Bipolar Disorder Flashcards
True or false: For something to be considered a manic episode, the individual needs to be distressed
False. Distress is not a factor for mania. People normally have poor insight and feel very little pain
what is psychosis
loss of contact with reality
mood congruent psychosis in manic vs depressive episode
in manic ep: typically be grandiose theme (you think you’re a prince, a billionaire, jesus)
in depressive ep: psychotic episodes consistent with the sadness, confessing to crimes they didn’t commit, themes of disease, delusion that everything including the self doesn’t exist, is destroyed
mood incongruent in manic vs depressive episode
in manic ep: not congruent with the state. Though insertion (people are inserting thoughts in your head), mind control (you are being controlled by someone else)
in depressive ep: unusual, happy states.
What is the difference in diagnosis between psychosis occurring during a mood episode and psychosis occurring outside of a mood episode?
If psychotic symptoms occur only during a manic or depressive episode, it’s diagnosed as a mood disorder with psychosis.
If psychotic symptoms occur outside of mood episodes, the diagnosis is schizoaffective disorder or schizophrenia.
Used to think more diagnostics in people with higher SES, but probably diagnostic bias. Can you explain?
People with low SES were more likely to be diagnosed with schizophrenia than bipolar
How long does it typically take for someone with bipolar disorder to receive an accurate diagnosis and appropriate treatment, and what is the common misclassification they experience initially?
It takes an average of 6 to 10 years for someone with bipolar disorder to receive an accurate diagnosis and appropriate treatment. Initially, about 60% of individuals with bipolar disorder are misclassified as having Major Depressive Disorder (MDD).
In bipolar disorder, for whom treatment will be less effective
mixed states, rapid cyclers
True or false: risk of death by suicide are 15x more high than the general population
True
What’s an particular class of stressors important in mania?
Goal-attainment events: You had something you were working for a long time and it ends up happening.
When people achieve a goal, become very happy, drink, stay out later, get affectively disregulated, less they sleep, take more stimulants, can spiral into mania.
What is the kindling theory in relation to bipolar disorder, and how does it explain the progression of episodes?
The kindling theory, developed by Robert Post, suggests that the first episode of bipolar disorder requires a significant amount of stress. Subsequent episodes require less stress to trigger them. Eventually, individuals may experience episodes without the need for external stressors, as the episodes occur spontaneously on their own.
How does sleep disruption relate to the onset of manic symptoms in bipolar disorder?
Sleep deprivation is a powerful predictor of mania in bipolar disorder. Less sleep on one day (day N) can predict an increase in manic symptoms the following day (day N+1).
What role does the striatum play in bipolar disorder, and what are the key findings related to its size in individuals with bipolar disorder?
The striatum, particularly the ventral striatum and nucleus accumbens, is involved in facilitating voluntary movement and reward processing, including reward and reinforcement. In individuals with bipolar disorder, the striatum is enlarged in both men and women. This enlargement is observed in both first-episode and multiple-episode bipolar disorder
What are the key phases during which abnormally elevated activity occurs in the ventral striatum (VS) in individuals with bipolar disorder?
Abnormally elevated activity occurs in the ventral striatum during:
- Reward anticipation (expecting a reward)
- Reward consumption (receiving the reward)
- Reward-predictive cues (signals that predict a reward)
How do the prefrontal regions of the brain contribute to reward processing in bipolar disorder, and what happens when these regions fail to regulate the ventral striatum (VS)?
The prefrontal regions are responsible for regulating emotional responses and controlling impulses. In bipolar disorder, these regions fail to effectively down-regulate the elevated activity in the ventral striatum (VS). This results in the brain’s reward system becoming overactive, leading to exaggerated responses to rewards and cues, which may contribute to manic episodes.
How does reward processing differ between Bipolar I (BP-I) and Bipolar II (BP-II) regarding ventral striatum activation?
In Bipolar I (BP-I), reward consumption (receiving the reward) is more prominently activated. In Bipolar II (BP-II), abnormalities are more noticeable in reward anticipation (expectation of rewards).
What mechanisms does lithium use to affect the brain?
Lithium works by deactivating an enzyme that interferes with the circadian clock, acting as a glutamate antagonist, and potentially interrupting dopamine signaling in the brain.
What are some common side effects of lithium, and why is it considered to have a narrow therapeutic window?
Common side effects of lithium include thyroid and kidney problems, dehydration, weight gain, acne, thinning of hair, and hand tremors. It has a narrow therapeutic window, meaning the difference between an effective dose and a toxic dose is small, requiring careful monitoring.
