Bipolar Disorders - Sutherland Flashcards
Through Emil Kraeplin’s studies on asylum patients, he described clear distinctions between persistent psychosis of Schizophrenia and episodic manic psychosis (bipolar) which included what two findings?
- Inter-episode clearing vs. persistent psychosis features
- Intra-episode unique “high energy” features of mania
What is the DSM-5 diagnostic criteria for Bipolar I Disorder?
- MANIA: Elevated, expansive, irritable mood lasting for 1+ week (can last up to 6 months)
- Plus 3 or more of the following:
- Grandiosity (inflated ideas: “I can have 6 careers”), decreased sleep need, pressured speech, flight of ideas, distractibility, increase in goal directed activity
- Symptoms severe enough to cause marked impairment in usual functioning
What is the DSM-5 diagnostic criteria for Bipolar II Disorder?
- HYPOMANIA = a mild form of mania, marked by elation and hyperactivity.
- Hypomania is usually perceived by the affected person as a positive experience
- No impairment in usual functioning; not fully manic
- Does not meet full mania criteria
What is the prevalence of Manic-Depression (Bipolar I Disorder)?
- 0.4-0.8%
- 80% twin-twin concordance in monozygotic twins
- First episode of mania will occur from teens to 30s.
How long does a manic episode last?
1 week to 6 months in duration
(usually not outside these parameters)
What is the DSM-5 diagnostic criteria for Disruptive Mood Dysregulation Disorder?
- Severe recurrent temper outbursts (verbal and/or physical) in response to common stressors
- Disproportionate reaction to stressors
- At least 3 per week for >1 year - occurring in at least 2 settings (severe in at least 1)
- Begins before age 10
How do children with Disruptive Mood Dysregulation Disorder get to a chronically emotionally dysregulated state?
Derailment of the normal development of emotional regulation
-derailment due to “nature” and “nurture”
What are the two processes for normal development of emotional regulation?
-
Attachment
- Transactional process of establishing security that enhances self regulation
- Temperament
-
Cognitive development
- External to internal control
- Egocentric to empathetic
- Public to private speech
- Executive functioning - begins in middle childhood and still developing in adolescence
What are the four genetic etiologic influences on the development of Bipolar Disorder that Dr. Sutherland discussed in class?
- 80% twin-twin concordance in monozygotic twins
- 64-85% heritability
- Studies of BDNF Val66Met Polymorphism (endogenous neuroprotective compound)
- Some studies have found association with psychiatric illness, non-specific to bipolar
- Inconsistently replicated
- Faraone genome-wide study
- “Suspicious” loci on 12p, 14q, 15q, 18q - unknown specific function
What areas of the brain showed biological changes in those with bipolar disorder compared to healthy control subjects?
- Deactivation in the inferior frontal cortex or ventrolateral prefrontal cortex, particularly in manic but not in euthymic and depressed states
- Limbic hyperactivity in individuals with bipolar disorder relative to that in healthy control subjects
What assessments should be performed when seeing a patient for bipolar disorder?
- Patient history - developmental, genetic, and personal medical
- Comorbidities
- Physical exam
- Mental status exam
- Review of PMHx and past lab work
- Patient screening questionnaires can be used in general primary care population
- Not predictably helpful in distinguishing between specific mood, behavior, and personality disorders
What is the Top 10 Checklist for Evaluation?
- Developmental history
- Genetic history
- Medical history
- Comorbidities - horses versus zebras (OCCAM’s Razor - childhood diagnosis of bipolar disorder)
- “Is this normal for you?”
- Seek collateral history to help evaluate “episodicity”
- Create a mood “seismic” chart
- Do a “stress inventory” to examine exacerbating factors
- Stick to DSM-5
- Apply the biopsychosocial model to determine context of symptoms
What is the suicide rate in bipolar disorder?
>10%
(compared to <2% in Major Depressive Disorder)
What are the only two pharmacological agents proven to have an anti-suicide effect?
Clozapine & Lithium
What are the five proprosed criteria best differentiating childhood mania from ADHD?
- Elated mood
- Grandiosity
- Flight of ideas/Racing thought
- Decreased need for sleep
- Hypersexuality
