Bipolar Flashcards
The initial stages of a manic episode are…
But then, as the thinking wheel gets faster…
a lot of fun - your self-esteem goes up, you feel important and confident (heightened wellbeing)
you get to the stage of euphoria and mania - ideas start coming quickly - people become agitated and irritable
Often in a manic episode, you will fluctuate between…
elation and irritability
Manic episode must last at least
one week
The new sub-criterion within Criterion A of Bipolar I states that the individual…
has increased goal-directed activity/energy, present nearly daily
During a manic episode, the individual can function very well on _______
~ 2 hours sleep
Manic patient is often involved in _______ behaviours
high-risk, dangerous
eg gambling, promiscuity
After a manic episode, the individual often feels
guilt/regret as to the damage they caused to their career, family etc
Criterion C of Bipolar I states that the mood disturbance is:
- sufficiently severe to cause marked impairment in occupational functioning or in usual social activities
- OR to necessitate hospitalisation to prevent harm to self/others
- OR there are psychotic features (hallucinations/delusions)
up to ____ of people with Bipolar I will attempt suicide
half
A hypomanic episode lasts at least ___ days
4
What is the difference between a hypomanic episode and a manic episode?
symptoms are the same.
Difference is in Criterion C
- While the disturbance & changes are observable to others, they are not sufficiently severe to cause marked impairment in occupational functioning/necessitate hospitalisation/no psychotic features
- highs are not as high (can still function)
Is a major depressive episode necessary for Bipolar I/II?
No for Bipolar I
Yes for Bipolar II
For Bipolar II, you need to have had
at least one MD episode and one hypomanic episode. No manic episodes.
Cyclothymic disorder is characterised by
numerous cycles of hypomanic symptoms and depressive symptoms that are not severe enough to meet criteria for manic or MD episode
= the chronic, less severe form of Bipolar
constantly oscillating
Duration of cyclothymic disorder?
Symptoms for at least 2 years, no more than 2 months without symptoms
why is dangerous to misdiagnose Bipolar as Unipolar Depression?
Antidepressants can trigger mania
Are there gender differences in bipolar?
no, except that rapid cycling seems to be affecting women more
often people with Bipolar will not receive treatment/be diagnosed correctly until
10-20 years after onset
Even when treated, ____ will relapse within 1-year, ___ within 5 years
40%, 73%
The course of bipolar is predominantly ________
depressive (Bipolar II more so than Bipolar I)
Bipolar patients do spend a significant portion of their lives feeling normal/well. This is called
euthymia
rapid cycling is …
4+ episodes a year - affects 5-15% of sufferers
Bipolar is often comorbid with..
Anxiety disorders (50%) Substance abuse (39%)
What are the 3 aetiological factors of Bipolar?
- Genetic/biological factors
- Environmental and Life stressors
- Psychological factors
If one parent has Bipolar the chance of their child developing it is ___. If both parents have bipolar the chance goes up to ____.
10%, 40%
Bipolar is a neurobiological disorder, largely due to the malfunction of three neurotransmitters:
serotonin, dopamine and noradrenaline
These biological vulnerabilities to bipolar may lay ______. Can be activated ________ or triggered by environmental/life ________.
dormant
spontaneously
stressors
Manic episodes are likely preceded by…
- disruption to routines and sleep-wake cycles
- excessive focus on goal attainment (over-invested in one thing)
Depressive episodes are likely preceded by…
- low social support
- low self-esteem
What are the psychological factors that contribute to Bipolar?
- negative cognitive style (esp. when paired with stressful events)
- mania = overcompensation for low self-esteem - cognitions go in opposite direction
Which personality traits are implicated in bipolar?
- perfectionism
- sociotropy = over-investment in social relationships, don’t take rejection well
According to the Diathesis-Stress model, what is the order of events to elicit Bipolar?
Life stressors causing poor social routines and/or sleep deprivation
—–> and you have biological vulnerability i.e. Circadian rhythm instability
—–> prodromal stage (early symptoms of mood disturbance)
——–>if you use poor coping strategies to deal with these early symptoms——->
Full-blown episode
which can lead back to causing stress
vicious cycle
Best treatment outcomes are achieved when…
We combine pharmacological treatment with (adjunct) psychological intervention. But pharmacological treatment will always be the primary treatment
Treatment needs to be tailored to the patient - depends on…
Illness stage (acute, maintenance) Predominant polarity (depressive, hypo/manic)
____ of patients relapse within ____ months of ceasing lithium
50%, 5
Anticonvulsants are used for people who..
have rapid cycling, increased levels of irritability
Sedative hypnotics (benzos) are given to help with
sleep
How are antidepressants administered to Bipolar patients?
Lower doses, shorter duration
- combined with mood stabilisers so they’re not at risk of inducing mania
____ is used when medication is not viable
ECT
What are the two main types of psychotherapy for Bipolar?
CBT and psycho-education
- equally effective
Atypical antipsychotics such as Olanzapine are used to counter the
psychotic features that may be present during a manic episode
Psycho-education is most commonly conducted…
in a group setting
Psycho-education provides info on…
- symptoms of BP
- strategies to cope with stressors
- need for routines —> minimise disruption of sleep-wake cycles
- identifying early signs of relapse
- diathesis-stress model of BP
- the rationale/importance of medication compliance
Psycho-education effects?
- delays recurrence
2. reduces frequency of future episodes
The key technique in CBT is ___. CBT is effective in…
cognitive restructuring - challenging and changing unhelpful thinking
reducing episodes and hospitalisations, improving medical compliance
Recent studies show benefits of …
MBCT in assisting the patient to manage both anxiety and depressive symptoms primarily between episodes
Male patients with bipolar are often misdiagnosed as having ____________, female patients with bipolar are often misdiagnosed as having ______________.
schizophrenia
unipolar depression
Lithium fully protects only ________ percent of patients against further episodes
25-50
What is the Goal Dysregulation Model?
Mania is the result of excessive goal engagement. Even when not in an episode, individuals with a history of bipolar I disorder have been found to place a higher emphasis on rewards and to be excessively engaged int he pursuit of achieving goals compared to those without the disorder
Johnson et al. (2000) found that specifically ____________ life events, and not __________ life events, were associated with elevations in subsequent manic symptoms. In contrast, ___________
goal-directed
general positive
goal attainment was not associated with changes in depression
Studies have found that symptom severity in bipolar is significantly associated with ….
sociotropy, negative interpersonal events and the interaction of the two
Why is mood monitoring an important intervention in the early stages of therapy?
Encouraging clients to keep structured mood diaries helps in identifying the triggers to mood shifts and the associated changes in thoughts and feelings
What is Interpersonal and Social Rhythm Therapy?
aims to reduce disruptions in daily routines and sleep/wake cycles that trigger bipolar episodes
- regulate social rhythms
- address interpersonal difficulties
The instability model of bipolar disorder relapse assumes four key mechanisms that trigger relapse in bipolar disorder. What are they?
- biological vulnerability
- medication non-adherence
- disrupted routines
- dysfunctional interpretations of life events
2,3 and 4 —-> sleep disturbance mania/depression
