Lecture 9 Bipolar Disorders Flashcards
Bipolar disorders
- presence or history of manic, hypomanic episodes, depressive episodes
- functional impairment
- suicide risk
phases of illness
acute stabilisation–> ongoing maintenance–> relapse prevention
treatment differs based on
phase, severity, polarity
polarity
normal, manic (high), normal, depressive (low)
DSM 5
Criterion A
- abnormally and persistently elevated irritable mood and increased goal directed activity
- present nearly everyday
Manic ep: - at least 1 week
- nearly everyday
Hypomanic ep: - at least 4 consecutive days
- nearly everyday
Criterion B
- inflated self esteem
- don’t rly need to sleep
- rapid, pressured speech
- flight of ideas or racing thoughts
- distractibility
- increase in goal-directed activity
- trying to do stuff that have high chance of negative consequences
Manic and Hypo eps: - at least 3 or more
- show noticeable change from usual you
Bipolar 1: Manic ep?
Yes
Bipolar 1: Hypo?
can be present, but not necessary for diagnosis
Bipolar 1: Major depressive ep?
can be present, but not necessary for diagnosis
Bipolar 2: Manic ep?
No
Bipolar 2: Hypo?
Yes
Bipolar 2: Major depressive ep?
Yes
Bipolar 1
- distinct periods of manic and depressive eps
- ratio to manic to depressive eps–> 1:3
Mania - severity–> impairment, disrupt functioning (work, school)
- hospitalisation often needed
- can be psychotic features at severe end of mania
Bipolar 2
Hypomania
- less severe than mania
- uncharacteristic of person
- mood disturbance= noticeable to others
- shorter duration than manic eps
- not severe enough to disrupt functioning
- not severe enough to result in hospitalisation
Cyclothymic disorder
- constant
- less severe form of bipolar
- numerous cycles of hypomanic and depressive symptoms
- not severe enough for manic or major depressive eps
- symptoms: for at least 2 years but no more than 2 months without symptoms
bipolar treatment depends on…
- illness phase
- predominant polarity
goal of acute stabilisation
reduce arousal, agitation, aggression
acute stabilisation
polarity: Mania
- treated medically–> hospitalisation
- pharmacotherapy= 1st line treatment
- beh. disturbance= antipsychotic medication
- severe= ELT
acute stabilisation
polarity: Depression
- goal: achieve complete and functional remission of depressive symptoms
- suicidal risk
- pharmacotherapy used
- 2nd generation antipsychotics or mood stabilisers
acute stabilisation
ECT
- use when medication isn’t working
- effective for treating acute mania and severe depression
- short term effects: confusion, memory loss
- pharmacotherapy– to maintain mood stability and prevent relapse
ongoing maintenance
medical
- prophylactic medication– prevents future episodes
ongoing maintenance
psychological
- CBT
- interpersonal and social rhythm therapy
- psychoedu
- family-focused therapy
ongoing maintenance
pharmacotherapy
- mood stabilisers: ex. lithium
- anticonvulsants
- antipsychotics
- antidepressants
ongoing maintenance
monitoring maintenance
- physical examination
- tolerability of side effects
- efficacy of pharmacotherapy to manage symptoms
Lithium
- treat mania and depression
- neuroprotective and anti-suicidal properties
- lithium toxicity
- high blood concentrations= toxic
- need regular monitoring= prevent toxicity
CBT aim
manage symptoms and prevent relapse
effective for depressive eps
CBT key tech
- more effective for depressive eps and for fewer past episodes
patient encouraged to: - monitory symptoms
- challenge/ change unhelpful thinking
- foster self-efficacy
- join it with mindfulness based cognitive therapy
treatment phases:
1. individualised formation, treatment goals - psychoeducation
- identifying and challenging negative thoughts
- beh experiments
2. cog and beh approaches to symptom managements - self monitoring
- self regulation
3. dealing with cog and beh barriers to treatment adherence
4. anti-relapse tech - relapse prevention
Mindfulness-based cog therapy
aim: teach people to become aware of thoughts and feelings
Interpersonal and social rhythms therapy aim
- improve interpersonal functioning
- reduce disruption to daily routine and sleep-wake cycles
- try to maintain social rhythms
- fixing waking up time
Psychoeducation aim
improve knowledge about managing condition, prevent relapse
Fam -focused therapy
enhance cargivers’ way of managing
involves bipolar person and their fam
- comm skills, problem solving, psychoeducation
relapse prevention
- mood monitoring– daily mood chart
- noticing early signs of episode
- relapse prevention plan
- prevent manic thinking
