Bipolar Disorder Flashcards
Definitions
Distinct episodes of depression & mania
Bipolar I; mania
Bipolar II; hypomania
Rare reports of just mania
Manic episodes can last from few days to several months
Hypomania
Noticeable different from own stable mood
Not considered abnormal or debilitating
Mania
Out of control happy, even during serious event e.g. funeral
Abnormal behaviour
To separate from hypomania, has to be; psychotic symptoms, significant impairment of daily life, manic person often in reciept of treatment due to symptom severity
Bipolar I
Presence or history of at least one manic episode; six subtypes
Manic episode may have been preceded by & May be followed by hypomania or major depressive episodes
Bipolar II
Involves it or more depressives episodes with at least one hypomanic
No manic episode
Criteria for manic episode
Unusual & continual elevated, unreserved or irritable mood
Unusual & continual increase in energy lasting at least a week (hypomania is 4 days)
Presence of at least 3; inflated sense of self esteem or grandiosity, less need for sleep, increased talkativeness, racing thoughts, easily distractable, increase in goal-directed activity or unitentional & purposeless motions, unnecessary participation in activities with high potential for painful consequences
DSM-5 changes
Criterion A for manic & hypomanic episodes now includes an emphasis on changes in activity & energy as well as mood
Requirement that individual simultaneously meets full criteria for both mania & major depressive episodes removed
Bipolar & related disorder diagnosis of don’t meet full criteria for bipolar II
Cyclothymic disorder; mild form of bipolar, sub threshold MDD & hypomania over 2 yrs
Under-diagnosis of BPD
Many individuals with MDD May have hidden bipolarity (up to 40%)
Non-response to antidepressant drugs in clinical trials has been correlated with undetected BPD
Adolescents may be over diagnosed due to commonly exhibiting a hyperthymic temperament
Prevelance
0.4-1.6% lifetime prevelance rate
Cost to the UK estimated to be £2 billion at 1999/2000 prices; 10% of cost NHS resource use, 4% non healthcare resource use, 86% indirect costs
Equal male:female ratio
Develops late teens-early 20’s, 50% diagnosed experience symptoms before age of 25
High SES
Increased in high-income countries
Increasing rates?
Youth diagnosis has increased in last few years; 6% in outpatient clinics, misdiagnosis
Nose fall into ‘bipolar disorder not otherwise specified’
Dangers of over-diagnosing youth
Prognosis
Lifetime disorder
Episodic; rapid cycling affects more women than men
High suicide risk; 1/3 attempt, 15x higher risk than gen pop
Courses of bipolar disorders
1) depression following mania
2) manic & depressive episodes independent
3) manic, hypomanic & depressive episodes
4) depressive episodes precede mania
5) rapid cycling (at least 4 mood episodes a year)
Mood disorders & creativity
Creativity associated with psychological disturbance & even madness
Link between mood disorders & artistic achievement & creativity
Andreasen (70’s); 30 authors, 80% had mood disorder, 2 suicides in 15 yr follow up
Jamison (1989); 47 authors & artists, 38% treated for mood disorder, artistic & scientific professionals, 38% treated for mood disorder
Kyaga et al (2013); supports higher prevelance rates in artistic & scientific professionals
What comes first? (Creativity or mood disorder?)
Creative individuals shown to have greater family history of psychological disturbances
Artistic communities value emotional expression & so would welcome those with psychological disturbances
Triggers for depressive episodes
Negative life events
Losses, failures
Seasonality
Triggers for manic episodes
Positive life event Increased responsiveness to reward Negative life event Medication; reactions to antidepressant Sleep/circadian rythym disruption Seasonality
Biogenetic factors
Genetic
Neurochemical
Neuropathology
Neuroendicrine
Psychological factors
Goal attainment
Cognitive bias
Insight
Substance abuse as a trigger & issues of sensitisation
Genetic & epigenetic mechanisms of illness progression
1) inherited vulnerability
2) stress sensitisation, episode sensitisation or cross sensitisation (SS leading to ES & vice versa)
3) cocaine sensitisation
Model re-loops
Different pathways, could be IV, ES, CS & SS
Main triggers for manic episode
Goal attainment; associated with dysregulation in the behavioural activation system which regulates sensitivity to rewards, physiological arousal, increased sociability, incentive-reward motivation
Sleep & circadian rhythms; sleep duration predicts hypomanic symptoms
Disruption to normal rhythms can lead to hypomania
Genetic factors
10-25% of 1st degree relatives of sufferers have reported symptoms of mood disorder
7% of first-degree relatives have bipolar disorder
Greater genetic component than major depression
MZ twins; 69.6%
DZ twins; 29.3%
Overlap in individual genetic variants implicated
Neuropathology
Brain regions involved in bipolar disorder; increased activation of amygdala, reduced activity of prefrontal cortex
Overlap between MDD & scz
Neurochemistry
Increased levels of norepinephrine during mania
Low levels during depression
Most effective treatment is lithium carbonate taken continually
Stabilises sodium & potassium ions in neuronal membranes, stabilising synaptic processes, affects gene expression
Psychological therapies
Monitor moods/prodromes
Improving coping/management of symptoms (cognitive/behavioural strategies)
Family focused therapy & marital intervention
Life goals
Sleep management
Insight development
Role of psychology in treatment
Mania as a protective response to the psychological state of depression
Mania as a defence mechanisms against depression in classical psychoanalysis
Targets of CBT interventions for bipolar disorder
Depression or mania Changes in thinking & feeling Changes in behaviour Impaired psychosocial functioning Psychosocial problems Emotional distress, sleep loss & other symptoms
Psycho-education
Psycho-education
Circadian rhythm; role of routine & minimising disruption
Recognition & anticipation of stressors
Recognition of prodromes
Boo-psychosocial treatment
Misattribution of sensations to weakness/powerfulness
Impact on support/family & stigma
CBT
Collaborative discovery of links between social/environment & affect, behaviour & cognition
Coping; behavioural inhibition during manic prodrome & activation during depressive prodrome, interpersonal & environmental stressors
Moderation of unhelpful beliefs
Misattribution of sensations to weakness/powerfulness
