Lecture 5 - Bipolar Disorder Flashcards
What are the diff types of bipolar disorders?
Cyclothymia: only sub-syndromal depression to sub-syndromal elevated mood
Bipolar Disorder Type II: From major depression to hypomania
Bipolar disorder Type I: Mainly mania, sometimes span to major depression
How to know if symptoms are ‘normal’?
Subjective: have I/my friends had them?, do they seem ‘normal’
Objective: on continuum, do people w/out disorder have them, can experience + function effectively?
What is a Mood Disorder Questionnaire?
Self-report inventory that screens for life time history of hypomanic experiences
What are characteristics of mood episodes in bipolar disorder?
Unequivocal change in functioning uncharacteristic of person when not symptomatic
Symptoms cause clinically significant distress/impairment in social/occupational/other important areas of functioning
Disturbance in mood/change in functioning observable by others
What are the symptoms of major depression?
At least 2 weeks of depressed mood (most of day/nearly every day) and/or markedly diminished interest/pleasure in all/almost all activities (most of day/nearly every day)
Plus at least three symptoms:
Significant change in appetite/weight, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue/loss of energy, feelings of worthlessness/inappropriate guilt, recurrent thoughts of death/suicidal ideation/suicide attempt/specific plan for it
What are symptoms of mania/hypomania?
Mania (at least 1 week), hypomania (at least 4 days) of abnormally/persistently elevated/expansive/irritable mood + abnormally/persistently increased activity/energy
Plus at least three or more of:
Inflated self esteem/grandiosity, decreased need for sleep, more talkative than usual, pressure of speech, flight of ideas, thoughts racing, distractibility, increase in goal-directed activity/physical agitation, excessive involvement in pleasurable activities that may have high potential for painful consequences
Mania must lead to marked impairment in social/occupational functioning, hospitalisation, or psychosis
What are predictors of relapse?
Stressful interpersonal life events, high ‘expressed emotion’ in family members (hostility, overprotectiveness, criticism)
Disrupted social rhythm events (includes sleep changes), goal attainment events (manic symptoms and not depression)
What is cyclothymia?
For at least 2 years: numerous periods of hypomanic symptoms not meeting threshold for hypomanic episodes, numerous periods of depressed mood/loss of interest don’t meet threshold for depression
Symptoms cause clinically significant distress/impairment in social/occupational/other area
What are other specific bipolar disorders?
Short duration hypomanic like episodes/major depressive episodes
Hypomanic-like episodes w/ insufficient symptoms + major depressive
More (in PPT)
What are the Bipolar At Risk (BAR) criteria?
Early detection of BD focused on familiar risk/identification of state-trait factors
Standardised BAR criteria developed by Bechdolf et al.
Youth (15-25) experiencing short duration high mood / high or low mood
First degree relative w/ BD plus low mood
Criteria has predictive validity + reliable assessed in NHS context, has clinical utility
Why is it important to identify bipolar early?
BD affects 1-3% of population, average duration 6-10 years or longer for onset in adolescence, longer duration associated w/ more mood episode + higher risk of suicide, economic impact in UK 8.2 billion by 2026
What are biological factors of bipolar treatment?
High heritability, separate heritability for mania + depression, genes for mania may involve reward pathways (dopamine function)
What 2 treatments are there for bipolar disorder?
Medication: typically mood stabilisers, antidepressants, antipsychotics
Psychological treatments
What are NICE guidelines for treatment?
Primary care: review treatment/care including medication, offer choice of evidence-based psychological intervention devleloped for BD
Secondary (deterioration in depressive symptoms/signs of hypomania/mania): pharmacological interventions (if mania/hypomania taking antidepressant try antipsychotics), offer evidence-based psychological intervention
How do we prevent relapse? (psychoeducation)
Provide (info about BD + how people learn to cope) - Identify (warning signs/relapse signature) - Work (collaborate to identify coping strategies)
Efficacy: Perry (1999): over 18 months longer time to relapse for mania but not depression, Colom (2003): reduced for mania/depression over 2 years
