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Perils and Pitfalls of the Diagnosis of The Bipolar Disorders. Discuss the recognition of bipolar disorder in the clinic setting Discuss the treatment options for bipolar depression Describe the efficacy and safety of treatment options for bipolar depression.
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Q: Is this episode of depression really due to Major Depression or due to Bipolar Disorder?
According to DSM-IV-TR:
Major Depression should only be DX’d after a H/O of mania/hypomania has been excluded and the bipolar disorders have been ruled out
Screening for H/O mania/hypomania is essential in order to differentiate the bipolar disorders from the depressive disorders
According to DSM-IV-TR :
Bipolar Disorder – manic, mixed, depressed
Bipolar Disorder – type II
Bipolar Disorder NOS, & Cyclothymia
There is no exclusion other than the ascription of a General Medical Condition or Drug Intoxication or Withdrawal Syndrome.
The Mood Disorder Questionnaire (MDQ) is a validated screening instrument for bipolar I and II disorders
Hirschfeld RM, et al. Am J Psychiatry. 157:1873, 2000
D Distractibility: poorly focused
I Insomnia: decreased need for sleep
G Grandiosity: inflated self-esteem
F Flight of ideas: c/o racing thoughts
A Activities: increased activities
S Speech: pressured or more talkative
T Thoughtlessness: “risk-taking” behaviors sexual, financial, travel, driving
Ghaemi et al, World J Biol Psych 2: 65, 2000
The Unmistakable Triad George Winokur, Classification of Mania & Depression, 1991EuphoriaPressured Speech Hyperactivity3 Signs in 3 Days in 3 Settings
The Questionable Quad –the 4 I’sGeorge Winokur, Classification of Mania & Depression, 1991IrritabilityInsomniaImpulsivityImpaired Social/Vocational Life>4 Days – Hypomania<4 Days – Bipolar NOS
Polarity of Symptoms
Divalproex DR Divalproex ER
Lamotrigine - M
Lithium - M
Depakote Depakote ER
FDA Approvals – Depression or Maintenance
Aripiprazole - M
Olanzapine - M
Quetiapine - Depr
Olanzapine/Fluoxetine – Depr Symbyax