Bipolar Disorder Flashcards
Mood disorders history
DSM-4: depression and mania in mood disorders
DMS-5: separated into depressive disorders and bipolar disorders
Bipolar: configurations of depressive and manic/hypomanic episodes
Mood/stress coming
Stressors are best dealt with by either
1. Active coping
•use metabolic resources (fight or flight)
•engage and try to change environment
•salient (active/desiring) motivational components
•positive activating emotional states
2. Passive coping
•conserve metabolic resources (learned helplessness - no point in wasting energy)
•tolerate and withdrawal from environment
•loss of motivational components
•negative depressing emotional states
People with bipolar
•wrong kind of coping
•coping is too extreme
•balance between the two is dysregulated
Bipolar
Dysregulation of mood
•periods of persistent depressed mood, and periods of elevated mood and energy/activity (mania)
•mania and hypomania (not as severe mood elevations) may or may not be distressing
•mania has too many thoughts racing (not very productive - can make you really anxious/make really bad decisions)
Manic episodes
Period with elevated mood and increased energy
•euphoria, happiness, irritability, anger
Other features (3 or more)
1. inflated self esteem/grandiosity
•can be delusional
2. decreased sleep
•feels fine with only a few hours
3. pressure of speech
•always talking/talking too fast
4. flight of ideas/racing thoughts
•tangential relatedness: topics with little connection/racing thoughts
5. distractible
6. goal-oriented activities (psychomotor agitation)
7. high risk activities (spend all money, substance use)
•they normally wouldn’t do these activities because in mania, they don’t understand the risk
One of
- marked impairment in work/social functioning
- need hospitalization to prevent harm from self/others
- psychotic features (hallucinations/delusions)
Persistent for one week or need hospitalization
•most of the day, nearly everyday (not sporadic)
Hypomanic episodes
Same as core features, but not the one of characteristics
•not significant impairment, no hospitalization, no H/D
•is still noticeable to others
•at least 4 consecutive days
Depressive episodes
5+ in 2 weeks (usually 11-13 weeks) nearly everyday that causes significant distress/impairment
- depressed mood*
- anhedonia(inability to experience pleasure)*
- weight/appetite fluctuation
- Insomnia/hypersomnia
- Psychomotor agitation/retardation
- Fatigue
- Feelings of guilt/worthlessness
- Concentration impairment/indecisiveness
- Thoughts of death/suicide ideation
Specifiers
- “with mixed features” (DSM-4: mixed epi)
•both symptoms: mixed episode
•manic or hypomanic episode with depressive features on most days (suicide risk)
•depressive episode with features on most days - “with rapid cycling”
•4+ distinct episodes in 12 months
•predicts poor outcomes (increased suicide) - “with psychotic features”
•mood congruent - psychotic features are consistent with the features they’re experiencing vs mood incongruent - delusion that doesn’t have to do with other manic symptoms - “with anxious distress”
•predicts poor outcomes (GAD-like symptoms)
•loss of anxiety during mania
Bipolar I
- At least 1 lifetime manic episode, often with 1+ depressive episode, but not required
- many also have hypomanic episodes (more than bipolar II)
- Impairment often from poor decisions/risky behaviour during manic episode
- Manic is most debilitating aspect
- High suicide risk (15x general population)
Prevalence
•1 year: 0.6%
•10%/slightly more common in men
•age: 18
•90% of people with single manic episode have more mood episodes (manic or depressive)
•60% of people’s first manic episode will have a depressive episode right after
Comorbitities
•anxiety, substance use, ADHD, impulse control, conduct disorders
•can have psychosis at height of manic episode, but not schizophrenia
Bipolar II
Atleast 1 lifetime hypomanic episode and 1 lifetime depressive episode
•mixed features during hypomania common
•depression is most debilitating aspect
•NOT a less severe disorder than bipolar I
•Lifetime total episodes more than in bipolar I
CHART
Prevalence
•1 year: 0.3-0.8%
•gender difference uncertain (perhaps more likely in women)
•women are more likely to report mixed features
•age: mid 20s
•usually depressive symptoms first (12% initially diagnosed with MDD)
Other features of bipolar
- Remission (normal behaviour) between episodes/when not rapid cycling
- Mood liability can occur between episodes
- Possible seasonal patterns
- NOT borderline (extreme reactions)
Biological factors
Strong genetic component
Bipolar I
•shared genetic factors with schizophrenia, more likely to have relatives with bipolar I and psychotic disorder (less common in II)
Bipolar II
•shared genetic factors with depressive disorders
Neurotransmitters
1. Serotonin low in both depressive and manic episodes (mood regulating)
2. Elevated norepinephrine during manic
3. Dopamine likely plays role (euphoria, hyperactivity, grandiosity)
•evidence: dopamine drugs (coke) can precipitate mania
Brain activity
- HPA-axis involved mostly in depressive
- Thyroid hormones sugessted importance
- Amygdala, thalamus, and basal ganglia (motor activities) implicate hyperactivity
- Hyperactivity in ventral prefrontal cortex •ex: thinking you’re going to be the best psychologist - put downpayment on office
- Possible that hyper responsiveness in positive emotion/reward circuits
Psychological factors
Very similar to depression
•Circadian rhythms/other biological rhythms
•changes in daily and seasonal cycles (sleeping)
•stressful life events trigger depression
•Achievement striving/reward sensitivity in mania
•Pessimism during depressive (sometimes mania)
Treatment
Goal: downplay both depressive and mania
Medications
•SSRIS can cause mania
•Mood stabilizers: lithium (oldest/most common), anticonvulsants (valproate, carbamezenepine)
*toxic/high OD potential (especially lithium)
•Antipsychotics: for psychosis/severe mania
Bipolar I: uses mood stabilizers and antipsychotics because mania is more of a threat
Bipolar II: uses mood stabilizers and antidepressants because depressive symptoms are more of a threat
Therapies
Depression symptoms: CBT, BA, IPT
Manic and depressive symptoms: ECT
