bipolar disorders Flashcards
placement of bipolar disorders category in DSM-5 & reasoning
bipolar disorders section placed between psychotic & depressive disorders due to shared similarities w/ symptoms, family history, & genetics
bipolar disorder subtypes
bipolar I, bipolar II, cyclothymic disorder, substance/medication induced bipolar & related disorder, bipolar & related disorder due to another medical condition, other specified bipolar & related disorder, unspecified bipolar & related disorder
bipolar I disorder diagnostic criteria
(1) At least 1 lifetime manic episode EITHER lasting 1 week or longer OR severe enough to require hospitalisation, w/ symptoms of: irritability, euphoria, decreased need for sleep, grandiose ideas, increased activity, impulsive behaviour, flight of ideas, racing thoughts, talkativeness
Mania alone is significant for diagnosis but may not present alone:
(a) may be experienced as a mixed episode (alongside depression)
(b) may be preceded or followed by
(b. i) a hypomanic episode (distinct episode of less severe mania lasting at least 4 days w/o causing severe impairment) OR
(b. ii) a major depressive episode
hypomanic episode
distinct episode of less severe mania lasting at least 4 days, without causing severe impairment
bipolar II disorder diagnostic criteria
(1) at least 1 lifetime hypomanic episode WITH
(2) at least 1 major depressive episode, including 2 or more weeks of: intense sadness, loss of interest, fatigue, insomnia, psychomotor agitation/retardation, weight change, cognitive dysfunction, feelings of worthlessness, suicidal ideation/attempts
approximate conversion rate from BD-II to BD-I
~11%
cyclothymic disorder diagnostic criteria
2 or more years of fluctuations between hypomanic & depressed symptoms (as in bipolar-II) without reaching the full criteria for either hypomania or depression
lifetime prevalence for bipolar-I & bipolar-II
3.9% for both
lifetime prevalence for cyclothymic disorder
4.2%
lifetime prevalence when including manic episodes resulting from antidepressant use
10%
median onset for bipolar disorders
median onset at 25 years, but 25% experiencing onset at 17 years
implications of earlier onset of bipolar disorders
earlier onset associated w/:
(1) poor outcomes: higher suicide rates, more depressive & manic episodes w/ greater severity, higher comorbidity & more psychotic features, greater likelihood of rapid cycling (4 or more episodes per year) in adulthood
common comorbidities with bipolar disorders
highest comorbidity w/ ADHD; also common w/ anxiety disorders, esp. panic disorder; substance abuse, esp. alcohol
percentage rates of illness recurrence over any 1 year, and over 2 years, of those diagnosed
37% of those diagnosed have at least 1 episode of depression of mania; rises to 60% over 2 years
symptoms between episodes
most experience mild/moderate symptoms between episodes
persistence of manic vs depressive symptoms
depressive symptoms persist longer than manic symptoms
attempted & completed suicide rates for bipolar disorders
suicide rate higher than w/ any other psychiatric disorder:
attempted suicide = 50%; 15x higher than typical population & 4x higher than depressed patients
completed suicide = 11%
risk factors for suicide in bipolar disorders
as w/ other populations: family history of illness, substance abuse, social isolation, anxiety, impulsivity; earlier onset/diagnosis
lithium & suicide in bipolar disorders
suicide rates are reduced by lithium
disability with bipolar disorders
(1) bipolar disorder ranked 6th leading cause of disability worldwide
(2) 57% of those diagnosed report being unable to work
prior effects of manic episodes
effects of a manic episode on work, social, & family disturbances can be observed up to 5 years prior
genetic susceptibility overlap for bipolar disorder & schizophrenia (twin studies)
monozygotic twins of schizophrenic patients = 8% increased risk for mania
monozygotic twins of manic patients = 13% increased risk for schizophrenia
neural atypicalities in bipolar disorder (2)
(1) lesions to left frontal cortex & left basal ganglia implicated w/ depression; right frontal cortex & right basal ganglia implicated w/ mania
(2) atypical prefrontal activation esp. in decision making implicated in manic episodes
role of dopamine in bipolar disorders (2)
(1) dopamine can induce mania in healthy individuals
(2) sleep deprivation can interfere w/ normalising dopamine receptors; mania can follow after only 1 night of sleep deprivation in bipolar patients
role of serotonin in bipolar patients
as w/ depression, bipolar disorder has been associated w/ decreased sensitivity of serotonin receptors
role of cannabis in risk of manic symptoms
around 6 studies have associated cannabis use w/ a 3x increased risk for new onset of manic symptoms
problem with developing bipolar mediactions
biological mechanisms underlying bipolar disorder are unclear, so medications not theoretically driven but developed by trial/error
stages of bipolar medication administration (2)
(1) acute - to resolve episodes
(2) maintenance - to prevent, delay, or reduce severity of subsequent episodes
mood stabilisers for treating bipolar disorder
mood stabilisers (ex: lithium) used to treat / prevent episodes w/o triggering opposite polarity, as seen w/ some antidepressants
lithium remission & relapse rates
around 60-70% remission but 40% relapse w/ lithium
antidepressants for treating bipolar disorder
antidepressants effective in reducing depression but may trigger mania, so often used in conjunction w/ lithium / other mood stabilisers
antipsychotics for treating bipolar disorder
antipsychotics sometimes used to block dopamine receptors; most effecting in combination w/ mood stabilisers
anticonvulsants for treating bipolar disorder
sometimes but rarely used due to sever side effects, incl. low white blood cell count
predictors of depression (3)
(1) negative cognitive style w/ tendency to attribute negative events to stable, long-term causes, global causes, or internal causes inherent to the individual
(2) stressful life events
(3) low social support
expressed emotion & role in relapse
EE: criticism, hostility, & over involvement from care-giver & family
EE predicts higher relapse w/in shorter time periods in patients post-hospitalisation; studies show that distress in response to criticism rather than criticism itself predicted depression, mania, & days in recovery
manic-defence hypothesis
based on psychodynamic ideas of defence against negative feelings about the self; says that negative thoughts/feelings in conscious mind are distracted against by a flurry of thoughts/activity, possibly leading to more positive thoughts/feelings
predictors of mania (3)
(1) reward sensitivity & goal dysregulation w/ excess focus on goals & high impulsivity disregarding social consequences
(2) possible positive interpretation bias suggested by some evidence
(3) sleep disruption due to life events or social influences
psycho-education
a psychological intervention to inform about bipolar disorder & how treatments work
FFT - family focused therapy
psychological intervention to help families support individuals w/ BD, esp. after treatment, by improving knowledge around BD, reducing expressed emotion, & enhancing communication
typical bipolar disorder assessment timeline (3)
(1) referred from primary care
(2) psychometric tests like ‘MINI’ (mini interpersonal neuropsychiatric interview) screening tool covering 17 psychiatric diagnoses including BD
(3) full psychiatric assessment in secondary care, incl. full history of symptoms/mood, social/personal functioning, potential comorbidity, treatment history; family member often encouraged to attend to corroborate history
assessment complexities (2)
(1) fluctuating course of BP can lead to different impressions of difficulties
(2) effects of medications
