Bipolar Flashcards
Manic episode
A. ≥ 1 week manic: Elevated, expansive, irritable mood and abnormal goal-directed activity
B. 3+ of:
1. ↑ SE or grandiosity
2. ↓ sleep (rested <3 hrs.)
3. ↑ talkative/pressured speech
4. Flight of ideas/racing thoughts
5. Distractibility
6. ↑ goal-directed activity
7. ↑ involvement in potentially risky activity
C. impairment or need for hospitalisation
D. Not due to substance
Bipolar Disorder 1
- Manic episode
- Not better explained by schizophrenic /psychotic disorder
Hypomanic epsiode
Mania but just 4+ days and not as severe
Bipolar Disorder II
- 1+ hypomanic episode and 1+ Major depressive episode
- There has never been a manic episode
- not better explained by schizophrenia spectrum or psychotic disorder
Cyclothymic Disorder
A.
* At least 2 years (never 2 months without symptoms)
- Numerous periods of sub-threshold hypomanic and depressive symptoms
- Symptoms for both present at least half the time
Epidemiology
(prevalence, age, gender, prognosis, cultural differences)
2-4% general population lifetime prevalence
* Average age of onset 18.4 - 20.0
* 1:1males and females
* managing - doesnt have cure
* no cultural difference
Differentials
- Psychosis
- Depression
- ADHD
- BPD- Bipolar more episodic, BPD more chronic and more rapid cycling (mood changes over minutes/hours rather than months with Bipolar)
Assessment
RISK
- Risk to self and others (driving, sexual, financial, physical, violence - think children and spouse)
- self-harm and suicide (20% higher than in the general population,
- Collateral info
- Differentiating from Dx (duration of mood changes)
- Identify triggers of ascent/descent behaviours
Psychometrics
Young Mania Rating Scale - GOLD STANDARD
- Parent Version of the Young Mania Rating Scale (5-17yrs)
- Beck Depression Inventory
- Beck Hopelessness Scale
Psychosocial causes
Negative family environment:
- frequent criticism and hostility = predictor of relapse.
family stressors interact with rhythm dysregulation and mood symptoms, when added to underlying neurobiological vulnerability, a manic episode or MDE is triggered
Stressful life events and - low social support
Goal attainment life event (possible underlying excessive reward sensitivity)
Biological causes
GENETICS
important, Twin studies – monozygotic twin 57% more likely, dizygotic 14% more likely.
- Risk of children among bipolar parents 4 x higher than normal.
NEUROLOGICAL
Neurotransmitter Dysregulation: excess of serotonin, norepinephrine, and dopamine.
SLEEP
Disruption of social rhythms:
Sig life events =
disrupt circadian rhythms =
further neurotransmitter dysregulation = behavioural changes & bipolar symptoms
Integrative Cognitive Model
BD is maintained by several factors that follow a trigger event.
- Trigger =
- Change in the internal state (their mood, physiology or cognitions).
- If appraised as having extreme personal significance/ an imminent catastrophe =
3. exaggerated attempts to control their internal state eg ascent or descent behaviours. - beliefs, life experiences and affect regulation also impact whether they engage in ascent or descent behaviours.
- Ascent = decreased sleep and risk-taking behaviour = have the effect of increasing the state of activation.
OR - Descent behaviours = withdrawal, sleep, = decrease the state of activation.
- These behaviours are negatively reappraisal and cause further internal changes (maintenance cycle).
Treatment (6)
MEDICATION eg mood stabilisers
CBT
- Recent research showed CBT to be effective for =
- cognitive restructuring -depressive/manic mood states
- moderating risky behaviour and situations
- scheduling in calming activities/relaxation
- self-monitoring of mood, thoughts and feelings to detect warning signs – then have clear strategies to prevent progression into full-blown episodes
- enhance general coping strategies and facilitate goal setting
- building social networks
INTERPERSONAL SOCIAL RHYTHMS THERAPY (IPSRT)
= stablising circadian rhythms with tools like sleep/light exposure/social exposure/exercise and their timing
PSYCHOEDUCATIONAL THERAPY
- the importance of structure and a regular routine, i.e., getting enough sleep, avoiding excessive stimulation and reducing activity level
- the importance of medication adherence for relapse prevention
FAMILY FOCUSED THERAPY (particularly for depressive episodes)
– is based on the finding that bipolar
clients in a high “expressed emotion” (EE) environment fare worse than those in a low EE environment.
- Therefore, therapy targets families after the client has been stabilised following an episode.
- Components include: Psychoeducation, communication training, problem
solving skills, relapse prevention.
GROUP THERAPY
can enhance medication adherence and other Treatments compliance and may be useful during
recovery phase
