Lecture 12 - Bipolar Disorder

Question 1

Illness cost of Bipolar Disorder

Answer 1

• 6th leading cause of disability worldwide

- other impairments: marital disputes, substance abuse, suicide, erratic work history…

Question 2

Main idea:

Answer 2

• affective disorder

- Episodes of mania (or hypomania), depression or mixed mood

Question 3

Manic episode - diagnostic criteria

Answer 3

• 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…

Question 4

Hypomanic episode

Answer 4

• manic symptoms BUT
• lasts 4 days consecutive
• less impairing

Question 5

Depressive Episode

Answer 5

• 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

Question 6

Mixed episode

Answer 6

• manic and depressive symptoms
• dysphoric mania, or agitated depression
• frustrating, confusing, most debilitating

Question 7

Bipolar Types

Answer 7

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

Question 8

Bipolar spectrum disorder idea

Answer 8

• patients converting from cyclothymia to BD II, from BD II to BD I
  (see slide 6 from Bipolar lecture)

Question 9

Recurrence (bipolar)

Answer 9

• over 1 year: 47%
• over 2 years: 60%
• over 5 years: 73%
• over 20 years: 74%
• depressive symptoms last longer than manic

Question 10

Epidemiology

Answer 10

• 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..

Question 11

Etiology

Answer 11

Heritability: ~80%

- BUT environment plays a role

Question 12

Trajectory

Answer 12

• 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

Question 13

Environmental effects

Answer 13

• reward hypersensitivity

- disruption of social/circadian rhythm

Question 14

Reward Hypersensitivity Model

Answer 14

• Reward system: regulates goal-directed behaviour and approach motivation
• activated by goal-reward related cues

Question 15

Social/circadian rhythm disruption model

Answer 15

• circadian rhythm:
• biological process repeated every 24 hours
• affected by social rhythm/life
• 2 main hormones: melatonin (sleep) + cortisol (alterness)

Question 16

Biological model

Answer 16

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**

Question 17

Psychological model

Answer 17

• neuroticism: only depressive symptoms
• low self-esteem: both depressive and manic symptoms
• ambitious goal-striving: 1st manic onset
• evening chronotype BD I patients

Question 18

Social model

Answer 18

• 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

Question 19

Screening

Answer 19

• Clinical interviews: MINI-PLUS, SCID, SADS-L

- Questionnaires: Questionnaire for Bipolar Illness, YMRS QIDS, GBI

Question 20

STUDY: longitudinal; examine the influence of emotionality, parental neglect,
exposure to parental BD, and their interplay on the risk for
developing mood disorders

Answer 20

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!