Bipolar Flashcards by Natasha Martorano

What is the main criterion for a bipolar disorder and what is the exception to this

Diagnosed based on the presence of a manic episode lasting at least one week (most of the day, nearly everyday) and must be a distinct period of change from normal functioning
Exception: if the person is hospitalized

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Manic episodes can consist of elevated ______ or extreme _______

Expansive mood; irritability

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True or false: people in a manic state will show persistently increased goal-directed activity or energy

True

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When would someone have to meet more criteria to qualify for a diagnosis of bipolar disorder

If they are only irritable during the manic episode

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What are the symptoms that can be seen during a manic episode

Inflated self-esteem/grandiosity
Decreased need for sleep - irritability often stems from inability to down-regulate/slow down
More talkative than usual - pressured speech/they feel like words are being pushed out of them
Flight of ideas/racing thoughts - jump from one idea to the next, appears similar to loose associations in schizophrenia, thoughts are racing and they can’t keep up
Distractibility: reported or observed, can contribute to the flight of ideas, sometimes leads to diagnostic difficulties with ADHD
Increase in goal-directed activities: can also be social, talk to strangers, call at all hours of the night, working on many projects at once
Increased libido
More active/agitated
Excessive involvement in pleasurable activities with high potential for painful consequences

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True or false: there is no problem with differential diagnosis in bipolar disorder

False

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What are examples of marked impairment needed for diagnosis

Hospitalization
Psychotic features
Extreme impairment in several domains (work, family etc.)
Distress is not a factor in mania - poor insight and often feel very little pain

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Who is Dr. Amy Joynt

Ph.D in clinical psych from UCLA
Prof of psychiatry at John Hopkins
Author of over 100 published articles
6 published books
MacArthur Genius Award winner (2001)
Diagnosed with Bipolar Disorder 3 months into her first job
Treated with Lithium and attempted suicide due to Lithium overdose

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What is the difference between Bipolar I and Bipolar II

Bipolar I: mania and episodes of MDD - the “traditional” bipolar
Bipolar II: HYPOmania and depression

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What distinguishes mania from hypomania

Same symptoms as mania but milder
No hospitalization
No psychosis
Mood is out of normal range but not distressing - often very fun due to less functional impairement
Stimulus seeking

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What is cyclothymia

2 or more years of switching but never meet the full criteria for mania and MDD
Hypomania and short depressive episodes
Chronic pattern but less severe
Lots of highs and lows
More extreme than normal mood fluctuations
Affects men and women equally
Often don’t seek treatment
Increased risk for Bipolar I
Antidepressant meds can be a trigger

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Who would be diagnosed with bipolar disorder with “rapid cycler” specifier

Someone who has 4 or more episodes within a year (either depressive or manic)
More likely in females
Predicts poor response to treatment
Mood stabilizers often ineffective
NOT a stable trait

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Psychotic symptoms can be mood _____ and mood ______

Congruent, incongruent

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What is mood congruent in mania

Thought insertion and mind control

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Was is mood incongruent in depression

Anything happy

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True or false: mood incongruent in depression is common

False, it is rare

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If psychotic symptoms occur during a manic or depressive episode, then it would qualify as a _______ with ________

Mood disorder, psychosis

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If psychosis symptoms occur outside mood episodes, usually it’s a _________ diagnosis

Schizoaffective

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What is the lifetime prevalence of either bipolar I or II

2-4%

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True or false: prevalence rates do not seem to differ as a function of sex, culture, countries, and different parts of the world

True

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What was a common belief about high SES and bipolar prevalence

Higher SES = greater prevalence

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True or false: bipolar is much higher among artists, poets and writers

True

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What is the prevalence of cyclothymia

4-5%

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True or false: unipolar mania has been reported in community studies

True

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What is the prevalence of unipolar mania in bipolar I patients compared to the general population

25-33% bipolar I patients compared to 1-2% general population

Studies found that if unipolar mania is followed for long enough, the majority of patients had at least one episode of depression during the follow-up. What further question does this bring us to?

It is not clear is unipolar mania is stable over the life course of whether most bipolar I patients, if followed long enough will develop a depressive episode.

How long does it take for an individual with bipolar disorder to receive a proper diagnosis and subsequent treatment

6-10 years

Misdiagnosed individuals consult an average of _____ physicians prior to receiving an accurate diagnosis

Close to _____ of individuals with bipolar disorder initially get misclassified as having _____

60%, MDD

True or false: people are most likely to seek treatment during a manic episode

False, more likely to seek treatment when depressed

How do treatment responses differ for unipolar and bipolar disorders

Bipolar: mood stabilizers like lithium and anti-convulsants Unipolar: anti-depressants

What is the age of onset of bipolar

20-30

What is the proportion of people who have a manic episode first compared to a depressive episode first

50-50

What is the proportion of people who present with only depression that convert to bipolar

5-10%

What kinds of people would be most susceptible to converting from depression to bipolar

If younger in age, heightened guilt, psychomotor retardation, family history of bipolar

How long do bipolar episodes last

2 months 8 months before effective treatment

What are poor prognostic indicators of bipolar disorder

Mixed states and rapid cycling

What is the relapse rate of bipolar over the lifetime

7-9 times

What is the risk of death by suicide in bipolar patients compared to the general population and compared to those with MDD

15x greater than the general population 4x greater than those with MDD

Some estimates of inpatients with bipolar suggest _____ die by suicide

11%

What are some risk facts for death by suicide in general

Younger age Recent illness onset Male gender Prior suicide attempts Family history of suicide Comorbid alcohol or substance use Rapid cycling course Social isolation

According to Sheri Johnson stress appears to increase in the 1st ____ months prior to an episode

True or false: according to Sheri Johnson and the etiological model of stress and adversity in Bipolar, frequent relapse rate is common following a stressful experience

True

What is a particular class of stressors important in mania and why

Goal-attainment events because when we achieve a goal, we become very happy; subsequently dysregulated and spiral into mania

Who proposed Kindling and what is it

Graham Goddard Stimulate areas of the brain repeatedly with electricity and seizures develop and over time lower doses of electricity are needed to provoke a seizure until it happens with no electricity

Who applied the kindling theory to bipolar patients and what was proposed

Robert Post 1st episode of bipolar requires a lot of stress 2nd episode of bipolar requires less stress 3rd episode even less Eventually you won’t need stress to provoke an episode, it will occur on its own

What is the association between sleep and bipolar

Sleep deprivation is a powerful predictor of mania Less sleep on day N will predict increases in manic symptoms on day N+1 Exposure to bright light which change circadian rhythms can trigger manic symptoms

What part of the brain is associated with bipolar

The ventral striatum (especially the nucleus accumbens)

What is the striatum

Central part of the basal ganglia - facilitates voluntary movement and reward processing

What can we say about the striatum in people with bipolar

Enlarged in men and women with bipolar patients Compare first and multiple episode bipolar and HC Enlarged in both affected and unaffected MZ twins discordant for BP

In bipolar there is abnormally elevated activity within VS during ____, _____, ______

Reward anticipation, reward consumption and to reward-predictive cues

Reward in bipolar is associated with a failure of the ______ regions to effectively _______ _______ responses

Prefrontal, down-regulate, VS

Reward consumption-related activation is more prominent in _____

Bipolar I

Abnormalities in reward anticipation-related activation are more prominent in _____

Bipolar II

What is the history of lithium as a treatment

Mid 19th century it was used to treat many disorders but quickly fell out of fashion Lobotomies became more common for BP Johan Cade saw its tranquilizing effects and began to be used on his hospitalized patients

True or false: far many years there was no consensus on how lithium works

True

Lithium deactivates an enzyme that interferes with ______

Our circadian clock

True or false: Lithium is a GABA antagonist

False, it is a glutamate antagonist

What is some recent evidence regarding lithium

It appears to interrupt dopamine signalling in the brain and has a very narrow therapeutic window

What are some side-effects of lithium

Thyroid and kidney problems Dehydration, weight gain, acne, thinning of hair and hand tremors