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Adult Psychopathology > bipolar disorders > Flashcards

bipolar disorders Flashcards

1
Q

placement of bipolar disorders category in DSM-5 & reasoning

A

bipolar disorders section placed between psychotic & depressive disorders due to shared similarities w/ symptoms, family history, & genetics

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2
Q

bipolar disorder subtypes

A

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

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3
Q

bipolar I disorder diagnostic criteria

A

(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

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4
Q

hypomanic episode

A

distinct episode of less severe mania lasting at least 4 days, without causing severe impairment

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5
Q

bipolar II disorder diagnostic criteria

A

(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

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6
Q

approximate conversion rate from BD-II to BD-I

A

~11%

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7
Q

cyclothymic disorder diagnostic criteria

A

2 or more years of fluctuations between hypomanic & depressed symptoms (as in bipolar-II) without reaching the full criteria for either hypomania or depression

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8
Q

lifetime prevalence for bipolar-I & bipolar-II

A

3.9% for both

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9
Q

lifetime prevalence for cyclothymic disorder

A

4.2%

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10
Q

lifetime prevalence when including manic episodes resulting from antidepressant use

A

10%

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11
Q

median onset for bipolar disorders

A

median onset at 25 years, but 25% experiencing onset at 17 years

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12
Q

implications of earlier onset of bipolar disorders

A

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

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13
Q

common comorbidities with bipolar disorders

A

highest comorbidity w/ ADHD; also common w/ anxiety disorders, esp. panic disorder; substance abuse, esp. alcohol

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14
Q

percentage rates of illness recurrence over any 1 year, and over 2 years, of those diagnosed

A

37% of those diagnosed have at least 1 episode of depression of mania; rises to 60% over 2 years

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15
Q

symptoms between episodes

A

most experience mild/moderate symptoms between episodes

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16
Q

persistence of manic vs depressive symptoms

A

depressive symptoms persist longer than manic symptoms

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17
Q

attempted & completed suicide rates for bipolar disorders

A

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%

18
Q

risk factors for suicide in bipolar disorders

A

as w/ other populations: family history of illness, substance abuse, social isolation, anxiety, impulsivity; earlier onset/diagnosis

19
Q

lithium & suicide in bipolar disorders

A

suicide rates are reduced by lithium

20
Q

disability with bipolar disorders

A

(1) bipolar disorder ranked 6th leading cause of disability worldwide
(2) 57% of those diagnosed report being unable to work

21
Q

prior effects of manic episodes

A

effects of a manic episode on work, social, & family disturbances can be observed up to 5 years prior

22
Q

genetic susceptibility overlap for bipolar disorder & schizophrenia (twin studies)

A

monozygotic twins of schizophrenic patients = 8% increased risk for mania

monozygotic twins of manic patients = 13% increased risk for schizophrenia

23
Q

neural atypicalities in bipolar disorder (2)

A

(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

24
Q

role of dopamine in bipolar disorders (2)

A

(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

25
Q

role of serotonin in bipolar patients

A

as w/ depression, bipolar disorder has been associated w/ decreased sensitivity of serotonin receptors

26
Q

role of cannabis in risk of manic symptoms

A

around 6 studies have associated cannabis use w/ a 3x increased risk for new onset of manic symptoms

27
Q

problem with developing bipolar mediactions

A

biological mechanisms underlying bipolar disorder are unclear, so medications not theoretically driven but developed by trial/error

28
Q

stages of bipolar medication administration (2)

A

(1) acute - to resolve episodes

(2) maintenance - to prevent, delay, or reduce severity of subsequent episodes

29
Q

mood stabilisers for treating bipolar disorder

A

mood stabilisers (ex: lithium) used to treat / prevent episodes w/o triggering opposite polarity, as seen w/ some antidepressants

30
Q

lithium remission & relapse rates

A

around 60-70% remission but 40% relapse w/ lithium

31
Q

antidepressants for treating bipolar disorder

A

antidepressants effective in reducing depression but may trigger mania, so often used in conjunction w/ lithium / other mood stabilisers

32
Q

antipsychotics for treating bipolar disorder

A

antipsychotics sometimes used to block dopamine receptors; most effecting in combination w/ mood stabilisers

33
Q

anticonvulsants for treating bipolar disorder

A

sometimes but rarely used due to sever side effects, incl. low white blood cell count

34
Q

predictors of depression (3)

A

(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

35
Q

expressed emotion & role in relapse

A

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

36
Q

manic-defence hypothesis

A

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

37
Q

predictors of mania (3)

A

(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

38
Q

psycho-education

A

a psychological intervention to inform about bipolar disorder & how treatments work

39
Q

FFT - family focused therapy

A

psychological intervention to help families support individuals w/ BD, esp. after treatment, by improving knowledge around BD, reducing expressed emotion, & enhancing communication

40
Q

typical bipolar disorder assessment timeline (3)

A

(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

41
Q

assessment complexities (2)

A

(1) fluctuating course of BP can lead to different impressions of difficulties
(2) effects of medications

Adult Psychopathology (7 decks)

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