Bipolar Disorders and Suicide

Question 1

Bipolar Disorders

Answer 1

=this is a category of multiple disorders 
=alter episodes of 
-Mania (BDI) or Hypomania (BDII)  
-Depression
=Mania/hypomania
-elevated mood state

Question 2

Mixed Episode

Answer 2

=difficult to differentiate from rapid cycling
=symptoms of hypomania and depression
=occur in BDI for at least a week
=~25% at least occasionally experience

Question 3

Manic Episode

Answer 3

=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

Question 4

Hypomanic Episode

Answer 4

=shorter duration ~4 days
=minimal impairment
=no psychotic symptoms
=more adaptive –> get a lot done, feels pretty good

Question 5

Thought Disorder in Mania

Answer 5

=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

Question 6

Cyclothymia

Answer 6

=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

Question 7

Medication

Answer 7

=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

Question 8

Prevalence and Features

Answer 8

=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

Question 9

1. % of rapid cycling
2. recurrence
3. depression or mania more prominent?
4. residual symptoms

Answer 9

1. 5-10%
2. highly recurrent - kindling: more episodes you have, the more you are likely to have
3. depressive episodes occur more often, last longer, and are more severe than manic episodes
4. are typical

Question 10

Incredibly Destructive

Answer 10

=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

Question 11

What Causes BD?

Answer 11

=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

Question 12

Sleep Disturbances

Answer 12

• 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

Question 13

Psychological Factors

Answer 13

=stressful life events –> disrupt sleep
=low social support exacerbates symptoms
=achievement striving and reward sensitivity

Question 14

Bipolar and Creativity

Answer 14

=risk for BD is linked with creativity and inspiration

=many famous artists, writers, musicians, etc have admitted or are expected to have bipolar disorder

Question 15

Psychotherapy

Answer 15

=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

Question 16

Mood Stabilizers

Answer 16

=oldest and still first line of meds
=good for prevention of episodes
=treats both mania and depression, but treats mania better

Question 17

Suicide

Answer 17

= 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

Question 18

Suicide Rates

Answer 18

=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

Question 19

Suicide Attempts

Answer 19

Most likely:

• young adults 18-24
• females
• separated/divorced or living alone
• recent interpersonal stressors

Question 20

Completed Suicide

Answer 20

=elderly >65 
= males --> choose more certain methods with less chance of rescue 
=white 
=certain diagnoses 
=hopelessness

Question 21

The Media and Suicide

Answer 21

=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

Question 22

Other Factors Associated with suicide

Answer 22

=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

Question 23

Protective Factors for suicide

Answer 23

=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

Question 24

Risk Assessment for Suicide

Answer 24

=weigh risks vs protective factors
-ex SAFE-T
=consider lethal means
=evaluate the patient independently of what they are telling you

Question 25

Suicide Treatment Options

Answer 25

=treat the disorder 
=target high risk groups to prevent suicide 
=provide crisis hotlines 
=novel intervention strategies 
-ex CLASP

Question 26

What to do if a friend is suicidal?

Answer 26

=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