分享
分享赚钱 收藏 举报 版权申诉 / 33

类型_Disorder INHIMA双相情感障碍的课件.ppt

  • 上传人:微传9988
  • 文档编号:2428664
  • 上传时间:2018-09-15
  • 格式:PPT
  • 页数:33
  • 大小:180.50KB
  • 配套讲稿:

    如PPT文件的首页显示word图标,表示该PPT已包含配套word讲稿。双击word图标可打开word文档。

    特殊限制:

    部分文档作品中含有的国旗、国徽等图片,仅作为作品整体效果示例展示,禁止商用。设计者仅对作品中独创性部分享有著作权。

    关 键  词:
    _Disorder INHIMA双相情感障碍的课件.ppt
    资源描述:

    1、,Diagnosing Bipolar Disorder,“Were all a little that way”,MH Disorders in OP Psychiatry,25% “Other” = Schiz, Anx, ADHD, PD 25% Depression -(often treatment resistant) 25% Bipolar disorder 25% “Bipolar Spectrum” Complicated, confusing, comorbid, poor treatment outcome,Diagnosis of Mood Disorders,The

    2、possibilities: Bipolar I = Mania with or w/o depression Bipolar II = Hypomania with depression Cyclothymia = hypomania with “minor” depression Major Depression = depression “Bipolar spectrum” = Depression + other complexities Bipolar NOS or Mood DO NOS,Always consider these:,Significant medical cond

    3、ition Depression due to general med condition History of many physical symptoms Secondary depression Significant recent substance use Meth and cocaine and pot = mania/psychosis Alcohol and cocaine withdrawal = depression,Diagnosis of BPAD,Assessment of cross sectional symptoms inadequate for dx One

    4、session = “One cut of an MRI”Assessment of longitudinal course essential Collateral info = other providers, admits, family history and input, follow-up visits “The whole MRI” “Biography”,Diagnosis,DSM IV TR criteria for mania Distinct period of abnormally and persistently elevated or irritable mood

    5、lasting a week or requiring hospitalization, or with psychosis Three or more of: grandiosity, decreased need for sleep; talkative; flight of ideas; distractibility; increase in goal directed activity; excessive involvement in pleasurable activities = buying sprees, sexual indiscretions, foolish busi

    6、ness investments,DSM 4TR criteria for depression(MDD),Depressed mood most of the day almost every day Diminished interest or pleasure Appetite and wt changes Sleep changes Agitation or slowness of movement Fatigue Guilt or “worthlessness” Poor concentration Thoughts of death or suicide,Other feature

    7、s of Depression,Psychosis-paranoia or hallucinations Seasonal component = SAD Postpartum onset Catatonic features=marked psychomotor disturbance, immobility or stupor Melancholic features = worse in a.m., anorexia or wt loss, marked guilt,Mixed Bipolar Episode,Meet criteria for both mania and depres

    8、sion Often most severely ill High suicide rate Looks like agitated depression,Depression: Bipolar vs MDD,More common in Bipolar Early age of onset Recurrence Postpartum Rapid cycling Brief duration Baseline hyperthymic personality Bubbly,outgoing, extroverted, etc,Symptoms: Bipolar vs Unipolar,More

    9、common in Bipolar “Atypical” sx Increased sleep & appetite, rejection sensitivity, mood reactivity, leaden paralysis Psychotic depression Anxious/agitated depression Irritability and anger,Treatment response: BPAD vs MDD,More common in BPD Antidepressant induced mania Antidepressant induced psychosi

    10、s, mixed states or suicidality,dysphoria (ACID syndrome)Nonresponse to good med trial Tolerance to medication = poop out effect Rapid cycling, including only w/in depressed range,Differences between BPAD I & II,BP-I BP-II Atypical features + + Mixed state/agitation + + Anxiety disorder + + Mood labi

    11、lity + + Social anxiety + + Female/Male ratio 1:1 2/1,The Galaxy of Possibilities,Single MDE *Atyp MDD *(PD)*Chronic MDD *Recurrent MDD*Psychotic MDD * *Dysthymia*“Bipolar Spectrum DO”*Bipolar NOS *Bipolar II*Bipolar I *(Psychosis) *(ANXIETY) *(Psychosocial Stress) (ADHD),Comorbid Illness,Substance

    12、dependence ETOH, etc. = 45% lifetime Anxiety DO GAD, PD, PTSD = 45% lifetime ADHD Shared cognitive deficits when euthymic Personality Disorders Cluster B = BP, NPD, ASPD,Bipolar Spectrum Disorder, proposed for DSM V,At least one MDE No spontaneous hypomania or mania Family Hx of BPD in 1st degree re

    13、lative or AD induced hypomania/mania Ancillary criteria: Hyperthymic personality Recurrent MDE Brief MDEs ( 3 mos) Atypical depressive sx Psychotic MDEs,Proposed definition cont.,Ancillary criteria cont: Early age at onset Postpartum depression Antidepressant wear-off (acute but not prophylactic res

    14、ponse) Lack of response to 3 AD trials Ghaemi and Goodwin,Bipolarity Index: 0 - 100 MGH Bipolar Program,Episode Characteristics Age of Onset Course of Illness Comorbidities, jobs, education, marriage, law Response to Treatment Positive or negative or worsening (ACID) Family History Scientific basis

    15、for BPD/UPD distinction manicdepressive.org,Misdiagnosis of BPAD I & II,“50% or higher rate (? 80%) of misdx” 50% of BPAD I present with depression 50% of BPAD II present with depression Up to 10 years of rx for MDD prior to dx of BPAD? Bipolar Spectrum Ill defined intermittent sx, etc,Misdx: patien

    16、t factors,Lack of insight with regard to mania Impaired memory for past depression Failure to report manic sx or behavior Experiencing hypomania as “normal good times” Cultural positive feedback for hypomanic/manic sx,Misdx: clinician factors,Failure to include family in eval Structure of DSM = “beg

    17、ins by separating bipolar from all depressions” Inadequate knowledge of mania criteria Intuitive “prototype” approach to dx Practical desire to make dx which is more palatable and more treatable STIGMA Lack of awareness of prevalence of bipolar,Misdx: Illness factors,First episode of illness often d

    18、epression May be recurrent for many years Dysphoric depression is not conceptualized as a mixed state Depressive episodes last longer than often fleeting hypomanic states,“There is no such thing as unipolar depresion”,How much bipolarity?,BPD: Treated vs Untreated Mortality ratios p.001,Treatment of

    19、 Mania and Maintenance,Lithium Valproate Carbamazepine Atypical Antipsychotics Olanzapine, risperidone, ziprasidone, quetiapine, aripiprazole Others = Oxcarb, Topirimate, Clonaz, Gabapentin,Treatment of Bipolar Depression Replicated RCT n100,Quetiapine 300mg - 600mg Olanzapine 5mg - 20mg Olanzapine/

    20、fluoxetine (Symbiax) Lamotrigine 50mg - 200 mg Lithium*,Antidepressants and BPDep,-No Prospective DB RCT adequately powered study in BP I or II (Olanzapine/fluoxetine combo) -Recent NEJM article (NIMH Sept 07)= depressive sx improve at same rate with and without AD -Treatment emergent affective swit

    21、ch (TEAS)-TCAVenSSRIBup -Treatment emergent rapid cycling -AD associated chronic irritable dysphoria,“ACID” (STEP-BD study),Unrelenting dysphoria Severe agitation Refractory anxiety Unendurable sexual excitement Intractable insomnia Suicidal obsessions and impulses “histrionic demeanor” Social, occu

    22、pational, marital dysfunction Improvement with stopping ADs,Antidepressants in BPD,Bipolar Treatment Centers 30% of patients on AD Community psychiatrists 50-60% of patients on AD Primary care providers 70-80% of patients on AD,Treatment of BP Spectrum Agitated Depression,Add mood stabilizer Lamotri

    23、gine - Oxcarb Lithium Depakote Taper and DC antidepressants if poss. Atypical antipsychotic Seroquel AbilifyZyprexa = Risp = Geodon Sleep agents,Novel Treatments: not EBM,Pramipexole 2 RCTs small numbers positive Omega 3 4 small studies positive as add-on Rx 1gm Inositol 6-20 gm/day, small studies,

    24、“suggestive”,BP Disorder Psycho-social treatments,Psychoeducation CBT Family Focused Therapy IPSRT (Interpersonal social rhythm therapy)*Psychosocial or physical stressors are the most robust predictors of relapse,Long term outcome,BPAD I & II 1/3 complete remission & funct. 2/3 fail to achieve pre-morbid function Chronic persistent sx in 20% Social incapacity in 30% “Bipolar Spectrum” Who knows?,

    展开阅读全文
    提示  道客多多所有资源均是用户自行上传分享,仅供网友学习交流,未经上传用户书面授权,请勿作他用。
    关于本文
    本文标题:_Disorder INHIMA双相情感障碍的课件.ppt
    链接地址:https://www.docduoduo.com/p-2428664.html
    关于我们 - 网站声明 - 网站地图 - 资源地图 - 友情链接 - 网站客服 - 联系我们

    道客多多用户QQ群:832276834  微博官方号:道客多多官方   知乎号:道客多多

    Copyright© 2025 道客多多 docduoduo.com 网站版权所有世界地图

    经营许可证编号:粤ICP备2021046453号    营业执照商标

    1.png 2.png 3.png 4.png 5.png 6.png 7.png 8.png 9.png 10.png



    收起
    展开