L10 - Bipolar and Related Disorders Flashcards
What are the criteria for Bipolar I Disorder?
A) At least one week of:
- abnormally elevated, irritable mood AND increase goal directed activity.
- Elated mood -> irritable mood.
B) ≥3 of:
- inflated self-esteem.
- decreased need for sleep.
- racing thoughts.
- risk taking behaviour.
C) Mood disturbances causing impairment in functioning, or psychotic features.
D) Not due to other medical condition or substance.
What is the difference in the classification of Bipolar I & II between DSM-IV and 5?
DSM-IV: - Mood Disorders. DSM-5: - Bipolar and related disorders. - BP I & II, Cyclothymic, Substance/Medication-Induced, etc.
What is the difference between symptoms in Bipolar I and Bipolar II?
- Bipolar II (Hypomanic) has the same symptoms as BP I, however duration of 4 days (not ≥7).
- Not severe enough to result in hospitalisation.
- No psychotic features.
Are depressive episodes necessary for the diagnosis of both Bipolar I & Bipolar II Disorder?
- A major depressive episode is necessary for BP II, but not for BP I (although may be present).
- Similarly, a hypomanic episode is necessary for BP II, but not for BP I (although may be present).
- A manic episode is necessary for BP I.
What is Cyclothymic Disorder?
- Cyclothymic Disorder is seen as a chronic, less severe form of Bipolar Disorder.
- Involves numerous cycles of hypomania and depressive symptoms, but not severe enough to meet mania or depressive episode criteria.
- Symptoms present for at least 2 years, with no more than 2 months without symptoms.
What are some of the diagnostic issues with Bipolar and related disorders?
- Often goes undetected/under-diagnosed.
- Incorrect diagnosis, especially in women with Borderline Personality Disorder due to overlap in mood, sexual indiscretions.
- Diagnosed as Schizophrenia or Unipolar Depression as help is usually sought in depressive cycles rather than manic/hypomanic.
- Diagnosed on average 18 years after symptom onset.
What is the prevalence and epidemiology of Bipolar I & Bipolar II in Australia?
- Bipolar I: 1% lifetime prevalence.
- Bipolar II: ~5%.
- There are no gender differences.
- 90% have recurrent episodes.
What is the clinical course for an individual with BP if they go untreated vs. treated?
Untreated: - 8-10 lifetime episodes of mania and depression. Treated: - 40% relapse within 1 year. - 75% relapse within 5 years.
What is the breakdown of depressive and manic episodes in those with Bipolar I & II?
Bipolar I: - 32% of the time depressed. - 9% manic. Bipolar II: - 50% time depressed. - 1% hypomanic.
What are the common comorbid conditions?
- 50% with anxiety disorders (especially panic and GAD).
- 39% with substance misuse disorder.
- At least 25% attempt suicide.
- 10-20% succeed.
What are the 3 main aetiological factors of BP?
1) Genetic/biological.
2) Environmental and life stressors.
3) Psychological.
What are the genetic/biological risk factors for BP?
- Lifetime risk of those with family members with BP = 10% (versus 1% in general population).
- Twin studies show a 80-85% heritability rate.
- Malfunction of serotonin, dopamine and noradrenaline.
What are the environmental risk factors for BP?
BP may lie dormant and be triggered by stressful life events.
Manic episodes are likely to be preceded by:
- disruption to routines & sleep-wake cycles.
- excessive focus on goal attainment.
Depressive episodes likely preceded by:
- low social support.
- low self-esteem.
What are the Psychological risk factors for BP?
- Negative cognitive style (paired with stressful life events).
- Mania may be a defence to counter negative thoughts/feelings relating to low self-esteem.
- Perfectionism and sociotropy.
What is the Diathesis Stress Model (Lam et al., 1999)?
It is a cyclic model whereby:
Life stressors causing poor social routines and/or sleep deprivation -> biological vulnerabilities (circadian rhythm instability) -> prodromal stage, then if poor coping strategies -> manic/hypomanic/depressive episode -> increased life stressors.
And repeat.
What is the preferred method of treatment for BP?
Treatment depends of illness stage (acute/maintenance) and predominant polarity.
Best treatment combines pharmacological and psychological interventions.
Evidence is based on BP I and extrapolated to BP II.
What are the pharmacological treatments available for BP?
Lithium:
- mood stabiliser.
- treatment of manic episodes and future episode prevention.
- 50% of patients relapse within 5 months of cessation.
Anticonvulsants:
- Lamotrigine for mood stability.
Atypical Antipsychotics:
- Olanzapine (mainly BP I).
Sedative hypnotics:
- Benzodiazepines.
Antidepressants:
- doses lower & shorter duration that for unipolar depression.
- combined with mood stabiliser to prevent mania induction.
When is Electro-Convulsive Therapy (ECT) used for BP?
- ECT may be used when medication is not viable.
- Effective for manic and depressive episodes.
What are the aims of Psychological Interventions in BP?
- To reduce symptoms.
- Prevent relapse.
- Improve quality of life.
- Improve medication adherence.
- Provide support.
Usually used in conjunction with medication.
CBT or Group Psycho-education are the most effective and commonly used.
