Bipolar Disorder

Question 1

DSM Criteria: Bipolar II Disorder

Answer 1

• Criteria have been met for at least one hypomanic episode (ie. Delusions of grandeur, paranoia) and at least one major depressive episode
• There has never been a manic episode (or a Mixed Episode)

Question 2

DSM Criteria: Bipolar I Disorder

Answer 2

Basically the same as Bipolar II (one hypomanic and one major depressive episode), but includes those episodes (ie. Manic or mixed) not allowed in a diagnosis of Bipolar II]

Question 3

DSM Criteria: Manic Episode

Answer 3

• Distinct period of abnormally elevated mood and goal-directed activity/energy, lasting at least a week
• 3+ of the following: Inflated self-esteem, decreased need for sleep, more talkative, racing thoughts, distractibility, goal-directedness, etc.

Question 4

Who gets bipolar disorder?

Answer 4

• Heritability estimate is extremely high -> variance explained mainly by genetics
• • No one gene for bipolar disorder
• Strong tendency to run in families
• Equal rates for males and females

Question 5

Bipolar disorders - major risks

Answer 5

• High rate of recurrence – usually conceptualized as a lifelong condition
• High risk for suicide attempts (25%-60% will attempt at least once in their life) and completed suicide (4-19%)

Question 6

Bipolar disorders - comorbidity

Answer 6

• Each case of bipolar disorder almost always has some comorbid illness
• Some of the most common comorbid health issues include:
• • Anxiety disorders
• • Substance use
• • Migraine
• • Cardiovascular disease

Question 7

Bipolar disorders - structural brain changes

Answer 7

• Consistent reports of overall reductions in gray matter
• Reports of several structures being smaller in patients with bipolar disorders:
• • Medial prefrontal cortex and other prefrontal regions
• • Left anterior cingulate cortex
• • Left superior temporal gyrus
• • Hippocampus
• Structural changes don’t necessarily line up with functional changes

Question 8

Pharmacological treatments for bipolar disorder

Answer 8

• It is possible to treat the individual phases of bipolar disorder:
• • Antidepressants for the depression
• • Antipsychotics (and others) for the mania or hypomania
• There are also drug interventions aimed at stabilizing mood

Question 9

3 types of mood stabilizers

Answer 9

• Lithium: Began being prescribed in the late 40s, later shown to have antimanic and antidepressant effects -> prevents cycling
• Anticonvulsants: Certain anticonvulsant drugs are considered to be effective mood stabilizers, but not as effective as Lithium (ex. Valproate semisodium, lamotrigine)
• Atypical antipsychotics: Certain atypical antipsychotics are considered to be effective mood stabilizers (ex. Quetiapine, olanzapine + SSRI, aripiprazole)

Question 10

Goals of bipolar psychosocial interventions

Answer 10

• Improving ability to identify and intervene early
• Increase acceptance of illness
• Enhance coping ability
• Stabilize sleep
• Re-engage with social, familial, and occupational roles
• Enhance family relationships and communication
• Note that these don’t directly cure bipolar disorder, they’re moreso compensatory strategies

Question 11

Disclosure of bipolar disorder - process

Answer 11

Social avoidance -> secrecy -> selective disclosure (certain people only) -> indiscriminant disclosure (not actively concealing it) -> broadcast experience (actively sharing it)

Question 12

bipolar disorder - reducing social stigma

Answer 12

• Effective interventions:
• • Educational interventions (e.g., communicating positive stories of people with mental illness)
• • Interventions that incorporate consumer contact
• • Generally just as good online as face-to-face
• Ineffective interventions:
• • Simulation of mental illness (e.g., simulation of hallucinations).
• • Educational interventions that focus on ‘medicalizing’ mental illness