Bipolar Flashcards
Key Features of Bipolar
- Alternating periods of mania with depression
- Used to be called “manic depression” or “cyclic insanity”
Lithium in Bipolar Treatment
Lithium is the typical drug used to stabilise mood
- Sometimes also taken with olanzapine (antipsychotic), showing that bipolar also shows symptoms of psychosis
- gold standard treatment, historically
Other Mood Stabilisers
- Anticonvulsants - sodium valproate
- Antipsychotics - in the case of psychosis
DSM Definition of a Manic Episode
→ a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy
- Lasting at least one week
→ 3 or more of the following
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Atypically talkative
- Flight of ideas
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement of activities with a high potential for painful consequences
→ the mood disturbance is sufficiently severe to cause a marked impairment in social or occupational functioning OR it necessitates hospitalisation to prevent harm to self or others OR there are psychotic features
Differences for Hypomania
- Lasting at least 4 consecutive days
- Milder version of manic episode
- NOT severe enough for marked impairment …
- The disturbance in mood or functioning is unequivocal and observable by others
Bipolar I Disorder
manic episodes alternate with MDE
- MDE is typical but not necessary
- Manic symptoms can be psychotic but typically aren’t
- 0.5-1%
- Typical age of onset is late teens, early 20s
- Typical length of mood episode: 2-6 months
- Rapid cycling: 4 or more episodes in previous 12 months
Bipolar II Disorder
hypomanic episodes with MDE
- Different to bipolar 1 is that MDE is necessary for diagnosis
- Average length of mood episode tends to be shorter than bipolar 1
- Higher likelihood of rapid cycling
- 15% of bipolar 2 transition to bipolar 1
Cyclothymia
hypomanic symptoms alternate with hypodepressive symptoms
Heritability of Bipolar
one of the most heritable mental disorders
- 4-9% for first degree relative
- Monozygotic twin is 45-75% chance compared to 15-25% for unipolar depression
- Unrelated is 0.5-1.5
- Combination of genes relate to bipolar
Basic Neurochemistry of Bipolar
Bipolar depression: low levels of the serotonin transporter
Mania: greater sensitivity to dopamine, using amphetamines mood increased much higher than healthy controls
- but findings have been inconsistent
Circadian Rhythms as a Theory for a Cycle
Observations
- Manic individuals tend to sleep very little, bipolar depressed people sleep a lot
- Sleep deprivation can improve mood in bipolar depressed patients, sleep deprivation can trigger mania
- In healthy people, circadian rhythms are set by zeitgebers such as light/dark cycles, meal times whereas for bipolar patients CRs become detached from these
- Bipolar = having longer circadian cycles
Evidence -
- Got bipolar depressed people, shone bright light on them in the morning for seven days to reset their circadian rhythms
- Compared to group taking lithium
- Produced comparable results
CBT for Bipolar
→ focus on promoting stability and routine, and medication compliance
- Helps patients identify warning signs for imminent mood shifts
- Sleeping less, full of energy, thoughts racing etc
CBT for depression - behavioural activation, pleasant event scheduling
CBT for mania - motivational interviewing - with regards to medication compliance, recognise that they’ve had the thoughts before (urge surfing)
Bipolar and Creativity
- Increased prevalence of bipolar disorder in artistic professions
- Research into the relationship between creativity and bipolar disorder yields inconsistent results
- Hypomania and hypomanic symptoms may be more associated with creativity than severe symptoms of mania
