Coding
Data
Data
Data
Data
100

coding for BP II consist of

1. must have a hx of 1 hypomanic episode but can not have a FULL manic episode

2. I manic episode and 1 depressive episode

3. psychotic sx can only occur in depressive episode, NOT hypomania ( that would be  BPI)

4. Severity is captured for severity of sx. NOT hypomania

5. specifiers can not be coded, current or most recent episode was hypomanic or depressed. 

         ex, Bipolar II disorder most recent episode                       hypomanic

6. if full criteria for mood episode are not currently met for 2 months use partial remission or full remission. 


100

What are some diagnostic considerations with BP?

sx start before age 18 in 2/3 of pts

GOOD HX and collateral informants are key!

pt typically present during depressive phase and not during mania or hypomania if they are not accompanied by negative consequences

sx are constantly with 2 poles but BPI can be dx without a depression episode

70% of pts are misdiagnosed 

 

100

Name the Disorder........

Mood changes: over minutes to hours

mood reactivity: depends on life even

Frequency: more common (6-10%

Tx: therapy. medication is NOT HELPFUL

Borderline Personality Disorder

100

Onset of BPI is _______ than MDD

onset ranges from ____ to ____

most cases  _______ teens to ________ adulthood

earlier

5 to 50

late, early

100

True or False

BPII is more likely to have a seasonal pattern




True

1. pts may develop their own pattern

2. depression likely in the winter, mania in spring /summer

3. enc pts to learn their pattern

200

All of the following can be considered?

w/ anxious features

w/ mixed features

w/ rapid cycling

w/ melancholic fx

w/ atypical fx

w/catatonia

w/ peripartum onset

w/ seasonal pattern


Additional specifiers of BPI & BPII

200
The risk factors pointing to depression are.......

poor or short lived ant depressant response despite trials of several antidepressants

multiple Antidepressant failures

rapid response to antidepressants ( mania)

consider reevaluating and changing strategies

200

Hypothyroidism is most ________ in BP pts and more likely in ________

More associates with BP _______

True or false 

Range of TSH is 0.3 -5 and treat over 3

common, females


Bipolar II


True

200

Peak age for BPI is....

Average age for males? females

90 % will have __________ _______alf of the pts have __________ polarity

20-30

22,21.5 (DSM 4 24.3)

manic episodes

predominate 

200

Name the co-occurring disorders  with BP

Suicide risk is higher in those with affective disorder plus use of substance use and anxiety disorders

SUD(ETOH use in males)

Panic 

OCD

Anxiety (females)

Eating (females)

can be assoc. or confused with ADHD

if mood changes in hours can be Borderline

300

Mixed Features were previously referred to as ________ __________


True or False 

In Mixed Features, the pt has both manic &depressive sx nearly everyday for a week in rapid sequence or simultaneously.

Mixed State


True

ex. crying during euphoria  or laughing while severely depressed. 


impairment and fxn should not be d/t medical or drug use. 

****** Mixed episodes can only occur in BPI or II

300

True or False

Bipolar sx are chromic and individuals will have more depression than mania

BPI disorder 32% asxmatic, 52% depressive 6% manic, and 9% mixed

BPII disorder 46% asxmatic, 5o% depressive 2% hypomanic, and 1% mixed



True

True

True

300

Which labs can be completed to suggest a alternate DX?

CBC-Anemia=fatigue confusion

Metabolic panel-abnormal NA levels=fatigue confusion

TSH levels- thyroid disease=change in mood

Pregnancy test-+HCG=change in mood/psychosis

UA-elevated specific gravity/hematuria= UTI/confusion

UDS-+ for Amphetamines, cocaine, MJ, benzos, PCP, opiates

EKG-prolong QTc, wide QRS. ST elevation or depression (MI)-agitation or confusion

CT of Brain- stroke, tumors, MS, intracranial hemorrhage



300

Environmental factors Assoc with BP

early emotional trauma

parental psychopathology

family conflict

SUD

300

Underlying pathology of BP is complexed assoc with ________ & ________ sxms along with _________ & __________ factors


emotional and behavioral 

biological and environmental 

400

Rapid cycling (RC) consist of _____ or more episodes of depression, hypomania, or mania in a year.

RC is more common in _________

RC does not respond to _________ and typically need ___________ does,

4 (no set requirement for # of episodes of depression vs mania)

Women

monotherapy, higher

side note 20% of ppl with BP have  RC

400

Adolescent presentation has _______ psychotic features and maybe present with ____________ instead of euphoria during the manic stages


more

irritability


they may have psychotic features as well

400

Noted difference between Bipolar and ADHD

BP pts are more talkative with pressured speech and more impulsivity, decreased need for sleep opposed to a few hours in the beginning of the night

400

Which chromosomes are identified

The more _____ degree family members with BP the _______ the risk

AA with BPI are at a ________ risk for being misdiagnosed with schizophrenia

18,21q & 22q

first, higher


increased ( r/t underlying paranoia d/t hx)

400

Before the focus was on which NTs in regards to BPD?

Current focus is on

The other NTs are_____ ____& ___ are affected

5HT,DA,NE The Amines)

5HT & DA

Glutamate, ACh, GABA

500

Name the DSM 5 TR dx for with the following sx:

A. numerous periods with hypomanic or sx that do not meet the criteria for hypomanic or depression episode going on for 2 yrs in adults, 1 yr for children and teens

B. Above 2 yr period adults (1 yr for children and teens) Criterion A sx have been present at least 1/2 the time the individual has not been without sx more than 2 months 

C. critera for major depression, hypomania, and mania have not been meet

D. SX n Criteraion A can not be better explained by schizoaffective disorder, schizophrenia, schizophreniform, delusional or any other schizophrenia , psychotic spectrum disorder

E. Not assoc. with medical or SUD

F. sx cause clinically significant impairment or distress in social, occupational, or any other important areas of fxning

Cyclothmia Disorder

500
Which Disorder is described:


Mood changes- weeks or months

Mood Activity-independent of live events

Frequency is rare

Treatment: primary medications & therapy 

Bipolar

500

BP is_________ among males and females

Man are more _______ and females more ________ and __________

Marital status is usually ________ & __________ in ________ socioeconomic status

equal 

manic, depressive & rapid cycling

Divorced and Single 

500

Stressful life events typically _______ mania

Mania was thought to be an active _________ mechanism to depression

proceed

defense 

(a way to handle developmental tragedy such as a death of a parent, 

500

Glutamate & Bipolar describe role

Increased during mania in the DLPC

binds to the NMDA and lingers longer

once over returns to baseline

M
e
n
u