bipolar

Question 1

DSM-5 criteria for bipolar

Answer 1

A: distinct period of abnormally and persistently elevated/irritable/expansive mood and energy/activity lasting at least 1 week (where its noticeable by others)
B: 3 or more of following:
- flight of ideas/thoughts racing, more talkative/pressure speech, decreased need for sleep, distractibility, increased goal directed activity/psychomotor agitation (cant sit still), excessive involvement in risky behaviours (ie spending spree, unsafe sex practices)

Question 2

bipolar disorders general

Answer 2

• bipolar 1: at least one manic episode, no need for depression episodes, often has worse prognosis
• bipolar 2: at least one hypomanic episode (at least 4 days) and at least one major depressive episode
• Cyclothymic disorder: numerous periods of subthresthold hypomania and numerous periods of subthreshold depression

Question 3

t or f: bipolar 1 is often comorbid with MDD

Answer 3

false, it cannot be comorbid with MDD

Question 4

lifetime prevalence of bipolar

Answer 4

• bipolar 1: 0.6%
• Bipolar 2: 0.4% (less common than unipolar disorders)

Question 5

Sex ratio and age of onset for bipolar

Answer 5

• sex ratio= 1:1 (slight more men for 1 and more women for 2)
• age of onset; late teens/early 20s

Question 6

ethnic disparities in bipolar diagnosis and treatment

Answer 6

• black ppl are more at risk of being misdiagnosed with schizophrenia
• if properly diagnosed, they are also less likely than white patients to receive treatment

Question 7

heritability estimate for bipolar

Answer 7

• 0.85
• children w/ parents with bipolar disorder are a 4 fold greater risk of developing a mood disorder but most wont develop manic/hypomanic symptoms

Question 8

GWAS (bipolar)

Answer 8

• genome wide association studies
• analyze entire genome (requires huge sample)
• looks for genetic markers that statistically distinguish traits from others

Question 9

from a genetic standpoint, BP has more in common with ____ than with ____

Answer 9

schizophrenia, unipolar major depression

Question 10

pharmacotherapy for bipolar

Answer 10

• lithium, anti convulsants (divalproex), anti psychotics (olazapine, quetiapine, risperidone, aripiproazole)

Question 11

what level of adults and adolescents are fully/partially non-adherent (no follow up) to medication after the first year

Answer 11

• adults=40-60%
• adolescents=65%

Question 12

lithium’s therapeutic window (mmol/L)

Answer 12

• <.4=little theraputic effect
• .4-1.0=manis prophylaxis
  -.8-1.2= acute mania treatment
  -1.2-1.5= possible renal impairment
• 1.5-3.0 = renal impairment, weakness, drowsiness, thirst, diarrhea
• 3.0-5.0= confusion, convulsions, coma, death

Question 13

adjunctive psychotherapy for bipolar examples

Answer 13

• Family focused therapy (FFT)
• Interpersonal and social rhythm therapy (ISRT)
• cognitive behavioural therapy

Question 14

Expressed emption (EE)

Answer 14

• family members’ attitudes toward person w bipolar
• examples: critical, hostile or over involved
• high EE is associated with higher relapse

Question 15

FFT (bipolar)

Answer 15

• family focused therapy, has 3 stages
• stage 1: psychoeducation of for patient and family about bipolar disorder
• stage 2: communication enhancement training (ie communication skills, active listening, making pos requests for change, express pos and neg feelings)
• stage 3: problem solving skills training (identify specific family conflicts, brainstorm and generate solutions together, evaluate dis/advantages together, develop implementation plan)

Question 16

Circadian rhythm disruption theory

Answer 16

• 24 hour sleep-wake cycle is regulated by suprachismatic nucleus, based on input from retina
• stims melatonin release from pineal gland
• example in high relapse rates during ramadan (mainly manic episodes)

Question 17

sleep deprivation trigger mania in ___% of patients

Answer 17

77%

Question 18

circadian rhythm disruption events

Answer 18

• social zeitgebers: enviro and interpersonal influences that keep time
• social zeitstorers: social influences that disrupt ability to maintain daily rhythms

Question 19

ISRT

Answer 19

• interpersonal and social rhythm therapy, 3 stages
• Stage 1: monitor behaviours and relationships associated with changes in mood (choose interpersonal prob area)
• Stage 2: track social rhythm regularity, adjust to regular social rhythms, work on interpersonal problem area
• Stage 3: developing skills to manage shifts in routines, build patient confidence

Question 20

what worksheet does ISRT use

Answer 20

• Social rhythm metric (SRM)
• shows goal activity, goal/target time to complete, when it was actually completed, and who was involved

Question 21

ISRT vs clinical management

Answer 21

• SRM scores increased sooner and remained high with ISRT vs clinical management
• regulation of daily routines mediated effect of ISRT on relapse

Question 22

t or f: both goal attainment events and general positive events predicted increase in manic symptoms

Answer 22

false, only goal attainment

Question 23

anticipation of reward vs punishment and goal attainment in bipolar

Answer 23

• greater activity in ventral striatum (nucleus accumbens) and orbitofrontal cortex
• people w bipolar disorder showed enhanced sensitivity to rewarding stimuli
• goal attainment and success inspire burts of confidence, fueling increased goal attainment in BP
• excessive goal attainment can accelerate dev of manic symptoms
• following goal attainment, teach self regulation as self management tool can help prevent mania

Question 24

recovery focused CBT

Answer 24

• Stage 1: introduce recovery approach to clients (assessing mood/function, discovering how they understand their diagnosis, making recovery informed therapy goals)
• Stage 2: chart relationships between mood and recovery goal (apply CBT techniques to facilitate pos coping
• Stage 3: consider wider function issues in recovery (develop and complete recovery plan, share lessons learned with their key supports)