✅ L5 - Bipolar Disorder Flashcards
What are the subtypes of bipolar disorders?
- Bipolar disorder is on a spectrum, consist of 5 defining stages:
(1) Major depression
(2) Sub-syndromal depression
(3) Sub-syndromal elevated mood
(4) Hypothemia
(5) Mania - Subtypes:
- Unipolar depression (4 only)
- Bipolar I (1 -> 5)
- Bipolar II (mainly 1 -> 4)
- Bipolar I - unipolar mania (mainly 4 -> 5, never falls below 2)
- Cyclothymia: From 2 -> 3 ONLY, experience mood swings that do not qualify for bipolar, but still cause impairment to daily functioning (experienced for >2 years)
- Other specified bipolar disorder (does not match any of the main types, short duration or lack of symptoms for specific stages)
Characterisations of mood
episodes in bipolar disorder?
- Mood episode associated with atypical change in functioning
- Symptoms cause significant distress or impairment in functioning (social, occupational, etc.)
- Disturbance in mood and change in functioning is observable (by others)
What are the symptoms of major depression in bipolar disorder? (related to W4 Depression)
- At least 2 weeks of:
- Depressed mood experienced in most days
- Markedly diminished interest or pleasure in (almost) all, activities most days. - Plus at least three symptoms:
- Significant change in appetite or weight
- Insomnia or hypersomnia
- Psychomotor agitation/ retardation
- Fatigue or loss of energy
- Feelings of worthlessness and/or inappropriate guilt
- Diminished ability to concentrate
- Recurrent suicidal thoughts (plan, death)
What are the symptoms of mania and hypomania in bipolar disorder?
- Mania (>1 week) OR Hypomania (>4 days) of:
- Abnormal &persistent elevated mood AND
- Abnormal & persistent increased activity/energy - Plus at least 3 of:
- Inflated self esteem
- Decreased need for sleep
- More talkative than usual, pressure of speech
- Racing thoughts
- Distractibility
- Increased in goal-directed activity/physical agitation
- Excessive involvement in pleasurable risky activities - Mania must lead to marked impairment in functioning, hospitalisation, or psychosis
Criticism: how do we know if the symptoms of a disorder are ‘NORMAL’?
- Require an objective diagnostic:
- Are they on a continuum, i.e. part of a ‘normal’ distribution
- Do people without a disorder experience them?
- Can a person experience them and function effectively
- Can they be explained by within ‘normal’ accounts of cognitive functioning? - Example: Mood Disorder Questionnaire to assess lifetime history of (hypo)manic experience among undergrad students
=> Student have some symptoms, but not quite meet the threshold for bipolar disorders
What are the 4 predictors of relapse?
- Stressful interpersonal life events
- High ‘Expressed Emotion’ (hostility, overprotectiveness, criticism) in family members
- Disrupted social rhythm events, including sleep changes
- Goal-attainment Events => for manic symptoms and not depression
What is the prevalence of bipolar disorder and the importance of early identification?
- Bipolar disorder affects 1-3% of the population
- Average duration of illness (DUI) is 6-10 years, or longer for onset in adolescence
- Longer DUI is associated with more mood episodes & higher risks of suicide
- Economic impact in the UK is predicted £8.2 billion (2026)
What are the criteria of Bipolar At Risk (BAR)?
- Early detection of BD focus on familial risk & trait-like states
- Standardised BAR criteria, where youth (15-25) experience:
- Short duration/less high & low mood
- First degree relative with BD plus low mood (heritability) - BAR criteria has predictive validity (NHS context)
What are the biological factors of bipolar disorder?
- High heritability
- Separate heritability of mania & depression
- Genes for mania may involve reward pathways, (e.g. dopamine function)
What is the NICE guideline for primary care and secondary care for bipolar disorder?
- Primary care:
- Review treatment and medication (e.g. antidepressants, mood stabilisers - lithium, antipsychotics) => high relapse rate despite adequate medications
- Offer evidence-based psychological intervention - Secondary care:
- Refer urgently if symptoms worsen for depression, or reveal symptoms of hypomania & mania
- Pharmacological interventions (e.g. stop antidepressants if signs of hypomania & mania show, offering antipsychotics instead)
- Offer evidence-based psychological intervention
=> Clients often ask for help to treat depression or mania symptoms (extremes)
What are the steps or psychoeducation/relapse prevention treatment?
Key stages: PROVIDE - IDENTIFY - WORK
- Provide information about bipolar disorder AND better coping.
- Identify warning signs – also called ‘prodromes’ or ‘relapse signature’.
- Work collaboratively to identify effective coping strategies (can get feedback from family members)
What are the steps for Family Focused Therapy (FFT) treatment?
Key stages: WORK - PROVIDE - IDENTIFY
- Work with families
- Provide psychoeducation to improve understanding of bipolar (prevent blaming)
- Identify hostility, criticism, and overprotectiveness
=> Help build up more collaborative and positive communication
What are the steps for CBT bipolar disorder focused treatment?
- Develop problem list with client based on stages:
- During depression, identify and challenge ‘negative automatic thoughts’, activity scheduling
- During hypomania, identify coping strategies
- During remission, engage in relapse prevention - Personalised treatment based on clients’ ‘schemas’ & test with behavioural experiments
=> Example: ‘I must be a complete success or my life is worthless’ – experiment with ‘less than perfect’ work
What are the efficacy for each type of bipolar disorder psychological treatment? (Relapse prevention, FFT, CBT)
Relapse prevention:
1. Perry et al. (1999):
- Intervention: 7-12 sessions of relapse prevention vs. treatment as usual
- Results: over 18 months, mania (longer relapse time), no effects for depression relapse time
2. Colom et al. (2003)
- Intervention: 21 sessions of group psychoeducation versus treatment as usual
- Results: reduced rates of relapse of mania and depression (>2 years)
——
FFT:
1. Miklowitz et al. (2003)
- Intervention: 21 sessions of family-focused intervention vs crisis management
- Results: reduced relapse rates and mood symptoms over 2 years
2. Rea et al. (2003)
- Compared FFT to individual psychoeducation
- Results: lower rates of rehospitalisation
——-
CBT:
1. Lam et al., (2003, 2005)
- Intervention: 20 sessions Individual CBT vs treatment as usual
- Results: reduced symptoms of depression, longer time to relapse, improved functioning
2. STEP trial – Systematic Treatment Enhancement Programme (Miklowitz et al., 2007)
- Result: Equal efficacy sessions of FFT, interpersonal therapy and CBT vs. minimal care => all effective in community settings
- Limitation: modest effect size, focus on relapse prevention rather than current symptoms and recovery
What is the integrative cognitive model (ICM) of bipolar disorder?
- Features/theory: Mood swings are due to multiple, conflicted, extreme, personal appraisals of changes in internal state
- feelings of high energy = imminent success vs. mental breakdown
- feelings of low energy = safe, relax vs. failure, boring - How? leads to internal struggle trying to exert extreme control over internal states
=> Cognitive appraisal is also influenced by personal beliefs and life experiences - How to measure cognitive appraisal: using Hypomanic and Positive predictions Inventory (example)
