Chapter 8 - Bipolar Disorder Flashcards
What do Bipolar Disorders involve?
-involve episodes (or symptoms) of hypomania or mania
-can alternative with episodes of depression (not required)
What are the depressive symptoms of bipolar disorders?
-gloomy
-withdrawn
-inability to make decisions
-fatigue
-slowness of thought
What are the manic/hypomanic symptoms of bipolar disorders?
-elation
-socially motivated, talkative
-impulsive actions
-hyperactivity
-racing thoughts
What are the DSM-5 Criteria for Manic Episode?
A: Abnormal and persistent elevated, expansive, or irritable mood*, & abnormal and persistent increased activity or energy, lasting at least 1 week, present most of the day, nearly every day (can be less than 1 week if hospitalized)
B: At least 3 of these, *4 if mood is irritable: inflated self-esteem or grandiosity; decreased need for sleep; talkative, pressured speech; flight of ideas, racing thoughts; distractible; increase in goal directed activity or psychomotor agitation; excessive sensation seeking/risky activity
C: Cause marked impairment in functioning or necessitate hospitalization
What are the DSM-5 Criteria for Hypomanic Episode?
A: Abnormal and persistent elevated, expansive, or irritable mood*, & abnormal and persistent increased activity or energy, lasting at least 4 consecutive days, present most of the day, nearly every day
B: At least 3 of these, *4 if mood is irritable: inflated self-esteem or grandiosity; decreased need for sleep; talkative, pressured speech; flight of ideas, racing thoughts; distractible; increase in goal-directed activity or psychomotor agitation; excessive sensation seeking/risky activity
C: the episode is associate with unequivocal change in functioning that is uncharacteristic of the individual
D: the disturbance in mood and change in functioning are observable by others
E: the episode is not severe enough to cause marked impairment or require hospitalization
How to differentiate between the Bipolar Disorders?
-Bipolar I Disorder: criteria met for at least 1 manic episode
-Bipolar II Disorder: criteria met for at least 1 hypomanic episode AND at least 1 major depressive episode;
-Cyclothymic Disorder: 2 years of numerous periods with hypomanic symptoms + depressive symptoms; not been without symptoms for more than 2 months; criteria for hypomanic, manic, or major depressive episode never been met
What are Mixed Features?
-symptoms of opposite poles within a single episode (experience both manic and depressive symptoms)
-specifier for bipolar disorders
What is Rapid Cycling?
-4 or more mood episodes in a given year (more common in people with early onset bipolar disorder)
-not a specifier
What is the prevalence of bipolar disorders?
lifetime prevalence
-bipolar I: 0.4-1%
-bipolar II: 0.6-1.1%
-cyclothymia: 0.4-1%
*peak age of onset is late adolescence, early adulthood
What are the sex differences of bipolar disorders?
-no sex difference for Bipolar I or cyclothymia
-mixed for bipolar II
-rapid cycling & mixed features more common among females
-females more likely to experience depressive episodes
What is the recurrence rate of manic/hypomanic episodes?
-50% have recurrence within 1 year
-many have at least 4 episodes in their lifetime
What else do bipolar disorders influence/increase the risk of?
-high comorbidity with substance use
-suicide risk is up to 20x greater than found in the general population
-high rates of unemployment & other functional impairment
How does heritability affect bipolar disorders (bio dimension)?
-concordance rate MZ twins 72% vs DZ twins 14%
-strong heritable component: 65% of variability in bipolar disorders is genetic
-bipolar I shared genetic vulnerabilities with schizophrenia
-bipolar II strongly related to depressive disorders
How does dysregulation in reward sensitivity affect bipolar disorders (bio dimension)?
-high reward sensitivity and responsivity –> mani symptoms
-when goals are obstructed –> deactivation of motivational systems –> depressive symptoms
How do neurotransmitters affect bipolar disorders (bio dimension)?
-increased glutamate levels –> increased risk of bipolar
-certain drugs/medications can trigger manic symptoms, suggesting other neurotransmitters may play a role (e.g., SSRIs)
