Lecture 18 - Bipolar Disorder Flashcards
What are the key characteristics of Bipolar I?
Elevated/irritable mood and increased goal directed behaviour. Manic episodes typically transition from elevated mood to euphoria. Fluctuation between elation and irritability. Must involve impairment.
What are the key characteristics of Bipolar II?
Similar symptoms to BPI but there is no impairment, hospitalisation or psychotic symptoms present.
What is necessary for a BPI diagnosis?
Only a manic episode is necessary, but depressive episodes may be present.
What is necessary for a BPII diagnosis?
A depressive episode and a hypomanic episode (mild mania) are necessary.
What are the key characteristics of Cylothymic Disorder?
Less severe but chronic form of bipolar. Hypomanic and depressive symptoms are not severe enough to be diagnosed with bipolar, but are distressing/impairing for almost 2 years.
What are diagnostic issues associated with bipolar? (4)
Undetected/undiagnosed.
Overdiagnosed (BP instead of BPD).
Misdiagnosed as schizophrenia or unipolar depression.
Tend to be diagnosed with depression as they only seek help during ‘downs’.
What is the Diathesis-Stress Model?
Life stressors cause poor social/sleep routines, which interact with a biological vulnerability. Symptoms begin to appear in the prodromal phase (best for treatment). Poor coping strategies lead to an episode, which then spur stigmas, which then causes stressors, and so on.
What is the best way to treat BP?
Treatments should be flexible and adaptable, depending on the patient (some are fine with side effects, others are not). Biological treatments (lithium -> stabilises mood) should be combined with psychological interventions.
What does Psycho-education involve? What are its outcomes?
Educating the patient and family members about symptoms, the diathesis-stress model, early warning signs, medication, how to deal with stress, emphasis of routine, etc.
Delays future recurrence and reduces frequency of future episodes.
What does CBT involve? What are its outcomes?
Cognitive restructuring to manage acute symptoms and prevent relapse. Patients are encouraged to monitor symptoms and challenge cognitions, particularly about medication.
Reduces episodes/hospitalisation and improves medical compliance in the first 6 months.
What does Interpersonal & Social Rhythm Therapy involve? What are its outcomes?
Aims to improve interpersonal relationships so as to reduce disruptions to routines/sleep-wake cycle. Identify unstable rhythms and set goals to obtain new behaviour.
Effective in reducing relapse.
What does Family-focused Therapy involve?
Focuses on how the family reacts to bipolar -> educate the whole family, improve communication and problem solving skills, reduce conflicts, etc.
What factors predict relapse?
Biological/genetic vulnerability.
Non-adherence to medication.
Dysfunctional beliefs about the self.
Disrupted routines.
