Lecture 9 - Bipolar Disorders Flashcards
what is bipolar
periods of mania/ hypomania and low mood
categogrised by 2 conditions
- bipolar 1 + bipolar 2
other diagnoses include: cyclothymia
defined by intensity and duration mania vs hypermmania
Describe the DSM for a manic episode
A. Abnormally and persistently elevated, expansive, or irritable mood… persistently increased goal-directed activity or energy, lasting at least 1 week… present most of day, nearly every day
o B. … plus 3 (or more) of following (4 if mood only irritable) …
* Inflated self-esteem or grandiosity
* Decreased need for sleep
* More talkative than usual or pressure to keep talking
* Flight of ideas/subjective experience that thoughts are racing
* Distractibility
* Increase in goal-directed activity or psychomotor agitation
* Excessive involvement in ‘reckless’ activities
o C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features
o D. …not attributable to psychological effects of a substance or another medical condition
*
Describe the DSM for a hypomanic episode
manic episode dsm
o A. Mood similar to manic episode but lasting at least 4 days
o B. … plus 3 (or more; 4 if mood only irritable) of manic episode criteria (category B)
o C. Episode associated with unequivocal (uncharacteristic) change in functioning
o D. Disturbance in mood/function change observable by others
o E. Not severe enough to qualify for manic category C
o F. …not attributable to psychological effects of a substance (but can ‘emerge’ during antidepressant treatment)
Describe the DSM for a major depressive episode
Major depressive episode (DSM-5)
o An episode of MDD within any bipolar disorder is diagnosed in the same way as unipolar MDD
o See MDD categories A-D
Describe the DSM for bipolar 1
A. Manic criteria A-D for at least one manic episode
o The manic episode MAY have preceded or be followed by hypomanic or depressive episodes
o B. Occurrence of manic and MDD episode(s) not better explained by schizoaffective disorder/schizophrenia (etc.
Describe the DSM for bipolar 2
A. Hypomanic criteria A-F for at least one hypomanic episode
o AND there MUST be current/past MDD episode
o B. There has NEVER been a manic episode
o C. The occurrence of hypomanic and major depressive episode(s) not better explained by schizoaffective disorder
explain the prevelance for bipolar
Prevalence bipolar less common than o 1% for Bipolar I; 0.5% for Bipolar II * But more severe – hospitalisation more likely * And more recurrent than MDD o No gender differences
what are the gender differences for bipolar
No gender differences
what bipolar is most likely to have a biological cause
bipolar 1
explain the heridtability of bipolar s
Genetic heritability
o Bipolar disorder one of most heritable conditions (Edvardsen, et al 2008)
o As high as 93% in some twin studies
* Also supported in adoption studies
o But genetics do not explain timing of mood swings
explain the biological causes ofbipolar
Neurotransmitters
o Facilitate activity between neurons
o Norepinephrine, dopamine, and serotonin strongly implicated
* High levels in manic
o Possible explanations relate to dopamine receptors
* Overly sensitive in bipolar
o We will revisit these models when we examine drug treatment
* Ion activity
o Ions are crucial for relaying messages within neurons
* Action involves potassium and sodium ions
o The pace of this activity regulates how often neurons ‘fire’
o Argued that irregular firing related to mood disorders (Manji & Zarate, 2011)
* Firing too quickly — mania
* Firing too slowly — depressio
esplain a psychological explanation of bipolar
Psychodynamic, behavioural and cognitive explanations are weak for manic symptoms, but… o Life events can trigger symptoms o Other potential triggers * Stressful or distressing events * Childbirth * Relationship breakdown * Money problems * Childhood sexual abuse * May be related to ion activity (Etain, et al., 2017) Impact of bipolar disorders * Relationships * Employment * University performance * Legal or financial consequences * Side effects from prolonged abuse of drugs/alcohol * Repetitive self-harming behaviours * Suicide
describe the link between suicide and bipolar
Suicide attempts more frequent in bipolar disorder than depression (Kessler, Borges, & Walters, 1999)
o Although attempts tend not occur during mania
* Supported by further evidence…
o Patients admitted after suicide attempt: 28% MDD dx; 39% BP (Raja & Azzoni, 2004)
o BP patients more suicide attempts (27%) than MDD pts (18%; Bottlender et al., 2000)
o Risk for death by suicide in BP patients 20–30 times higher than general population (Pompili et al., 2013)
explain some medical treatments for bipolar and their side effects
Typical treatments (see Grunze et al 2010 for overview):
o Mood stabilisers
o And/or antipsychotic medication
* Some mood stabilisers only treat mania (and mood cycling)
o But not effective for depression
* Valproic acid, carbamazepine
o Others can also treat depressive symptoms
* Lamotrigine, lithium carbonate
* Some atypical antipsychotics also have mood stabilizing effects
o Normally used to treat psychoses
* But useful in severe depression (including ‘psychotic’ type)
o Some of the most common include:
* Clozapine, olanzapine, quetiapine, aripiprazole, risperidone
* Lithium carbonate frequently used in bipolar disorder
o Mania associated with irregular ‘protein kinase C’ (PKC) activity
* Lithium carbonate inhibits PKC activity
* Side effects
o Discomfort, frequent urination, mild thirst, nausea, diarrhoea, drowsiness, lack of coordination, muscle weakness, vomiting
* Dose must be calculated to body weight
o Dosage needs to be high enough to work
* But not too close to toxicity levels
Blood levels and kidney function should be monitored closely
describe the effectiveness of medication on bipolar
Lithium has better efficacy than several comparator treatments
o Chlorpromazine, sodium valproate
* And as good as risperidone
o Generally better side effect profiles too
* Considered to be best ‘first-line’ treatment
* Antipsychotics, such as quetiapine, better as ‘second-line’ (Brahm et al 2007)
o Although some studies suggest antipsychotics should be added to lithium
* e.g. Lithium and quetiapine better efficacy than lithium alone (Vieta et al 2008)
