Bipolar Flashcards
Bipolar disorders are Classified by the presence of ______ or ______ episodes.
manic, hypomanic
Usually manic episodes precede / follow depressive periods, (fill in ) percent of the time
(~70%)
Manic episodes tend to be (FILL IN) than depressive bouts
~3X shorter
Bipolar individual is between episodes but not experiencing
symptoms of either depression or mania, that is referred to as …
euthymic
BIPOLAR 1, BIPOLAR 2, Cyclothymia 12 MONTH PREVALNCE
.6%, .3%, .4-1.0 %
BIPOLAR 1, BIPOLAR 2, Cyclothymia
GENDER DISPARITY
SLIGHTLY HIGHER IN MALE, INCONLCUSIVE, EQUAL
BIPOLAR 1, BIPOLAR 2, Cyclothymia
AVERGAE AGE ONSET
18 YEARS AGE, MID 20s, ADOLECENCE
Depressive episodes in BD= consist more of (4) …
mood lability
more psychotic features
more psychomotor retardation
more substance abuse
Depressive episodes in MDD= consist more (4)
anxiety, more agitation, more
insomnia, weight loss
Generally, bipolar depressive episodes tend to be (FILL IN ) than MDD episodes
more severe
People with bipolar typically experience more _______ episodes than people solely with MDD
lifetime depressive
Predominant mood state in bipolar is ..
depression
FOR BOTH MANIC AND HYPOMANIC , (fill in ) or more symptoms are present to a ( fill in) and represent to a (fill in ) from usual behavior
3 , significant degree , noticeable
change
DIFFERNCE FOR MANIC AND HYPOMANIC (duration for diagnostic)
MANIC LASTS 1 WEEK
HYPOMANIC LASTS 4 DAYS
MANIC EPISODES CAUSE SEVERE (FILL IN ) AND MAY NEED (FILL IN )
IMPAIRMENT , HOSPITALIZATION
HYPOMAINIC EPISODES (FILL IN ) CAUSE SEVRE IMPAIRMENT AND ( FILL IN ) NEED HOSPITALIZATION
DO NOT, DO NOT
People in hypomanic states may (FILL IN ) of these
symptoms
fail to report / complain
Bipolar I:
* Person has (FILL IN) and can also have (FILL IN).
* Person can have periods of (FILL IN)
manic episode, HYPOMAIC EPISODE, DEPRESSION
Bipolar II , Must have (FILL IN) AND (FILL IN)
hypomania, major depressive episode
DIFFERENCES BETWEEN BIPOLAR AND BORDERLINE PERSONALITY
MOOD SWINGS NOT CAUSED BY LIFE EVENT IN BIPOLAR
FAMILY HISTORY OF BIPOLAR
LESS CHRONIC IN BIPOALR
BIPOLAR IS CLASSIFIED BY CLASSICAL SYMPTOMS
Cyclothymic Disorder: Diagnostic Criteria -> REQUIRMENTS
- At least 2 years (at least 1 year in children and adolescents
- HYPOMANIC SYMPTOMS ( NOT HYPOMANIC EPSIODES
- DEPRESSIVE SYMPTOMS ( NOT A DEPRESSIVE EPISODE )
- SYMPTOMS PRESENT FOR HALF THE TIME
-NOT BEEN WITHOUT SYMPTOMS FOR 2 MONTHS
If you have full-threshold hypomanic episodes
but no full threshold depressive episodes, you
would be diagnosed …
with “other specified bipolar
disorder”
Specifiers ARE …
Diagnostic extension that accounts for variation in disorder →
dimensionalize disorders
Bipolar With
Melancholic
Features
Loss of pleasure in all activities, depression worse in the
morning
Bipolar With Atypical
Features
Mood reactivity—brightens to positive events
Bipolar With
Catatonic
Features
psychomotor symptoms mutism
rigidity
With
Seasonal
Pattern
At least two or more episodes in past 2 years that have
occurred at the same time (usually fall or winter seasons), and
full remission at the same time (usually spring).
Bipolar With
Peripartum
Onset
Mood symptoms occurred during pregnancy, or in the 4 weeks
following delivery
Bipolar With Anxious
Distress
distressed,
anxious.
Fear of losing control
Fear of something bad might happen
*only specifier to be
applied to cyclothymia
With
Psychotic
Features
Delusions or hallucinations (usually mood congruent) present;
feelings of guilt and worthlessness common. Specify further:
Mood-congruent OR MOOD- INCONGRUENT
With Mixed
Features
In Depression -Mania-like but does NOT meet criteria for bipolar
disorders.
In Manic / hypomania –
Depressive-like but does NOT meet criteria for depressive
disorder.
In partial remission
Symptoms of previous episode are ______, but full criteria are ______ met, or there is a period lasting less than _______ without any _______ symptoms
present, not met, 2 months
significant
In full remission
During the past ______ or more, no _______ signs or symptoms of the disturbance were ______
2 months, significant, present
Mild
Few, if any, symptoms in excess of those required to make the diagnosis
are present,
Symptom intensity distressing but manageable,
Minor
impairment
Moderate:
number of symptoms, intensity of symptoms, and/or functional
impairment are between those specified for “mild” and “severe.”
Severe
number of symptoms is substantially in excess of that required to
make the diagnosis,
Symptom intensity seriously distressing and
unmanageable.
Markedly interfere with social and occupational functioning.
rapid cycling (FOR BIPOLAR)
Presence of at least _____ mood episodes (usually more) in the previous ______ that ______ the criteria for manic, hypomanic, or major depressive ______.
four, 12 months, meet, episode
FOR RAPID CYCLING These episodes can occur in any …
combination and order
FOR RAPID CYCLING episodes must be demarcated by either a (FILL IN) or a (FILL IN)
period of full remission (2
months symptom free)
Change in mood of the opposite polarity
FOR RAPID CYCLING, FEMALES ARE …
MORE LIKELY
RAPID CYCLING IS MORE COMMON IN
BIPOLAR 2
RAPID CYCLING has a
WORSE LONGTERM OUTCOME
Ultra-rapid cycling
switches between states in the magnitude of days-
weeks
Ultra-ultra rapid cycling
switches between states in the
magnitude of hours-days
Bipolar is considered one of the most (FILL IN ) driven disorder, SO PSYCHIATRIST RELIED ON ( FILL IN)
“biological”, MEDICATION
Severe mania usually leads to (FILL IN)
* Therefore the intervention is (FILL IN), not therapy
hospitalization, MEDICATION
Multiple endpoints (“poles”) of the disorder make it hard to (fill in ) for in (fill in) experiments
control for, psychological
Gray’s Reinforcement Sensitivity Theory
Two motivational systems
that work inversely of each other and are responsible for coordinating
behavior
* Behavioral Activation System (BAS)
- Behavioral Inhibition System (BIS)
Behavioral Activation System (BAS)
Behavior to attain rewards and goals
Behavioral Inhibition System (BIS)
Avoidance behavior to avoid threats / punishment
High scores in (FILL IN) categories associated with higher probability of (FILL IN)
as well as be an indicator of an upcoming episode
BAS , bipolar diagnosis
Gray’s Reinforcement Sensitivity Theory Idea: In people with bipolar disorder, their (FILL IN) system is (FILL IN) ; as well as prone to extreme
fluctuations
BAS, weakly
regulated and highly sensitive
WITH Hypomania / Mania = (FILL IN) becomes overly active = (FILL IN) in
goal attainment, reward-seeking, elevated energy
BAS , increase
WITH Depression = (FILL IN ) becomes deactivated / shutdown =
(FILL IN ) in motivation to approach / obtain rewards (anhedonia, low
energy
BAS , decrease
Response Styles Theory – 4 response or coping styles
Ruminative Style, Distraction Style, Risk-taking Style, Problem-Solving Style
Ruminative Style
thoughts/behaviors that focus the individual’s attention
on their symptoms and the causes/consequences of those
Distraction Style
thoughts/behaviors that take the individual’s mind off
their symptoms (actively ignoring symptoms
Risk-taking Style
maladaptive distractions (usually dangerous activities)
Problem-Solving Style
plan of action to alleviate symptoms
Depression - scoring high in (FILL IN) style , associated with (FILL IN)
rumination, prolonged depressive symptoms/episodes
Hypomania/Mania – scoring high in ( FILL IN ) STYLES
RUMINATION, DISTRACTION, RISK TAKING
Manic-Defense model - psychodynamic approach
mania is viewed as an unconscious defense mechanism to maintain psychological
homeostasis and evade the depressive state / cognitions
Manic-Defense model - psychodynamic approach - Life events that may be a (FILL IN ) to an underlying fragile self-esteem lead to (FILL IN ) to prevent the underlying (FILL IN ) from entering consciousness
threat, mania-like symptoms, depressive cognitions
Manic-Defense model - psychodynamic approach- Mania is not seen as (FILL IN ) of depression but rather (FILL IN )
opposite, one entity
Extensions of the cognitive styles for unipolar depression
Individuals
with mania have positive cognitive distortions/ schemas about themselves /
environment
Extensions of the cognitive styles for unipolar depression- > View mania is (FILL IN) of depression
polar opposite
Extensions of the cognitive styles for unipolar depression -> Bipolar individuals developed (FILL IN ) that may (FILL IN ) the risk for mania which may be activated by positive events later in life
* So, positive cognitive schemas= (FILL IN )
positive cognitive styles, increase, DIATHISIS
Typically all PSYCHOLOGICAL interventions used in conjunction with …
medication
Psychotherapeutic approaches are (FILL IN) designed as a treatment in an acute episode
NOT
Prodromes ARE
early symptom(s) indicating onset of disease/illness
Gold Standard in Treatment: The Barcelona Approach
1.) Awareness of disorder,
2.) Medication nonadherence (patients don’t take medications as
prescribed)
3.) The importance of avoiding substance abuse
4.) Early detection of new episodes
5.) Lifestyle regularity
Prodromes for Mania
Poor quality of sleep / start to decrease need for
sleep, Elevated mood, Increased activity, Extreme goal-setting
Prodromes for Depression
Sleep disturbance, anxiety, tension, G.I. problems, fatigue, emotional distancing,
Family-focused therapy -> GOAL
Address family dynamics and relationships and how they contribute to factors
that help or hurt the illness
Family-focused therapy STRUCTURE
1.) Assessment, Psychoeducation component, Communication enhancement component:, Problem-solving skills training component:
Family-focused therapy -> ASSESMENT
Identify communication patterns of family. Identify if high expressed
emotion (EE) is present
expressed emotion
attitudes, behaviors, emotions by the caregiver toward the
person being cared for
Family-focused therapy ->
Psychoeducation component
Discuss Etiology of illness, Identify prodromes, Improve medication adherence
Family-focused therapy -> Communication enhancement
Enhancing quality / efficiency of family’s communication
Family-focused therapy -> Problem-solving skills training
Come up with a relapse prevention plan, identifying what to do during the aftermath
CBT BASIC TENET
Change conceptualization of how the individual structures
and interprets their moods, experiences, and behavior
CBT IS (FILL IN ) when someone has manic symptoms
more difficult
IN CBT, focus on Target (FILL IN) during the (FILL IN) period
cognitions, prodromal
CBT Daily mood monitoring-
connections between mood
and sleep / stressors, seasonal changes
CBT Activity scheduling-
enhance beh. activation
depressive episodes; minimize stimulation during mood
elevation
CBT Identify early warning signs / limit impulsivity -
“48
hours before acting” rule – WAIT 48 HOURS before acting on any major decision / purchase
CBT Treatment contracting
formulate written plan for
support team
DBT GOAL ->
How thoughts and emotions affect behavior. Dialectical = integration of
opposites: how acceptance and change can coexist
DBT is not trying to focus on (FILL IN ) your cognitive schemas, but rather
(FILL IN ) that intense emotions/distress can happen and figure out a way to
(FILL IN ) from this.
changing, accept, move on
DBT Hierarchy of behavioral targets
- Decrease life-threatening behaviors
– Decrease therapy-interfering behaviors
– Change quality of life-interfering behaviors
– Increase skills development
DBT COMPONENTS
Mindfulness, Distress tolerance, Emotional regulation, Interpersonal effectiveness, Walking the middle path
DBT STRUCTURALY CONSITS OF
Weekly individual therapy session , Skills group training , In the moment telephone consultations ,Therapy team consultation
WITH DBT, Client becomes (FILL IN) to operate independently and self-soothe
own therapist
Circadian / social rhythm disruption theory
Life provides internal / external
cues that entrain our circadian rhythm. Disruption in these cues
lead to potential development / trigger of mood episodes
Circadian / social rhythm disruption theory -> Bipolar disorder is a result of (FILL IN ) circadian rhythm
dysregulated
Photic stimuli
endogenous 24-hour
biological cycles ( sunlight, seasonal changes)
Circadian / social rhythm disruption theory -> Bipolar disorder is a result of (FILL IN ) social rhythm
dysregulated
Nonphotic stimuli
exercise, social interactions, eating/ drinking
patterns, life events
Circadian / social rhythm disruption theory RELEVANCE -> Disrupted sleep is (FILLL IN ) in mood episodes, is associated with a
(FILL IN ), and can present an e(FILL IN) for
triggering the episodes
prevalent , worse course of illness, Early warning sign
IPSRT
To regularize daily
routines = stabilize moods and
prevent episodes, restore
rhythmicity
IPSRT Use (FILL IN ) to
quantify daily social rhythms
social rhythm metric
IPSRT , Increases (FILL IN ), lengthens
(FILL IN )
recovery, time between episodes
IPSRT focus on resolution of (FILL IN ) and
prevention of future problems
current interpersonal problems
Heritability index (H2) ->
estimate the degree of variance in a
trait/disorder in the population due to genetic variance
Genes contribute more of a role in (FILL IN ) than (FILL IN )
bipolar disorder, major
depressive disorder
Major depressive disorder (GENE ROLE)
25-40%
BIPOALR ( GENE ROLE)
60-85%
Usually measure GENE CONTRIBUTION by examining / comparing
TWIN STUDIES, PARENT/ OFFSPRING STUDIES, ADOPTION STUDIES
Agree that disorders are …
polygenic
old” way in examining genetic
markers for a disorder ARE
CANDATE GENE STUDIES
Candidate genes
genes involved in
processes that are believed to be aberrant
EXAMPLE CANIDATE GENE STUDY
Examined serotonin-transporter
gene in depression
People with s/s were (FILL IN ) as likely to experience (FILL IN ) as l/l
2X , MDD
“new” way in examining genetic markers for a disorder
GWAS STUDY
GWAS
study where the entire genome is
investigated to identify candidate genes by comparing polymorphisms in individuals without disorder/disease and individuals with
disorder/disease
IN BIPOLAR Decreased (FILL IN ), increase in (FILL IN )
cortical thickness , ventricle size
candidate genes still do not provide a direct ….
biological
mechanism
Can also look at how BPD genes overlap with other disorders, EXAMPLE
BPD1 genes linked closer to schizophrenia
BPD2 genes linked
closer to MDD
IN BIPOLAR , Decreases in….
gray / white matter integrity
FOR ANATOMICAL CHNAGES (FILL IN ) between subtypes of BD
No differences
Evidence points more towards (FILL IN ) vs.
structural changes in a specific brain area
dysfunction in brain networks
Brain network
coordinated brain activity – how activity of brain
regions correlate with each other
We do know there is shifting activation between poles / episodes =
usually (FILL IN )
lateralized shifting of activity
People with bipolar disorder usually show some extent of altered
connectivity among …..
triple network model:
Default mode network
Brain regions that
are active when you are not engaged in a task
Default mode network May be (FILL IN ) in BPD in absence of stress
overactive
Salience network
Detecting / shifting attention, integration of
and filtering of salient stimuli
Central Executive control network
IUnvolved in working memory,
reasoning, problem solving, flexible thinking, rational decision making
Monoamine hypothesis
depletion in serotonin / norepinephrine
responsible for mood / emotion imbalances
Dopamine hypothesis
Faulty mechanisms leading to hyperdopaminergic
states (mania) and hypodopaminergic states
Glutamate / GABA imbalance
altered balance of glutamatergic
(excitatory) and GABAergic (inhibitory) markers, in particular to an increased glutamatergic tone during mania / decreased GABAergic activity
MEDICATION CONSISTS OF A combination of …
Mood Stabilizers, Anticonvulsants, Antipsychotics
medication may depend on THE
…
predominant state
antidepressants can cause a (FILL IN ) therefore caution is greatly used when administering in a
bipolar depressive episode
switch to hypomania /
mania,
(FILL IN) are fully
or partially nonadherence in the year after a manic episode
60%
Patients who discontinue medications are at a greater increased risk of ..
relapse and suicide
Factors in choosing WHICH BIPOLAR MEDICATION
Past history
-Severity
-Predominant polarity
-Speed of onset
-Patient preference
-Family history
-Side effects
Lithium WAS FDA-approved for manic illness IN
1970
LITHIUM IS A
MODD STABILIZER
LITHIUM HAS (FILL IN ) in preventing depressive and manic episodes
Equal efficacy
LITHIUM Found (FILL IN ) of suicide attempts if taken
significantly lower levels
LITHIUM RESPONSE
5-14 DAYS
LITHOIUM YOU (FILL IN) THE DOSE
TITRATE
LITHIUM Requires close-monitoring of …
blood levels
LITHIUM SIDE EFFECTS
Kidney problems, hypothyroidism, weight gain
LITHIUM negative effect on
glutamate / dopamine system
LITHIUM positive effect on
GABA system
LITHIUM Influences ..
intracellular signaling cascades
LITHIUM Produces
neuroprotective effects
LITHIUM Influences resetting of
circadian rhythms
Anticonvulsants EX
Valproate,Lamotrogine, Carbamazepine, Divalproex
Anticonvulsants ARE Used in (FILL IN) treatment (usually in conjunction with (FILL IN)
maintenance , lithium
Anticonvulsants ARE A (FILL IN) AND (FILL IN) channel blocker. Suppress
release of(FILL IN) , diminishing (FILL IN) and enhancing (FILL IN)
SODIUM, CALCIUM , glutamate, excitation, inhibition
First-generation ARE …
TYPICAL
Ex. 1st generation –
Thorazine (chlorpromazine), haloperidol (Haldol)
second-generation ARE…
atypical
Ex 2nd generation –
Zyprexa (Olanzapine), Risperidol
ANTIPSYCHOTICS ARE Typically (FILL IN) than (FILL IN) at treating manic episodes
faster, LITHIUM
ANTIPSYCHOTICS Focus on …
positive symptoms
BOTH typical and atypical have the same …
efficacy
Atypical antipsychotics have
fewer…
extrapyramidal side effects
ANTIPSYCHOTICS Block the action of (FILL IN) primarily by blocking (FILL IN). Also act on (FILL IN) and
(FILL IN) receptors
dopamine, D2
receptors, acetylcholinergic, serotonin
Tardive dyskinesia
Involves involuntary
movements of the lips and tongue
Neuroleptic malignant syndrome
characterized by high fever and extreme
muscle rigidity that can be fatal if left
untreated
Long-term exposure TO (FILL IN) can be detrimental
ANTIPSYCHOTICS
WITH ANTIPSYCOTICS YOU CAN Observe slight changes within(FILL IN) , but takes (FILL IN)
24 hours, days to several weeks
Diathesis Stress Model
Depression develops from vulnerabilities/predispositions
for depression combined with stressful conditions
IN THE Diathesis Stress Model THESE vulnerabilities can be
genetic, biological,
psychological, or cognitive
Early Adversity
refers to many different kinds of difficult early life experiences that
contribute to hardship (distal risk factor)
a lot of evidence that early adversity can play a (FILL IN) in the development of depression
causal role
Retrospective Studies
find people who are depressed and ask them if they
experienced early adversity
Prospective Studies
select a sample of children from family services and
follow up with them to see if there are differences between those
who were maltreated and those who were not
retrospective studies are influenced by (FILL IN ) and (FILL IN)
recall bias, current psychopathology
prospective studies give (FILL IN) for the causal role
of early adversity
good support
Mediators
explains
the relationship
between two variables
Moderators
influences the
strength or direction of
the relationship
between two variables
Early adversity is a subset of what we might refer to as (FILL IN) –
any events, either acute or chronic, that cause stress
life stress
USED THE contextual threat method TO DEVELOP THE
Life
Events and Difficulties Schedule (LEDS)
(LEDS)
way to define and rate acute / chronic stressors
(FILL IN ) of inds. With depression report an acute, severe life event
(FILL IN) to the onset of a depressive episode
50-80% , prior
certain types of stressful life events that are especially
likely to lead to depression ->
Loss events, humiliation-entrapment
events, and targeted bullying/criticism/discrimination
Kindling Theory
first episodes of
depression require a lot more stress
than later episodes
Kindling Theory -> stress may become (FILL IN) over time
less or not
important
Sensitization Theory
that minor stressors play a more important role in
later depressive episodes
Sensitization Theory -> stress becomes (FILL IN) over time
more important
Higher (FILL IN) is associated with (FILL IN) outcomes in
bipolar individuals, in particular manic episodes
life stress, poorer
Stressful life events are associated with (FILL IN)
in individuals with bipolar disorder in a very similar way as in
individuals with (FILL IN)
Depressive episodes, MDD
Events that activate the (FILL IN)
can trigger manic episodes
BAS SYSTEM
(FILL IN) of suicide victims had a psychiatric disorder at time
90%
Some groups that experience higher rates of suicide
Veterans
– RURAL POP.
– Sexual and gender minorities
– Middle-aged adults
– Native Americans
risk factors for completed suicide
-History of psychiatric disorders
– Family history of suicide
– Sexual minority and gender minority identity
– Early adversity
– Financial/legal problems
(FILL IN ) is the #1 risk factor for suicide
Depression
Contagion effect
suicidal behavior is “contagious” either through direct
or indirect involvement with an individual who has committed suicide
Passive Suicidal Ideation
Having thoughts of your own death, but not about killing yourself
Non-Specific Active Suicidal Ideation
Concrete thoughts of killing oneself but no specific methods/plans
Specific Active Suicidal Ideation
Having thoughts of suicide along with thoughts of at least one method of how one
would do so. Can have a plan or not.
Imminent Risk
someone has active suicidal ideation, has a plan, has access to
their means/methods, and has an intention to carry it out.
