Lecture 12 - Bipolar Disorder Flashcards
Illness cost of Bipolar Disorder
- 6th leading cause of disability worldwide
- other impairments: marital disputes, substance abuse, suicide, erratic work history…
Main idea:
- affective disorder
- Episodes of mania (or hypomania), depression or mixed mood
Manic episode - diagnostic criteria
- at least 3 symptoms present most of the day, during the same 1 week period.
1) irritability
2) grandiosity
3) distractibility
4) less need for sleep
5) pressure of speech
6) more activity
7) impulsivity
8) flight of ideas - Impairment of social, occupation…
Hypomanic episode
- manic symptoms BUT
- lasts 4 days consecutive
- less impairing
Depressive Episode
- at least 5 symptoms pressent most of day, during the same 2 week period
1) depressed
2) anhedonia
3) change in weight
4) change in sleep
5) psychomotor agitation
6) fatigue
7) feeling of worthlessness/excessive guilt
8) diminished concentration
9) suicide ideation/attempt - impairment
Mixed episode
- manic and depressive symptoms
- dysphoric mania, or agitated depression
- frustrating, confusing, most debilitating
Bipolar Types
BD I: severe, more than 1 manic episode lasting more than 1 week
BD II: lifetime hypomanic episode, at least one depressive episode
Cyclothymia: more than 2 years of alternations b/w hypomanic and depressive
Bipolar spectrum disorder idea
- patients converting from cyclothymia to BD II, from BD II to BD I
(see slide 6 from Bipolar lecture)
Recurrence (bipolar)
- over 1 year: 47%
- over 2 years: 60%
- over 5 years: 73%
- over 20 years: 74%
- depressive symptoms last longer than manic
Epidemiology
- lifetime prevalence: 1% (not sex - specific)
- onset: 17-30 years; when depression comes first often misdiagnosed for unipolar depression
- High risk of comorbidity ADHD, ODD, anxiety disorders, substance abuse..
Etiology
Heritability: ~80%
- BUT environment plays a role
Trajectory
- high-right individuas tend to present:
- anxiety & sleep disturbances in childhood
- adjustment and minor mood disorders during puberty
- MDD in adolescence
- BP in early adulthood
Environmental effects
- reward hypersensitivity
- disruption of social/circadian rhythm
Reward Hypersensitivity Model
- Reward system: regulates goal-directed behaviour and approach motivation
- activated by goal-reward related cues
Social/circadian rhythm disruption model
- circadian rhythm:
- biological process repeated every 24 hours
- affected by social rhythm/life
- 2 main hormones: melatonin (sleep) + cortisol (alterness)
Biological model
Altered functioning of neurotransmitters:
- Dopamine: higher or lower receptor sensitivity - BD related behavioural symptoms (ex: activity, pressured speech)
- Serotonin: higher/lower receptor sensitivity - cognitive symptoms (ex: worthlessness)
- nature of dysregulation is unknown**
Altered neural activity
- frontal limbic circuitry: lower prefrontal and higher amygdala activation in response to emotional content
- frontal striatal circuitry: higher orbitofrontal and higher striatal activation in response to reward anticipation
- Inconsistent results on gene polymorphisms**
Psychological model
- neuroticism: only depressive symptoms
- low self-esteem: both depressive and manic symptoms
- ambitious goal-striving: 1st manic onset
- evening chronotype BD I patients
Social model
- negative life events (ex: definite failure or loss) - BD symptoms
- low social support: families with negative attitudes (ex: hostility, guilt) have 94% relapse within 1st year (compared to 17% with supportive)
**need studies investigating bio-psycho-social factors combined as predictors of bipolar disorders
Screening
- Clinical interviews: MINI-PLUS, SCID, SADS-L
- Questionnaires: Questionnaire for Bipolar Illness, YMRS QIDS, GBI
STUDY: longitudinal; examine the influence of emotionality, parental neglect,
exposure to parental BD, and their interplay on the risk for
developing mood disorders
Results:
Diagnosis:
- 44% developed BD
- Mean age of onset: 18 years
Contribution to risk:
- Emotionality: risk for BD
- Parental neglect : risk for BD
- Exposure to parental BD: risk for BD
- ↑ Emotionality x ↑ Exposure to parental BD: ↑↑ risk for BD
*Importance of early psychosocial support!
