5: Bipolar

Question 1

what characterises bipolar type 1?

Answer 1

episodes of mania

Question 2

what characterises bipolar type 2?

Answer 2

Hypomania & 1 experience of major depressive episode

Question 3

what is the difference between mania and hypomania?

Answer 3

Hypomania is a milder version of mania that typically lasts for a shorter period

Question 4

what characterises cyclothymia?

Answer 4

Not met the criteria for a hypomania/ major depressive episode
Could be due to insufficient symptoms or a shorter time frame

Question 5

what characterises a mood episode for bipolar?

Answer 5

• an unequivocal change in functioning
• clinically significant distress or impairment to social, occupational etc functioning
• the disturbance in mood and change is observable by others

Question 6

what are the 2 key symptoms for mania/hypermania?

Answer 6

hypermania= at least 4 days:
mania= at least 1 week
abnormally and persistently elevated, expansive or irritable mood
and
abnormally & persistently increased activity or energy

Question 7

what are the 9 extra symptoms of hypermania/mania necessary for a diagnosis?

Answer 7

Inflated self esteem / grandiosity
Decreased need for sleep
More talkative than usual, pressure of speech
Flight of ideas, thoughts racing
Distractibility
Increased in goal-directed activity / physical agitation
Excessive involvement in pleasurable activities that may have high potential for painful consequences

Question 8

what are the symptomatic requirements for cyclothymia

Answer 8

numerous periods of hypomanic symptoms not meeting threshold for hypomanic episodes
Numerous periods of depressed mood /loss of interest that do not meet depression
The symptoms cause clinically significant distress or impairment in:
-Social
-Occupational
-other important areas of functioning

Question 9

what characterises unipolar depression?

Answer 9

big influxes and defluxes in phases of depressive symptoms

Question 10

what characterises unipolar mania?

Answer 10

big influxes and defluxes in phases of manic symptoms

Question 11

what are 5 predictors of relapse for bipolar?

Answer 11

Stressful interpersonal life events eg childhood trauma
High ‘Expressed Emotion’ (hostility, overprotectiveness, criticism) in family members
Disrupted social rhythm events including sleep changes
Having a healthy balance & structure to their lifesty;es
Goal-attainment Events - something that creates a lot of excitement in a person (only for mania)

Question 12

what is the normal timeline for onset to diagnosis for bipolar?

Answer 12

6-10 years

Question 13

what are the primary care recomendations for bipolar?

Answer 13

Review treatment & care, including medication
- Antidepressants can put people at greater risk of manic episodes
Offer choice of psychological intervention e.g. Cognitive Behavioural Therapy, Interpersonal Therapy, or Family Focused Therapy

Question 14

what the the secondary care recomendations for bipolar?

Answer 14

Pharmacological interventions: If mania or hypomania develops & person is taking antidepressant, consider stopping the antidepressant and offer an antipsychotic
Offer evidence-based psychological intervention

Question 15

define: prodrome

Answer 15

relapse signature/warning signs

Question 16

which is more effective, family therapy or individual psychoeducation

Answer 16

family therapy

Question 17

what does CBT target for each part of bipolar

Answer 17

During depression, identify ‘negative automatic thoughts’ & challenge; activity scheduling
During hypomania, identify coping strategies
During remission, engage in relapse prevention

Question 18

how do appraisals influence and exacerbate mood swings in bipolar

Answer 18

Mood swings are a consequence of multiple, conflicted, extreme, personal appraisals of changes in internal state
Leads to internal struggle trying to exert extreme control over internal states rather than active, successful ways of pursuing goals

Question 19

how are internal states (eg appraisals) significant to predict bipolar?

Answer 19

Predicts bipolar symptoms over one month in 50 patients
Reduced conviction in beliefs after successful CBT
Clearly differentiates Bipolar from Unipolar depression & health controls

Question 20

how does the integrative cognitive model explain bipolar?

Answer 20

a triggering even leads to a change in internal state, this is appraised as having an extreme personal meaning (positive or negative) modulated by beliefs about the word, self and others as well as life experience