Bipolar and Related Disorders Flashcards
Epidemiology
- Up to 21% of patients with major depression may have undiagnosed bipolar disorder
- Bipolar I—more common in males
- Bipolar II—more common in females
- Cyclothymia—usually begins in adolescence or early adulthood
- Onset can begin at any age
Biological Risk Factors
- Genetic: runs in families
- Neurotransmitters: norepinephrine, dopamine, & serotonin
- Neurobiological: prefrontal cortical region, hippocampus, & amygdala
- Neuroendocrine: hypothalamic-pituitary-thyroid-adrenal (HPTA) axis
Environmental Risk Factors
Stressful family life and adverse events may result in more severe course of illness
Bipolar I disorder
- Most severe form
- Highest mortality rate of the three
- At least 1 manic episode
Bipolar II Disorder
- At least 1 hypomanic episode
- At least 1 major depressive episode
Cyclothymic Disorder
- Alternate with symptoms of mile to moderate depression for at least 2 years (adults)
- Rapid cycling possible
Bipolar I disorder
- At least one manic episode.
- Symptoms of alternating manic episodes with major depressive episodes (MDE) and/or hypomanic episodes.
- A psychotic episode (delusions/hallucinations) or MDE may be absent over the lifetime of the person, but this would be very unusual.
- The more manic episodes that occur the more intense they are. (Implication for medication adherence)
- The highs mirror the lows in depth and intensity.
Clinical Feature of Mania
DIG FAST
D-distractibility
I-indiscretion
G-grandiosity
F-flight of ideas
A-activity increase
S-sleep deficit
T-talkativeness
Behaviors of Mania: What Mania Looks Like
- Mood lability: rapid extreme mood swings, with irritability or sudden outburst of misplaced rage.
- Quick to anger/feels misunderstood/ low frustration tolerance
- Pacing
- Dramatic mannerisms
- Uses jokes, puns
- Flamboyant or sexually suggestive dress
Bipolar II
- Presence or history of at least one Major Depressive Episode
- Presence or history of at least one Hypomanic Episode
- Never had a manic episode
- Impairment in functioning in at least one area
- No psychosis with hypomania but may have during the depressive phase
Mixed Features
symptoms of both depression and mania occur at the same time
Rapid Cycling- four or more
manic episodes for at least 2 weeks in 12 months. Partial or full remission for 2 months at a time or switch to opposite episode. High risk of recurrence; resistant to drug therapy; greater severity of illness; depressive symptoms predominate
Hypomanic Episode
The same criteria for Manic Episode with these exceptions
* The episode is associated with a definite noticeable (by others) change in functioning uncharacteristic for the individual.
* The episode is NOT severe enough to cause a marked impairment in social or occupational functioning or hospitalization.
* No psychotic features in the hypomanic phase
* Elevated, expansive, or irritable mood for at least 4 days.
Cyclothymic Disorder
- Presence for at least 2 years in adults (1 year in children/adolescents)
- Multiple hypomanic symptoms but not hypomanic episode
- Depressive symptoms but no MDE, manic, or mixed episodes.
- Symptoms present more than half the time; has not been without symptoms for more than 2 months at a time.
- Fluctuating hypomanic and depressive symptoms
- Alternate with symptoms of mile to moderate depression for at least 2 years (adults)
- Rapid cycling possible
Bipolar Disorders Mood
Mania, hypomania, depression, lability
Bipolar Disorders Behavior
Agitated, manipulative, restless, pacing
Bipolar Disorders Thought Processes
Loose, tangential, flight of ideas
Bipolar Disorders Thought Content
Grandisoe, paranoid, persecutory delusion
Bipolar Disorders Speech Patterns
Pressured, circumstantial, clang
Bipolar Disorders Cognitive Functioning
Deficits possible
Assessment Guidelines for Bipolar Disorders
- Danger to self or others
- need for protection from uninhibited behaviors
- need for hospitalization
- medical status
- Coexisting medical conditions
- family’s understanding
