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PSYC3018 > Bipolar > Flashcards

Bipolar Flashcards

1
Q

What are the symptoms of a “high”?

A
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2
Q

What are the characteristics of a Major Depressive Episode in Bipolar?

A

A. At least 5 + symptoms during 2 week period (need #1 or # 2)

1. Depressed mood most of the day, nearly every day

2. Markedly diminished pleasure/interest in activities

  1. Significant weight loss or weight gain
  2. Insomnia or hypersomnia nearly every day
  3. Psychomotor Agitation
  4. Fatigue/Loss of energy nearly every day
  5. Feelings of worthlessness, excessive guilt nearly every day
  6. Diminished ability to concentrate nearly every day
  7. Recurrent thoughts of death, suicide, suicide attempts

B. Clinically significant distress or impairment

C. Not attributed to substance use or other medical condition

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3
Q

What are the diagnostic differences between Bipolar I and Bipolar II?

A

Bipolar I:

  • Manic episode(s) must be present
  • Major depressive and Hypomanic episode(s) can be present but not necessary for diagnosis

Bipolar II:

  • Hypomanic episode(s) must be present
  • Major depressive episode(s) must be present
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4
Q

What are some of the diagnostic issues associated with bipolar disorders?

A
  • Underdiagnosed (~18 years late)
  • Overdiagnosed (e.g. Borderline)
  • Misdiagnosed (as Schizophrenia or Unipolar depression)
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5
Q

How can stressful life events affect Manic and Depressive episodes of BD?

A

Manic episodes likely preceded by:

  • Disruption to routines & sleep-wake cycles
  • Excessive focus on goal attainment

Depressive episodes likely preceded by:

  • Low social support
  • Low self-esteem
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6
Q

How much does genetic account for the prevalence of BP?

A
  • Lifetime risk for family members of BP patients: 10% (vs.1% in the general population)
  • Twin studies: BP heritability rate of about 85%
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7
Q

What is the lifetime prevalence of BP?

A
  • Lifetime prevalence:
    • Bipolar I: up to 1%
    • Bipolar II: ~5%
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8
Q

What is the 12-month prevalence of BP?

A
  • 12-month prevalence: 1.3%
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9
Q

Is there any sex differences in BP?

A

NO

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10
Q

How long is the delay in patient seeking treatment?

A

10-25 years

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11
Q

What is the outcome of untreated BP?

A

8-10 lifetime episodes of Mania and Depression

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12
Q

What is the relapse rate of bipolar patients who received treatment for their disorder?

A
  • 40% within 1 year
  • 73% within 5 years
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13
Q

What the main characteristics of Cyclothymic Disorder?

A
  • Chronic + less severe than BP
  • Numerous episodes of hypomania and depression symptoms that are not severe enough to meet criteria for manic or major depressive episodes
  • Symptoms presents for at least 2 years, with no more than 2 months without symptoms
  • Distress and impairments in functioning
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14
Q

What are the characteristics of a hypomanic episode?

A
  • Uncharacteristic change of the individual
  • Disturbance and change are observable by others
  • No psychotic features
  • Not severe enough to cause impairment (e.g. no hospitalisation)
  • Not due to medical/substances condition
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15
Q

What are the characteristics of a major depressive episode in BP-I?

A

A. At least 5 + symptoms during 2-week period (need #1 or # 2)

1. Depressed mood most of the day, nearly every day

2. Markedly diminished pleasure/interest in activities

  1. Significant weight loss or weight gain
  2. Insomnia or hypersomnia nearly every day
  3. Psychomotor Agitation
  4. Fatigue/Loss of energy nearly every day
  5. Feelings of worthlessness, excessive guilt nearly every day
  6. Diminished ability to concentrate nearly every day
  7. Recurrent thoughts of death, suicide, suicide attempts

B. Clinically significant distress and impairment

C. Not due to other substances/medical condition

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16
Q

What is the course of BPs?

A

Predominantly depressive

  • Bipolar I: 32% of time depressed, 9% manic
  • Bipolar II: 50% depressed, 1% hypomanic
  • 5-15% patients have 4+ episodes per year >> rapid cycling
17
Q

Identify other disorders that have high comorbidity with BPs.

A
  • 50% Anxiety disorders (GAD, panic, social phobia)
  • 39% Substance misuse (“self-medication”)
18
Q

What is the suicide rate of BP patients?

A
  • 15x higher than general population
  • 25% will attempt suicide
  • 80% usually during depressive episode
  • 10-20% will complete suicide
  • Higher in BP-II (due to more frequent depressive episode?)
19
Q

Explain the Diathesis-Stress Model of Bipolar Disorders?

A
20
Q

Pharmacotherapy for BP

A
  • Lithium:
  • mood stabiliser
  • main component of standard care
  • not used regularly until ’60s
  • for treating manic ep. and prevent future ep.
  • 50% relapse within 5 months of ceasing
  • Anticonvulsants
  • Atypical Antipsychotics
  • Sedative Hypnotics
  • Antidepressants:
  • doses lower and duration shorter than for unipolar depression
  • combined with mood stabiliser to prevent inducing mania
21
Q

Electro-Convulsive therapy (ECT)

A

​​

  • Used when medication is not viable (e.g. pregnant women)
  • Effective for treating manic & depressive ep.
  • Short-term side effects: confusion, disorientation, memory loss
  • Pharmacotherapy required to maintain mood stability & prevent relapse
22
Q

Psycho education

A

Group setting

Provide info about

  • Symptoms of BP
  • Diathesis-stress model
  • Identifying early warning signs of relapse
  • The importance of medication compliance
  • Strategies to cope with stressors
  • Need for routines & sleep-wake cycles
23
Q

CBT for BP

A
  • Aim: manage acute symptoms and prevent relapse
  • Key technique: cognitive restructuring
  • Patients encouraged to:
  • Monitor symptoms
  • Challenge hyper-positive symptoms
  • Improve medication adherence
  • Doster self-efficacy
24
Q

How effective is CBT for BP?

A

​​

  • Reduce episodes and hospitalisations
  • Improve medication adherence (esp. within 6 months post-treatment)
  • Benefits of Mindfulness-based Cognitive Therapy
25
Q

Interpersonal and Social Rhythm Therapy

A
  • Aim:
  • Improve interpersonal functioning
  • Reduce disruption to routines & sleep-wake cycles
  • Patients helped to:
  • Identify unstable rhythm
  • identify realistic goals for change
  • Establish and maintain new routines
  • Particularly effective in reducing relapse.
26
Q

Family-focused Therapy

A
  • Aim: improve
  • knowledge about bipolar
  • family communication and problem-solving skills
  • family functioning: reducing criticism or hostility
  • Support for family interventions found in reducing relapse rates, hospitalisations and time to relapse
27
Q

What are the key factors for risk of relapse?

A
  • Genetic vulnerability
  • Medication non-adherence
  • Dysfunctional attitudes and beliefs
  • Disrupted routines (& sleep-wake routine)

>> ALL impact sleep disruption, triggering (hypo)mania or depression

28
Q

What does Relapse Prevention address?

A
  • 4 sessions
  • Reduce feelings of hopelessness
  • Greater perceived control over internal states
29
Q

How is BP linked to creativity?

A
  • 17% of a sample of British poets received treatment for manic episodes
  • Enhanced creativity likely linked to manic/hypomanic states & accompanying suprasensory changes
  • E.g. Van Gough, Virginia Woolf

PSYC3018 (15 decks)

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