Lecture 9 - Bipolar Disorder Flashcards
What are the characterisations of mood episodes in bipolar?
- Mood associated with an unequivocal change in functioning that is uncharacteristic of the person
- Symptoms cause distress or impairment in social and occupational functioning
- Observable by others
What are the symptoms of MAJOR depression?
2 weeks minimum of depressed mood 24/7, diminished interest or pleasure in anything
At least 3 of the following:
- Weight change
- Insomnia or hypersomnia
- Agitation
- Fatigue
- Worthlessness
- Suicidal ideation
What are the symptoms of mania (one week) & hypomania (4 days)?
- Abnormally and persistently elevated, expansive or irritable
- Increased activity and energy
3 or more: - Inflated self esteem
- Decreased need for sleep
- More talkative
- Flight of ideas
- Distracted
- Excessive involvement in pleasurable activities
What are some predictors of relapse?
- Stressful interpersonal life events
- High expressed emotion (hostility or criticism) from family members
- Disrupted social rhythm (sleep)
What is Cyclothymia?
For at least 2 years:
- Numerous hypomanic symptoms but not meeting a hypomanic episode
- Numerous periods of depression that does not meet major depression
- Distress or impaired functioning
How is BD detected early?
- Familial risk
- State-trait factors
- Standardised Bipolar At Risk (BAR) criteria
- Youth (15-25) experiencing short duration of high mood, low mood, or have first degree relative with BD
How much of the pop does BD affect?
1-3%
What is the average duration of Bipolar diagnosis?
6-10 years til a proper diagnosis
What is the economic impact of BD in the UK (by 2026)
Predicted to be 8.2 billion
Evidence of high functioning hypomania
12 individuals 30+, history of hypomanic episodes:
- Never sought treatment
- No history of depression
- No bipolar diagnosis
- High functioning, low catastrophising
What is primary care?
Review the treatment and care, medication, offer psychological intervention (CBT, interpersonal therapy)
What is secondary care?
If mania or hypomania develops and person is taking anti depressants, consider antipsychotics
What are the treatments for bipolar?
- Medication such as lithium, anti depressants, antipsychotics
- Psychological intervention - relapse prevention, family focused therapy and CBT
What is Psychoeducation and relapse prevention?
Provide info about BD and how to cope, identify warning signs of relapse (changes in thoughts, feelings, behaviours), work together to find coping strategies
What is the efficacy of relapse prevention? - Perry et al. (1999)
7-12 sessions
Over 18 months, longer time to relapse with mania but no effects on depression relapse
What is the efficacy of psychoeducation? - Colom et al. (2003)
21 sessions
Reduced rates of mania and depression over 2 years
What is family focused therapy?
Work with families
Provide info (psychoeducation)
Identify any hostility or criticism - establish a collaborative environment
What is the efficacy of family focused therapy? - Miklowitz et al. (2003)
2 sessions of FFT, psychoeducation and behaviour intervention vs Crisis Management
- Reduced relapse rates and mood symptoms over 2 years
How does CBT treat Bipolar?
- Develop problem list
- Identify negative thoughts and challenge them
- Identify coping methods
What is the efficacy of CBT for Bipolar? - Lam et al. (2003/5)
20 sessions
Reduced symptoms of depression and longer time to relapse over 2 years, improved functioning
What is the STEP trial?
Systematic Treatment Enhancement Programme - Miklowitz et al. (2007)
What does the Integrative Cognitive Model of Bipolar consist of? - Mansell et al. (2007)
Triggering event -> change in internal state -> appraised as having extreme personal meaning -> descent or ascent behaviours
Life experiences -> beliefs about self, world, others -> appraised as having extreme personal meaning -> behaviours or change in internal state
What does the Integrative Model propose?
Mood swings consequence of personal appraisals in changes in internal states
High energy - imminent success vs mental breakdown (all comes crashing down)
Low energy can be safe and relaxing vs low energy = failure
What are appraisals and attributions within the ICM of BD?
Certain cognitive biases that contribute to the onset and persistence of mania and depression
What is goal dysregulation within the ICM of BD?
Difficulties in goal setting, fluctuations in goals, rapid shifts between high energy during mania and decreased motivation in depression
What is cognitive control within the ICM of BD?
Dysfunctions of cognitive processes - rumination and worry
What are contextual factors within the ICM of BD?
Environmental and interpersonal factors - life events, social rhythms, relationships
What are ascent behaviours?
Taking on more and risk taking - manic
What are descent behaviours?
Withdrawing - depression
