Bipolar Disorders and Suicide Flashcards
Bipolar Disorders
=this is a category of multiple disorders =alter episodes of -Mania (BDI) or Hypomania (BDII) -Depression =Mania/hypomania -elevated mood state
Mixed Episode
=difficult to differentiate from rapid cycling
=symptoms of hypomania and depression
=occur in BDI for at least a week
=~25% at least occasionally experience
Manic Episode
=elevated mood - “on top of the world” “never been better” or very irritable, very angry
=Additional Symptoms
-pressure to keep talking
- lack of sleep
- racing thoughts
- increased activity, psychomotor agitation
- hedonism - unprotected sex, gambling
=Psychotic Symptoms
-voice of God, hallucinating angels
-reflect themes of grandiosity and inflated self esteem
=lack of insight into the symptoms
-often think they are productive and achieving goals
Hypomanic Episode
=shorter duration ~4 days
=minimal impairment
=no psychotic symptoms
=more adaptive –> get a lot done, feels pretty good
Thought Disorder in Mania
=flight of ideas - nonstop talking, consistent topic change
=circumstantiality - talk around the question, a lot of unnecessary details before finally answering
=tangentiality - going off on a tangent and never getting back to the question
=clanging - speaking in rhyme or alliteration
Cyclothymia
=for at least two years
=numerous periods of hypomania symptoms but does not meet criteria for hypomanic episode
=numerous period with depressive symptoms but does not meet criteria for a depressive episode
Medication
=mood stabilizers: lithium =antiseizure: depakote =antipsychotics: seroquel =antidepressants: celexa - risk: does not help mania =lots of side effects from medication -trouble with people adhering to medication -often people are on a lot of meds
Prevalence and Features
=1% lifetime prevalence for BDI
=2-3% lifetime prevalence for BDII
=typical onset is 18-22 years for BDII, later for BDI
= BDII progresses to BDI in only 5% of cases
=gender, race, ethnicity, SES, cross cultural patterns
-equally distributed among men and women
- % of rapid cycling
- recurrence
- depression or mania more prominent?
- residual symptoms
- 5-10%
- highly recurrent - kindling: more episodes you have, the more you are likely to have
- depressive episodes occur more often, last longer, and are more severe than manic episodes
- are typical
Incredibly Destructive
=marriages, friends
=health - STDs, consequences of drug/alcohol use
=finances
=arrests
=assaults
=in a very short time frame - a week of manic behavior - can very easily destroy one’s life
=followed by depression when you realize you ruined your life
What Causes BD?
=neurotransmitters -heavily biologically and genetically based -NE, dopamine, serotonin =brain structure -frontal limbic activation =hormones -HPA axis, thyroid, elevated cortisol =genetics -polygenic - lots of genes contribute -highly heritable =biological rhythms -sleep disturbances =psychological factors are less important, but not unimportant
Sleep Disturbances
- hypersomnia in depression, no sleep in mania
- changes in sleep are a sign of a an episode coming
- external reasons for lack of sleep can lead to an episode
Psychological Factors
=stressful life events –> disrupt sleep
=low social support exacerbates symptoms
=achievement striving and reward sensitivity
Bipolar and Creativity
=risk for BD is linked with creativity and inspiration
=many famous artists, writers, musicians, etc have admitted or are expected to have bipolar disorder
Psychotherapy
=does not work alone =but it does greatly improve outcomes =family focused therapy =psychoeducation =CBT =IPSRT - interpersonal and social rhythm therapy -eat and sleep and work at a rhythm -fix conflicts and maintain social relationships
Mood Stabilizers
=oldest and still first line of meds
=good for prevention of episodes
=treats both mania and depression, but treats mania better
Suicide
= majority of completers are in a depressive episode
= time of greatest risk is when emerging from the a depressive episode
-able to think clearly enough and have energy to make plan and complete it
=90% of completers have a psychiatric diagnosis
Suicide Rates
=10th leading cause of death in US -35,000 completers/year -500,000 attempts/year =3% of Americans have attempted =9% have serious suicide ideation = Us is about in the middle globally =highest is risky mountain states, lowest is New England -suicide rates correlated with gun ownership
Suicide Attempts
Most likely:
- young adults 18-24
- females
- separated/divorced or living alone
- recent interpersonal stressors
Completed Suicide
=elderly >65 = males --> choose more certain methods with less chance of rescue =white =certain diagnoses =hopelessness
The Media and Suicide
=does suicide contagion really happen?
- yes, but probably not as often as we might think
- bigger issue is how media covers non-celebrity suicides, especially those of adolescents
Other Factors Associated with suicide
=impulsivity and aggression
=pessimism and negative affect
=negative life events
=strain, imprisonment, interpersonal crises
=history of family psychopathology or instability, maltreatment in childhood
=family history
-short copies of serotonin allele
Protective Factors for suicide
=strong social support
=good problem solving ability and conflict resolution skills
=access to care, strong therapeutic relationship
=religious beliefs - catholic
=having dependents - including pets
=being married
=restricted access to lethal means
Risk Assessment for Suicide
=weigh risks vs protective factors
-ex SAFE-T
=consider lethal means
=evaluate the patient independently of what they are telling you
Suicide Treatment Options
=treat the disorder =target high risk groups to prevent suicide =provide crisis hotlines =novel intervention strategies -ex CLASP
What to do if a friend is suicidal?
=take the person seriously -express concern -listen and pay attention =get help -don't leave the person alone until in the hands of a professional =self care
