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Effective Treatments > Chapter 4 > Flashcards

Chapter 4 Flashcards

1
Q

__ interrupted by relatively short bouts of ___ or ____ are the key features of bipolar disorders.

A

Chronic depression; mania; hypomania

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2
Q

What are the group of bipolar and related disorders?

A
  • Bipolar I
  • Bipolar II
  • Cyclothymic disorder
  • Substance/medication-induced bipolar and related disorder
  • Other specified bipolar
  • Unspecified bipolar
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3
Q

Symptoms of an ___ are the same for bipolar disorders as they are for a major depressive disorder.

A

Major depressive disorder

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4
Q

How long must a client experience symptoms to be diagnosed with MDE?

A

a two week period in which at least five of the following symptoms occur most of the day, nearly every day (with at least one for the symptoms being depressed mood or loss of interest or pleasure)

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5
Q

What are the symptoms for MDE?

A
  • Anhedonia (diminished pleasure in things once enjoyed)
  • Significant weight loss/gain or increased/decreased appetite
  • insomnia or hypersomnia
  • agitation or psychomotor retardation almost every day during the 2 wk pd.
  • a feeling of being slowed down
  • fatigue or loss of energy
  • guilt or worthlessness
  • indecisiveness, can’t concentrate
  • thoughts of death/suicidal ideation w/o plan
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6
Q

The presence of an MDE is not a requirement for diagnosis of _____ since some people may first present in a manic episode.

A

Bipolar I

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7
Q

In BP II, suicide attempts occur ___ times more often during depressive states that during hypomanic states.

A

30

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8
Q

Define a manic episode.

A

a period of increased energy and elevated mood or irritability that lasts for at least 7 days.

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9
Q

What are the symptoms of a manic episode? how many must be present to be diagnosed?

A
  • grandiosity
  • decreased need for sleep
  • increased talkativeness
  • racing thoughts
  • distractibility
  • increased activity
  • excessive pleasure-seeking behaviors that have a high likelihood of having negative conseq.
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10
Q

Define hypomania.

A

4 consecutive days of expansive, elevated, or irritable mood and increased activity or energy. During this period 3 or more of the defined symptoms must be present (4 if the mood is irritable)

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11
Q

What are the symptoms of hypomania?

A
  • increased self-esteem
  • reduced need for sleep
  • more talkative than usual
  • racing thoughts or flight of ideas
  • being easily distracted
  • an increase in goal-directed behavior or psychomotor agitation
  • excessive involvement in activities w/negative conseq.
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12
Q

Describe the change in the DSM-V around how a TEAS effects a bipolar diagnosis.

A

Treatment-emergent affective switch now adds to the clarity of the diagnosis instead of being a “rule-out”; indicates an increased risk of developing a hypomanic or manic episode later.

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13
Q

In addition to a hypomanic episode, a BP-II diagnosis also requires a history of _____.

A

Major depressive episode

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14
Q

What are the symptoms and qualifiers of the “with anxious distress”?

A

minimum of two symptoms listed must be present most days during an episode of mania, hypomania or depression.
Symptoms: tension/spun up, restless, unable to concentrate, anxiety/dread that something terrible will happen, fear of losing control

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15
Q

Describe the severity levels for the anxious distress specifier.

A

2 symptoms = mild, 3 = moderate, 4-5 = moderate-severe, 4-5 + motor agitation = severe

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16
Q

Assessment of anxious distress in the moderate - sever range of anxiety distress should trigger an assessment of what kind of risk?

A

Suicidal risk, meaning past history of attempts, current ideations, concrete plans, means to do so, etc.

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17
Q

Describe rapid cycling.

A

Refers to the rate of switching between a MDE and either manic or hypomanic episode; presence of at least 4 mood episodes in the past 12 months indicate rapid cycling.

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18
Q

What are some contributing factors to rapid cycling?

A

Medications/substance abuse, other medical conditions (hypothyroidism, etc), and history of childhood abuse (physical or sexual); Women also experience this more

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19
Q

Risk of affective switching is ______ when electroconvulsive therapy or monoamine oxidase inhibitors are used than tricyclic antidepressants or SSRIs.

A

Lower

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20
Q

What are the symptoms of atypical features of BP?

A

Mood reactivity, ability to experience pleasure during an MDE, increased appetite and weight gain, hypersomnia, leaden paralysis (feeling weighted down); rejection sensitivity is also common and indicates a lifelong pattern of over sensitivity to rejection.

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21
Q

What assessment should be triggered by presence of atypical features of depression?

A

They are associated with high presence of BP-II and so the clinician should assess for family history and other symptoms of BP

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22
Q

Psychotic features can be experienced during a _____ or _____ episode but not during a hypomanic episode.

A

Manic; depressive

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23
Q

How are psychotic features determined to be mood-congruent or mood-incongruent?

A

When the hallucinations/delusions are consistent with or inconsistent with the current mood state.

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24
Q

Describe depressive psychosis.

A

Typically involves feelings of guilt, worthlessness or impaired reality testing.

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25
Q

Describe symptoms of Catatonia.

A

Symptoms must be present during most of the mood episode and include: motor immobility, posturing, echolalia or echopraxia

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26
Q

Describe symptoms of peripartum onset.

A

More common in first-time births; symptoms must begin during pregnancy or within 4 weeks of birth; symptoms include: severe anxiety, mood lability, obsessive thoughts (mostly focused on baby’s welfare)

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27
Q

Describe BP I.

A
  • must include 1 episode of mania (lasts 7 days)

- on average the manic episode lasts about 2-6 weeks, followed by MDE that may last from 6-9 months

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28
Q

Without treatment, those with BP I are likely to have ____ or more episodes across their lifespan. Frequency may vary from __ a year to __ every 10 years.

A

10 + episodes; 3 a year; 1 every 10 years

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29
Q

Studies have found a ____% likelihood of a comorbidity with BP disorders. What is the most common comorbidity?

A

100%; anxiety disorder

30
Q

What are the benefits of conjoint couples counseling for BP clients?

A

for the client with BP: provides support, opportunity to work together as couple to help overcome; can also provide a reality check and level of accountability

for partner: receive psychoeducation and be able to discuss issues of mutual concern

31
Q

What is the mean age for onset of first manic/hypomanic/depressive episode?

A

18 yo

32
Q

___% of children with at least one BP parent had a psych disorder.

A

51%

33
Q

What are predictive factors of increased severity suicidal ideation and planning for children?

A

Low self-esteem (stronger indicator), depression, hopelessness, quality of life, family rigidity (stronger indicator)

34
Q

What are some misdiagnoses for BP?

A

If manic symptoms are severe enough for psychosis, can be misdiagnosed as schizo; if client first presents with MDE, can be misdiagnosed as unipolar depression

35
Q

What is the Bipolarity index?

A

A tool to help clinicians differentiate between BP I and MDD:

  1. Hypomania/Mania - presence of symptoms?
  2. Age of onset: generally before 25 for BP; later for MDD
  3. Family Hx of psych disorders more frequent for BP than MDD
  4. Course of illness - episode recurrence higher in BP than MDD
  5. Response to treatment - treatment failure more common in BP than MDD
36
Q

What is the MDQ?

A

Mood Disorder Questionnaire; 13-item self report; 7 of 13 items test positive for mania or hypomania

37
Q

Studies indicate that quality of ____ _____ ______ predicts better success in managing manic symptoms.

A

therapist-client alliance; this is also considered the first line of defense against recurring BP symptoms.

38
Q

Which medications form the foundation of evidence-based practice for BP? When are they the most effective?

A

mood stabilizers and other medications; in the acute phase of manic, hypomanic or mixed episodes

39
Q

What does research suggest is a more effective treatment for the depressive episodes in BP?

A

psycotherapy

40
Q

Which medication type was found to be ineffective in treating BP?

A

antidepressants

41
Q

Which drug works best for treatment of mania?

A

Lithium

42
Q

What reasons do clients cite in discontinuing medications for BP?

A

cost of meds, debilitating side effects, and stigma; other factors include weak alliance with therapist or lack of insight of client that anything is wrong with BP (anosognoisa)

43
Q

Medication compliance should be a ____ of therapy for BP clients.

A

goal

44
Q

What are the 3 medications approved by the FDA for bipolar depression?

A

Lurasidone (Latuda), quetiapine (Seroquel), olanzapine + fluoxetine (Symbax)

45
Q

What psychosocial treatments have empirical support in treating BP?

A

Family-focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT), and CBT (adding mindfulnes component shows greater improvement on symptoms)

46
Q

Describe IPSRT in treating BP

A
  • routine and consistency combined with support help build a solid foundation for client
  • focus on circadian rhythms and tracking sleep and wake cycles help client better predict what might trigger an episode and plan for it
  • being proactive and becoming balanced in lifestyle shortens time spent in depressive phase
  • clients that stay in IPSRT have fewer recurrences when compared to those that switch to other modalities
47
Q

Describe CBT in treating BP

A
  • use of behavioral contracts and cognitive techniques to improve adherence to medication
  • new clients: focus on self-monitoring moods/thoughts, challenging faulty beliefs, replacing with healthier thinking
  • long-term clients: schedule pleasurable activities, improving interpersonal communications, developing gratitude checklist
  • all clients: stress reduction techniques, recognizing and controlling negative thoughts
  • mania focus: noticing excessively goal-oriented thoughts and activating behaviors
  • usually presented in 20 -25 sessions of individual or group therapy
48
Q

Describe MBCT in treating BP

A

(Mindfullness-based CBT) - not yet enough research to deem evidence-based but shows promise

  • improves emotional processing
  • reduce anxiety in BP clients
  • more positive affect
49
Q

Describe DBT in treating BP

A
  • supported as an adjunct to medication

- adolescents showed less depressive symptoms, attended more sessions and exhibited 3x less suicidal ideations

50
Q

Describe FFT in treating BP

A
  • starts with psychoed for families to learn how to communicate effectively without criticism or high expressed emotion
  • problem-solving is also taught
  • takes about 21 sessions over 9 month period
  • helps clients understand disorder better (behaviors that might trigger episodes, important of good sleep, med compliance)
  • studies show that FFT decreases rehospitalization and increase time between relapses when compared to individual therapy
51
Q

Describe ECT and rTMS in treating BP

A

Electroconvulsive therapy and Repetitive Transcranial Magnetic stimulation

  • usually reserved for situations where pharmacotherapy is contraindicated and those whose depression is treatment refactory.
  • both proven to be effective in reducing depression, but rTMS has less side effects
  • ECT works best when used during a manic episode
52
Q

When is group therapy not recommended for BP treatment?

A

When the person is in the midst of a manic episode or is severely psychotic as this would prevent them from getting therapeutic work done

53
Q

Per the text - no ____ _____ trials have yet been conducted on treatment of children and adolescents with BP.

A

randomized controlled trials

54
Q

What did research indicate about adjunctive FFT and pharmacotherapy in treatment of adolescents with BP?

A

It was not more effective than pharmacotherapy and brief psychoeducation.

55
Q

Describe RAINBOW therapy.

A

Child and Family Focused Therapy CBT

  • 12 session manual based psychosocial intervention fo ages 7-13
  • Combines elements from CBT, Interpersonal psychotherapy, and mindfulness
  • research indicates it is helpful in reducing symptoms
  • treatment protocol includes education of siblings to help increase empathy toward the BP sibling
56
Q

What is the prognosis of BP?

A

BP is a chronic, severe disorder, with relapse almost assured even with recommended treatment.
- prognosis is worse when there have been multiple episodes or in presence of co-occuring substance abuse, rapid cycling or negative family affective style

57
Q

What is the primary goal of treatment of BP?

A

To follow a collaborative care model that monitors clients for suicidal ideation, medication adherence, and providing additional support through skills-based psychotherapy

58
Q

As much as __% of people with a depression diagnosis are found to have BP. An average of ___ years pass between the first onset of symptoms and the correct diagnosis of BP.

A

40%; 10 years

59
Q

What must be present for a diagnosis of BP II?

A

a current or past history of BOTH hypomanic episode and an MDE, with no history of a manic episode. Also the depressive symptoms must cause functional impairment

60
Q

What is one reason BP II goes undiagnosed for years?

A

symptoms of hypomania can go unnoticed or may be viewed as being enhanced or having a “happy” period following the depressive episode

61
Q

What are some risks involved in a misdiagnosis of BP?

A

When hypomanic symptoms are missed, clinicians may prescribe antidepressants to deal with the depressive symptoms, triggering a medication-induced mania if antidepressants are prescribed or increased suicide

62
Q

What tend to be the dominating symptoms of BP II?

A

Depressive symptoms

63
Q

What is euthymia?

A

When a BP client is asymptomatic

64
Q

When do most people with BP II seek treatment?

A

During a depressive episode

65
Q

What are some early warning signs of a depressive episode in BP II?

A

low energy level, low libido, self-criticism, anhedonia, withdrawal or isolation from others

66
Q

What are some early warning signs of a hypomanic episode in BP II?

A

feeling euphoric, increased seuality, racing thoughts, fast associations (word play or creative thoughts), taking on too many projects at once, staying up all night, feeling confident, talking faster or louder than usual

67
Q

What percentage of BP II clients have 3 or more comorbid mental disorders? what is the most common one?

A

60%; Anxiety disorders

68
Q

A manic episode and psychotic symptoms do not exist in BP _

A

II

69
Q

How can BP II be distinguished from other specified BP disorders?

A

by the presence of an MDE

70
Q

How can BP II be differentiated from borderline?

A

BP II has a episodic nature

71
Q

What is a strong indicator to a clinician to screen for a history of manic/hypomanic symptoms?

A

Depressive symptoms

72
Q

What are some assessments to screen for hypomania v manic symptoms?

A
  • Hypomania Checklist (to distinguish between depression with and without

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