Bipolar and Related Disorders Flashcards
What are the different types of Bipolar and Related Disorders?
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder (milder form)
Substance/Medication-induced Bipolar and Related Disorder
What are the characteristics of Bipolar disorder?
- Excessive elation or some combination of periods of elation interspersed with periods of depression and lethargy
- Affect functional ability in global fashion
- Usually fluctuate between mania and depression
- Conceptualized on a spectrum, between psychotic disorders and depressive disorders
How many episodes of mania need to occur for a diagnosis of Bipolar disorder?
an individual who has a single manic episode may be diagnosed with bipolar I disorder
What are the differential diagnosis for Bipolar Disorder?
Other psychotic disorders
Mood disorders
Substance-related disorders
What are the comorbidities for Bipolar disorder?
Substance-related disorders
What is the diagnostic criteria for Bipolar I Disorder?
At least one manic episode
Consistent elevated or irritable mood with abnormal increased goal-directed activity or energy most of the time for at least a week.
At least three of:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Excessive talkativeness or pressure to speak
- Distractibility
- Increased goal-directed activity or psychomotor agitation
Excessive involvement in activities with possible bad consequences
Impaired work function or to require hospitalization to prevent harm
May include one or more major depressive episodes, before or after manic episode, or both
Depressed mood almost every day. 5 of these symptoms:
- Anhedonia—lack of pleasure or interest in daily activities (must)
- Weight loss without dieting or decrease in appetite
- Insomnia or hypersomnia almost every day
- Fatigue or low energy
- Feelings of worthlessness or guilt
- Difficulty concentrating
- Recurrent thoughts of death, suicidal ideation or attempt
- Distress and functional impairment
What are the symptoms of Hypomanic Episode?
Shorter duration than manic episode (four days rather than 1 week)
Symptoms of manic episode but less severe
Less problematic functional consequences
What are the symptoms of Manic/Hypomanic Episodes?
- Usually with abrupt onset
- Major changes in attitude, behavior, and cognition
- Decreased need for sleep
- Talkativeness
- Distractibility
- Increased activity
- Excessive involvement in pleasurable activities with disregard for the consequences
Do Bipolar 1 symptoms include hypomanic and/or depressive episodes?
May include hypomanic and/or depressive episodes, but not required
What is the diagnostic criteria for Bipolar II Disorder?
At least one hypomanic episode
Abnormally elevated or irritable mood with increased activity or energy for at least four consecutive days
Three or more of:
- Grandiosity or inflated self-esteem
- Decreased need for sleep
- Talkativeness and/or pressured speech
- Flight of ideas
- Distractibility
- Increase in goal-directed activity
- Excessive involvement in activities with a high probability of bad outcome
The episode is not severe enough to cause substantial functional impairment or a need for hospitalization (this is a distinguishing characteristic as opposed to the criteria for a manic episode)
At least one major depressive episode and no manic episode
What is the etiology for Bipolar Disorders?
Typical onset in adolescence or young adulthood
Two major patterns of onset:
- early and repeated depression
- initial manic symptoms (Forty, 2009).
Genetic component
Environmental, social, personal factors
Situational stressors
What is the prognosis for Bipolar Disorders?
Individual episodes resolve relatively quickly (days to a month or more)
But disorder tends to be chronic with exacerbations and remissions
Early onset suggests more severe course
13% encounter legal difficulties
What are the implications for function for Bipolar Disorders?
Work, social, leisure habits, roles, and routines deteriorate during episodes
Motor hyperactivity-lots of energy
Cognitive and perceptual processing deficits
Executive function particularly impaired; Judgment, decision making
Lack insight: Don’t know what happened during episode
Function tends to improve between episodes
Less severe for hypomanic episodes
What treatments are used for Bipolar Disorders?
Psychotropic medications, particularly lithium: Must be maintained over time, leading to difficulty with adherence due to potential side effect
Family therapy
Educational approaches
Cognitive behavioral interventions
Interventions work best in combination with medication
Hospitalization may be required
Rapid intervention to avoid problematic consequences of behaviors
What are the symptoms of Cyclothymic Disorder?
- At least 2 year period with multiple periods of hypomanic symptoms that don’t meet the criteria for a hypomanic episode and depressive symptoms that don’t meet the criteria for a major depressive episode
- These symptomatic periods are present at least half the time with no period of more than 2 months at a time completely symptom free
- The individual’s symptoms have never met the criteria for a manic, hypomanic, or major depressive episode
Which is the least severe of bipolar disorders?
Cyclothymic Disorder
What is the etiology of Cyclothymic Disorder?
similar to bipolar disorders
Is Cyclothymic Disorder chronic?
yes
How do manic and depressive episodes differ in cyclothymic disorder as compared to other bipolar disorders?
Both manic and depressive episodes cause fewer functional deficits
But mood tends to be consistently either excessively high or depressed
What can Cyclothymic Disorder lead to?
At high risk of developing bipolar I or bipolar II disorder
What are the implications for OT for Bipolar & Cyclothymic Disorders?
- Monitoring behavior changes as medication is implemented
- Providing a structured environment and routines
- Coping strategies with chronic illness
- Help the individual identify strengths, weaknesses, likes, and dislikes through exposure to a wide range of activities
- Assisted in setting meaningful goals
- Time management strategies
- Self-appraisal/self-esteem
- Manage behavioral difficulties by altering lifestyle, monitoring symptoms
- Family education and support
What are the cultural considerations for Bipolar and Related Disorders?
Timing of diagnosis following the onset of symptoms, especially delay before diagnosis
The consequences in terms of access to and outcomes of care
Extent to which manic behavior is tolerated varies
Acceptability of use of medication
Extent of associated stigma
What is the prognosis for early development of Bipolar and Related Disorders?
predicts more severe and chronic course and greater probability that psychopharmacological intervention will be less effective
What is diagnosis in children is complicated by?
potential for overlap with ADHD and other conditions
What kind of behavior or characteristics are commonly seen in children with Bipolar and Related Disorders?
anxiety
school refusal or school problems
negative behavior
irritability
aggressiveness and anger
low self-esteem
For adults, what often accompanies Bipolar and Related Disorders?
dementia
Why may adults with Bipolar and Related Disorders have increasing difficulties?
More severe functional deficits
Changes in physiology make medication management more difficult in older adults
