Bipolar Disorders Flashcards
Most poorly understood neuropsychiatric disorders and most disabling
Bipolar disorder
Subthreshold bipolar
Having 2 or more core features of hypomania but not meeting proper criteria
Risk factors if bipolar
1st degree relative with BPD (7-10x)
Season of birth
Stressful life event
Traumatic brain injury
MS
BPD characterized by
Mood episodes (changes in mood with associated symptoms)
Building block of disease
Key feature for a diagnosis of BPD
At least one episode meeting criteria for manic, hypomanic, or mixed
Types of mood episodes (4)
Manic
Hypomanic
Mixed
Depressed
DSM-5 criteria A
MANIC EPISODE
Distinct period of abnormally/persistently elevated, expansive or irritable mood AND abnormally persistently increased goal directed active OR energy for 1 week (have so much energy)
Abnormally happy
Criteria B
Manic episode
If they have criteria A
If euphoric/expansive = 3
Irritable = 4
Grandiosity/inflated self esteem Diminished need for sleep More talkative Flight of ideas Distracting little Increased goal directed activity Excessive pleasurable activity
Diagnostic criteria
Hypomanic Criteria A
Distinct period of abnormally and persistently elevated, expansive, irritable mood AND abnormally and persistently increased energy or activity for 4+ days
SAME as manic but not as severe (criteria B is also same)
Criteria E
Hypomanic
Not severe enough to cause marked impairment or necessitate hospitalization (psychosis episode is by definition manic)
Notable difference with hypomania
Changes must be observable by others
Symptoms represent change from baseline
Symptoms do not cause impairment (labeled manic)
At least one prior episode of mania
BPD I
No manic, has hypomania. More than one episode of MDD
BPD II
No mania, mixed, no hypomania
MDD
No mania, mixed, can have elevation, can have depression symptoms
Cyclothymic
Some symptoms of everything but don’t meet criteria for any one disease
Specifies of bipolar
Anxious distress Mixed features Mood congruent Catatonic Peri partum Seasonal pattern Severity
Mixed features
Can be applied to episodes of mania, hypomania, depression
Mania or hypomania with symptoms of depression
Depressive episode with mixed features
Mixed features correlates with suicidality, anxiety, and early onset
BPD I and BPD II are at very ___ rates of suicide
High
50% have suicidal ideation and 20% attempt suicide
Cognitive deficits
Can be present during episodes and outside of episodes
Include impaired attention and executive functioning
Features of longitudinal course
Age of onset: teens to 20s
Most of time in depressive episode
BPD I patients experience mixed episode in illness
Rapid cycling = worse prognosis
SSRI switching is not actually common
Rapid cycling
> 4 episodes/year
Neurobiology of BPD
White matter connectivity abnormalities
Increased volume in striatum and amygdala
Decrease PFC activation (ventral and medial lateral)
Increased amygdala activation
Genetics of BPD
Highly heritable
L-type VG-Va channel (lithium)
80% of risk = inherited
Presence of psychosis without mood symptoms is differentiating factor
Schizophrenia/schizoaffective
Treatment
Education
Medication
Therapy
Other
Must determine mood state
Acute and maintainence treating
Regular sleep schedule
SSRIs
Can be good for use with an initial episode if used in combination with lithium
Avoid __ drugs
Tricyclics antidepressants and venlafexine
