive episode, without full manic episodes.
- Cyclothymic Disorder: A milder form involving numerous periods of hypomanic and depressive symptoms that do not meet the criteria for a major depressive episode, persisting for at least 2 years in adults.
Clinical Features
- Manic Episode:
- A period of abnormally elevated, expansive, or irritable mood and increased activity or energy lasting at least one week.
- Key symptoms: Inflated self-esteem, decreased need for sleep, more talkative than usual, distractibility, increase in goal-directed activity, engagement in activities with a high potential for painful consequences.
- Hypomanic Episode:
- Similar to manic episodes but of shorter duration (at least four consecutive days) and not severe enough to cause marked impairment in social or occupational functioning.
- Major Depressive Episode:
- Symptoms include depressed mood, markedly diminished interest or pleasure in all or almost all activities, significant weight change, insomnia or hypersomnia, fatigue, feelings of worthlessness, diminished ability to think or concentrate, recurrent thoughts of death or suicidal ideation.
Diagnosis and Assessment
- Diagnostic Criteria: Use DSM-5 criteria to diagnose and differentiate from other mood disorders.
- Assessment Tools: Utilize scales such as the Young Mania Rating Scale (YMRS) and the Hamilton Depression Rating Scale (HDRS) to quantify symptom severity.
Management Strategies
- Acute Treatment:
- Manic Episodes: First-line treatments include lithium, valproate, and atypical antipsychotics.
- Depressive Episodes: Mood stabilizers like lamotrigine, combined with antidepressants if necessary, ensuring careful monitoring to avoid triggering mania.
- Maintenance Therapy:
- Continue mood stabilizers to prevent new episodes; the choice depends on the patient's response history and side effect profiles.
- Psychotherapy:
- Incorporate CBT, family-focused therapy, and psychoeducation as part of comprehensive treatment.
Monitoring and Long-Term Care
- Regular Follow-Up: Essential for monitoring medication adherence, effectiveness, and side effects.
- Side Effects Management:
- Monitor lithium levels to avoid toxicity; watch for renal and thyroid function.
- Check metabolic parameters with antipsychotic use.
- Risk Management:
- Assess and manage suicidality.
- Educate patients and families about warning signs of mood changes.
High-Yield Points for Step 3
- Clinical Decision-Making: Ability to manage bipolar disorder in various settings, including outpatient, inpatient, and emergency scenarios.
- Interprofessional Collaboration: Coordinate care with psychologists, psychiatrists, and social workers to optimize treatment outcomes.
- Treatment Challenges: Address the complexities of treating bipolar disorder, including treatment resistance and the management of bipolar depression.