Bipolar (Related) Disorders Flashcards
What are the DSM criteria for a Manic episode?
A: 1+ weeks of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy
B. 3+ symptoms of creativity, mysticism, irritability or disinhibition such as: - Inflated self-esteem or grandiosity - Decreased need for sleep - Rapid or pressured speech - Flight of ideas or racing thoughts - Distractibility - Increase in goal-directed activity or psychomotor agitation - Excessive risky behaviour
C. Involves marked impairment (occupation, psychotic features or need of hospitalisation)
D. Not due to drugs or other medical condition
What is a hypomanic episode?
A. At least 4 days of: abnormally & persistently elevated, expansive or irritable mood, and increased goal directed activity/energy, present nearly daily
B. 3+ symptoms of creativity, mysticism, irritability or disinhibition such as:
- Inflated self esteem or grandiosity
- Decreased need for sleep
- More talkative/pressured speech
- Flight of Ideas; racing thoughts
- Distractibility
- Increased goal-directed activity or psychomotor agitation
- Excessive involvement in risky behaviours
C. NOT severe enough to cause marked impairement, hospitalisation, NO psychotic features
D. not due to drugs or other medical condition
What is the difference between Bipolar 1, Bipolar 2 and Cyclothymic disorder?
Bipolar 1: Presence of Manic episodes. (depressive and hypomanic episodes can be present but are not necessary for diagnosis)
Bipolar 2: No manic episodes, but presence of both depressive and hypomanic episodes
Cyclothymic disorder: chronic, less severe form of bipolar disorder. Numerous cycles of hypomania symptoms and sub-threshold depression symptoms. Persists 2+ years without break of over 2 months.
What is the epidemiology of Bipolar disorders?
Statistics
- Lifetime prevalence (Australia): Bipolar I 1%, Bipolar II ~5%.
- No gender differences
- Onset: peak at 15-25 years (for both genders)
Course
- 10-20 years delay in seeking treatment,
- Untreated: 8-10 lifetime episodes of mania & depression
- Treated: 40% relapsing within 1-year; 73% within 5-years
- Predominantly depressive (BP1 32% to 9% mania, BP2 50% to 1% hypomanic)
Comorbidity
- 50% anxiety disorders
- 39% substance misuse (self medication)
- 25% attempted suicide, 10-20% successful
What are the main diagnostic issues around Bipolar disorders?
- Undetected/Undiagnosed
- Over-diagnosed (i.e. Borderline Personality Disorder)
- Misdiagnosed as Schizophrenia or Unipolar Depression
What are the main aetiological factors in bipolar disorders?
Genetic factors: BP heritability rate of about 85% in twin studies, 10% : 1% chance for families
Stressful Life events:
- manic episodes preceded by: abnormal sleep patterns, focus on goal attainment, routine interruption
- depressive episodes preceded by: low social support, low self esteem
Psychological Factors
- A negative cognitive style enhances vulnerability
- Temperament factors: perfectionism & sociotropy
- Mania may be a defense to counter underlying negative self-esteem
What is the Diathesis-Stress model?
A theory of bipolar that shows a cycle between 4 factors:
Life Stressors: causing sleep or social deprivation
trigger —> biological vulnerability
Biological Vulnerability; i.e. Circadian rhythm
instability triggers –>
Prodromal Stage: (Early symptoms of mood disturbance)
+ poor coping strategies triggers —>
Episode: manic, hypomanic, depressive
+ stigma or relationship problems triggers –> Life stressers
What are the main considerations when choosing a course of treatment for Bipolar disorders?
- illness stage (acute, maintenance)
- predominant polarity (depressive, hypo/manic)
- patient preferences (Treatment adherence depends on the value patients place on treatment efficacy versus side-effect burden)
What are the main medical treatments for bipolar disorders?
Drugs
- Lithium: mood stabiliser & main component of standard care. Treatment of manic episodes & for preventing future episodes. 50% patients relapse within 5 months of ceasing
- Antidepressants: doses lower & duration shorter than for unipolar depression, combined with mood stabiliser to prevent inducing mania
- other (antipsychotics, anticonvulsives, sedatives)
Electroconvulsive therapy
- Used when medication is not viable
- Effective for treating both manic & depressive episodes, but not in preventing relapse
- Short-term side effects: confusion, disorientation,
memory loss
What is the psycho-education model of treatment for bipolar disorders?
Most commonly in a group setting
Providing information about:
- Symptoms of BP disorder
- Diathesis-stress model of BP disorder
- Identifying early warning signs of relapse
- The rationale/importance of medication compliance
- Strategies to cope with stressors
- Need for routines & sleep-wake cycles
Delays recurrence + reduces frequency of future episodes:
What is the CBT model for treatment of bipolar disorders?
Aims to to manage acute symptoms & prevent relapse
through cognitive restructuring by
Strategies
- Monitor symptoms
- Challenge hyper-positive cognitions
- Improve medication adherence
- Foster self-efficacy
- wellbeing plans; plans of action and permission for others to take action
CBT effective in reducing episodes and hospitalisations,
improving medication compliance within 6-months post-treatment
What is the Interpersonal and Social Rhythm therapy model of treatment for bipolar disorder?
Aim: to improve interpersonal functioning and to
reduce disruption to routines & sleep-wake cycles
strategies
- identify unstable rhythms
- Identify realistic goals for change
- Establish and maintain new routines
particularly effective in reducing relapse
What is the Family focused model of treatment for bipolar disorder?
Aims to improve:
- knowledge about Bipolar disorder
- family communication and problem solving skills
- family functioning; reducing any criticism or hostility
Support for family interventions found in reducing
relapse rates, hospitalisations & time to relapse
What are the risk factors for relapse?
- Biological/genetic vulnerability
- Medication non-adherence
- Dysfunctional attitudes & beliefs
- Disrupted routines (& sleep-wake routine)
