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Mental Health and Wellbeing > bipolar disorder > Flashcards

bipolar disorder Flashcards

1
Q

what are the symptoms of mania

A

At least one week of persistently euphoric, expansive or irritable mood P
lus at least three or more of:
• Inflated self esteem / grandiosity
• Decreased need for sleep
• More talkative than usual, pressure of speech
• Flight of ideas, thoughts racing
• Distractibility
• Increased goal-directed activity
• Excessive involvement in pleasurable activities that may have high potential for painful consequences

Must lead to marked impairment or psychosis

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2
Q

how long is hypomania for

A

(Hypomania >4 days; no impairment)

more than 4 days

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3
Q

what does mania require to be a clinical problem

A

‘Mania’ requires:
– Euphoric or irritable mood plus 3 of the others
– One week or more of symptoms
– Marked impairment, hospitalisation or psychosis

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4
Q

what does hypomania require to be a clinical problem

A

– Euphoric or irritable mood plus 3 of the others
– 4 or more days of symptoms
– No necessary impairment but not ‘normal self’

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5
Q

what is unipolar depression

A

at least one episode of depression in their lifetime

neve had hypomania or mania

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6
Q

bipolar 1

A

at least one episode of mania and one episode of depression

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7
Q

bipolar 2

A

at least one episode of depression and one of hypomania

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8
Q

bipolar 1 - unipolar mania

A

at least one episode of mania

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9
Q

what are the associated symptoms of mania

A
  • Symptoms during mania also include dysphoria, anxiety, panic and aggression (e.g Cassidy et al., 1998)
    • Symptoms of depression typical even during remission (Judd et al., 2002)
    • High levels (>50%) of comorbid disorders: anxiety, personality, substance abuse
    • Studies show 2x UP rate of certain anxiety disorders (OCD – Chen & Dilsaver, 1995; panic & GAD – Simon et
    al., 2003)
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10
Q

what are the biological factors of mania

A

Heritability high – (Kieseppa et al., 2004)
more likely to have it if have first degree relative who has it

• Separate heritability of mania & depression (McGuffin et al., 2003)

• Genes for mania may involve reward pathways, i.e. dopamine function
highs - reward pathwasy
lows- neuroticism

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11
Q

‘resistance’ to bipolar disorder

A

High levels of functioning
– Lower levels of catastrophising about changes in internal states
– Reported ‘awareness’ of behaviour and social impact when feeling high

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12
Q

what are the predictors of relapse

A
  • Stressful interpersonal life events (Hammen et al., 1992) M&D
  • High ‘Expressed Emotion’ (hostility, overprotectiveness, criticism) in family members (Miklowitz et al., 1988) M&D
  • Disrupted social rhythm events (Malkoff-Schwartz et al., 1998) – Mania not D - going outside normal sleep wake patterns
  • Goal-attainment Events (Johnson et al., 2000) – Manic symptoms not D - achievingthings
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13
Q

important issues predicting relapse in bipolar

A
  • Poor compliance with medication – normative; often ineffective; side effects
  • Poor acceptance of ‘illness’ - normative
  • Poor recognition; delays in diagnosis
  • Ambivalent views of hypomanic symptoms
  • Stigmatisation
  • Stress on family members
  • Interpersonal processes during therapy - therapists have to be malleable to change in mood
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14
Q

what is the treatment for BP - medication

A

• Medication
– Typically mood stabilisers (e.g. lithium) but also anti- depressants, ant-psychotics and anxiolytics
– large majority of treated people with BP
– high relapse rates despite adequate medication (Solomon et al., 1995) – c.60% in 2 years

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15
Q

what is the psychological treatment for BP

A

Psychological Treatments (usually in addition to med):

– Relapse prevention or psychoeducation – effective (Colom et al., 2003; Perry et al., 1999)

– Family Focused Therapy (Miklowitz et al., 1988)

– Cognitive Behavioural Therapy (Lam et al., 2003)

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16
Q

what is psychoeducation/ relapse prevention

A

Provide information about bipolar disorder and how people with BP learn to cope better

• Identify warning signs – also called ‘prodromes’ or ‘relapse signature’
– Changes in thoughts, feelings, behaviours
– Quantified and grounded in personal experience
– Judge early, middle and late strategies

• Work collaboratively to identify effective coping strategies, e.g. relax, postpone behaviour, get feedback from family members

17
Q

does relapse prevention work

A

Perry et al. (1999)
– Intervention: 7-12 sessions of individual relapse prevention vs. treatment as usual – Results: over 18 months, longer time to relapse with mania but no effects on time to relapse with depression

• Colom et al. (2003)
– Intervention: 21 sessions of group psychoeducation versus treatment as usual – Results: Reduced rates of relapse of mania and depression over 2 years

18
Q

what is FFT

A

Family Focused Therapy
• Work with families or groups of families
• Provide psychoeducation to improve their understanding of BP – non-blaming
• Identify hostility, criticism and overprotectiveness & help build up more collaborative, positive communication

19
Q

efficacy of FFT

A

Miklowitz et al., 2003
– 21 sessions of family-focused psychoeducation and behavioural intervention vs crisis management
– Reduced relapse rates and mood symptoms over 2 years

• Rea et al. 2003
– Compared FFT to individual psychoeducation
– lower rates of rehospitalisation

20
Q

what happens in CBT

A
  • Develop problem list with client
  • During depression, identify ‘negative automatic thoughts’ & challenge; activity scheduling
  • During hypomania, identify coping strategies
  • During remission, engage in relapse prevention

• May develop a personalised formulation of client’s ‘schemas’ – problematic personal rules &
test with behavioural experiments
• E.g. ‘I must be a complete success or my life is worthless’ – experiment with ‘less than perfect’
work

21
Q

efficacy of CBT

A

• Lam et al., 2003, 2005
– Groups: c.20 sessions Individual CBT vs treatment as usual
– Results: reduced symptoms of depression, longer time to relapse over 2 years, improved functioning

• STEP trial – Systematic Treatment Enhancement Programme (Miklowitz et al., 2007)
– 15 sites across USA
– Equal efficacy of 30 sessions of FFT, interpersonal therapy and CBT vs. minimal care – Intensive psychological therapies are all effective in community settings

• But effect sizes are modest, and focus is on prevention of relapse rather than current symptoms and recovery

22
Q

what are mood swings according to the integrative cognitive model

A

Mood swings are a consequence of multiple, conflicted, extreme, personal appraisals of changes in internal state

23
Q

what are examples of mood swings

A

– feelings of high energy = imminent success
– vs. feelings of high energy = mental breakdown
– Feelings of low energy = safe, relaxing
– vs. Feelings of low energy = failure, boring

24
Q

what do mood swings lead to

A

leads to internal struggle trying to exert extreme control over internal states rather than active successful ways of pursuing goals

25
Q

what is the integrative cognitive model of bipolar disorder

A 
triggering event
change in internal state
appriased as having extreme personal meaning
beliefs about self world and others
life experiences
ascent behaviours
descent behaviours
26
Q

probability of bipolar as a function of positive and negative appraisals

A

high negative and positive appraisals

27
Q

what does TEAMS stand for

A 
think
effectively
about 
mood
swings
28
Q

what does TEAMS involve

A

– Focused on present problems, e.g. depression,anxiety, irritability, high mood
– Working through the principle of safety – engagement
– experience – formulation – change
– Identify core personal goals and values
– Explore and monitor internal states on a continuum and identify their various appraisals
– Facilitate reappraisals and broaden ‘bandwidth’ in internal states that are tolerated and acceptable
– Form a flexible ‘healthy self’ that achieves goals that are less dependent on internal states

29
Q

what happens in goal identification

A

Goal Identification
• Expressing needs is a major factor in recovery
• Questions to elicit goals e.g. “How would you like things to be?”
• Identifying long-term goals
• e.g. “What makes this particularly important for you?”
• Making things concrete
• e.g. “What would this look like?”

30
Q

what happens in exploring internal states

A

Exploring Internal States
• Feelings are a normal and important part of life
• Put yourself in their shoes e.g. “What does that feel like right now?”
• Explore metaphors
• e.g. “When you say a ‘buzzy’ feeling, what makes it like this?”
• Ground in body and mind
• e.g. “What does it feel like in your head when you are buzzy?”
• e.g. “What’s do you notice in your body?”

31
Q

what happens when plotting a continuum

A
  • Thinking in ‘shades of grey’ is more effective that black & white
  • Identify extremes
  • e.g. “What does depression involve for you at its worst?”
  • e.g. “Could you describe to me your most extreme highs?”
  • Describe ‘middle’ states
  • e.g. “What kind of states do you have in the middle range?”
  • Explore duration and control
32
Q

what happens in pros and cons

A

Pros and Cons
• All moods have both advantages and drawbacks
• Recognise both sides
e.g. “Can we talk about what you think of this state of mind?”
• Explore the negatives
• e.g. “What are the diffculties about being in this state?”
• Explore the positives
• e.g. “Are there any good things about being in this state?”
• Reflect
• e.g. “What do you make of the pros and cons we listed?”
• e.g. “Any more we might have missed?”

33
Q

what is the metaphor for bipolar

A

icarus

34
Q

what is the pyramid of therapy principles

A 
safety
engagement
experiential processing
awareness of formulation
change and recovery
35
Q

was there an effect of TEAMS

A

no effect of TEAM vs TAU in any measures
despite bulding model and being a strong predictor of mood swings when employed clincially - couldnt detect a large enough effect of therapy on symptoms

36
Q

summary of BD

A

Bipolar disorder can have a huge impact on functioning
• Symptoms of BP are on a continuum with ‘normal’ experiences
• Several psychological treatments are effective
• Emerging evidence to support the Integrative Cognitive Model and TEAMS therapy

Mental Health and Wellbeing (11 decks)

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