Bipolar Disorders

Question 1

key features of bipolar

Answer 1

cycles of 1+ episodes of elevated/irritable mood alternating w/ 1+ major depressive episodes
- extremes can change quickly
- manic mood can be negative (irritability/hostility, sexual disinhibition) or positive (elation)
- child/adol. tend to be more negative, in late adol/adults it becomes more positive

Question 2

other features of bipolar (not key ones)

Answer 2

goal directed activity, sleeplessness, pressured speech (talking too fast), racing thoughts, distractibility, feelings of grandiosity (can lead to harm/death), flight of ideas (answering question w/ answer that makes no sense)

Question 3

bipolar |

Answer 3

1+ manic episode, may/may not have 1+ major dep. episodes
- manic episodes: elevated/irritable mood, increased goal-directed activity for at least 1 week, plus 3+ symptoms (ex: inflated self-esteem, little sleep)
- specify severity, presence of psychotic symptoms

Question 4

bipolar ||

Answer 4

1+ major dep. episodes, and 1+ hypomanic episodes
- hypomanic episodes: parallel symptoms to mania, but less severe and shorter duration, may be ~4 days

Question 5

cyclothymic disorder

Answer 5

subthreshold (not quite meeting diagnostic criteria) manic symptoms and subthreshold depressive symptoms at least 1/2 of the time for at least 1 year
- causes sig. functioning impairments, increased rates of comorbidity and suicidal behs
- impact doesn’t differ much from bipolar |

Question 6

another specified
bipolar disorder (textbook)

Answer 6

individuals who display symptoms of BP but don’t meet criteria for any type of BP disorder

Question 7

prevalence, sex & age differences

Answer 7

• bipolar || and cyclo more common in adols. than BP |, manic symptoms don’t last 2 weeks
• sex: similar rates, more boys may have prepuberty onset, and more girls may have puberty onset
• age: rare in children (youngest typically is around puberty), mean onset=18yrs (BP|) and 20yrs (BP||)
• early onset: depression usually occurs first
• later onset: mania usually occurs first

Question 8

comorbidity

Answer 8

• anxiety, ADHD, ODD/CD, and substance use disorders are common
• psychotic symptoms and suicidal ideation/attempts are not unusual
• highest rate of suicide for any psychiatric diagnosis*

Question 9

etiology: biology

Answer 9

• one of the most heritable forms of mental disorder (.80+)
• family/gene studies: high bio vulnerability AND environmental factors impt. - increases risk for earlier age of onset
• brain structures/functions: structural diffs (amygdala, prefrontal, hippo.), dysreg. of neurotransmitter systems (GABA, dopamine, serotonin) evident
• structural differences often occur AFTER onset of BP, not before

Question 10

etiology: environmental

Answer 10

not well understood because there is a strong focus on biology
- chronic stressors (in family context, ex: negative family climate), negative life events, inc. sensitivity to rewards and failure

Question 11

interventions used

Answer 11

primary goal: stabilize mood, manage symptoms, prevent relapse

multimodal approach: mood-stabilizing meds, education for youth/family, therapy (CBT, family)
- Lithium is med of choice, FDA approved down to age 7, but can have serious effects (kidney functions long-term, reduces compliance=relapse, requires a lot of monitoring)

Question 12

outcomes of BP

Answer 12

difficult to identify = 5-10yr lag b/t symptoms onset and problem identification
- recovery from BP episode can be quick, but the disorder is chronic + resistant to treatment
- symptoms often persist b/t episodes

Question 13

progressive sequence of development of BP

Answer 13

sleep disorder in childhood –> mood disorder in adolescence –> manic/hypomanic episode as a young adult
- presence of psychotic symptoms is linked to transition of going from depression to mood disorder

–> means increased risk