Maladie Affective Bipolaire Flashcards
what is the estimated lifetime prevalence of illness across bipolar I, II and subthreshold bipolar disorder subtypes according to the world mental health survey
2.4%
(1.5% 12 month prevalence)
what is the lifetime prevalence of bipolar I
0.6%
(0.4% 12 month prevalence)
what is the lifetime prevalence of bipolar II
0.4%
(0.3% 12 month prevalence)
what are the 3 “age of onset” age ranges for BDI
early onset (large/42%)–> around age 17 +/- 3 years
middle onset (smaller/26%)–> 24 years +/- 5 years
late onset (34%)–> 32 +- 12 years
what comorbid conditions/symptoms are associated with earlier age of onset
longer delay to treatment
greater depressive severity
higher levels of anxiety and substance use
in which cases should organic mania be considered and investigated
when mania onset occurs after age 50
(though manic episodes can occur for first time after age 50)
for what % of the time are people with BD generally unable to maintain proper work role function
about 30% of the time or mroe
why do we are about preventing mood episodes in BD
because on average the risk of recurrence increases with # of previous episodes
also–> number of previous episodes is associated with increased duration and symptomatic severity of subsequent episodes
also–> number of episodes is associated with lower threshold for developing further episodes
also–> increased risk of dementia with more episodes
what are the three broad clinical stages in the staging system for BD
- individuals at increased risk for developing BD due to family history as well as certain subsyndromal symptoms predictive of conversion to full BD
- patients with fewer episodes and optimal functioning in interepisodic periods
- patients with recurrent episodes as well as decline in functioning and cognition
*heterogeneity in BD has prevented clinical use of staging systems
list 10 features of depression that may increase suspicion of bipolarity
- earlier age of illness onset
- highly recurrent depressive episodes
- family history of BD
- depression with psychotic features
- psychomotor agitation
- atypical depressive symptoms
–hypersomnia
–hyperphagia
–leaden paralysis - postpartum depression and psychosis
- past suicide attempts
- antidepressant induced manic symptoms
- rapid cycling
what is the second most common misdiagnosis for BD
schizophrenia and other psychotic disorders –> occurs as initial diagnosis in asm any as 30% of patients
what is a good screening tool for flagging patients who may have signs/symptoms of BD
the Mood Disorders Questionnaire (MDQ)
this is a validated self report instrument
what % of identified patients with BD die by suicide
6-7%
what % of patients with BD worldwide report SI
43%
21% have plan
what % of patient with BD have attempted suicide in the past year worldwide
16%
list 9 factors that have been significantly associated with suicidal ATTEMPT in BD
- female sex
- younger age of illness onset
- depressive polarity of first illness episode
- depressive polarity of current or more recent episode
- comorbid anxiety disorder
- comorbid SUD
- comorbid cluster B/borderline PD
- first degree family history of suicide
- previous suicide attempts
what are the only two risk factors that have been significantly associated with suicide DEATHS in BD
- male sex
- first degree family history of suicide
*older age also results in a higher degree of lethality of attempts with higher ratio of death:attempts
what % of suicides in BD occur DURING an inpatient stay
14%
what % of suicides in BD occur within 6 weeks of discharge
26%
for which psychosocial interventions is there positive evidence in the maintenance phase of BD
CBT (2nd line)
family focused therapy (2nd line)
interpersonal and social rhythm therapy (3rd line)
peer support (3rd line)
what psychosocial intervention is first line in maintenance phase of BD
psychoeducation
how many sessions of individual psychoeducation would be required to be a first line intervention for relapse prevention in BD?
at least 5 sessions
level 2 evidence for relapse prevention
is CBT recommended in acute bipolar depression
yes–> second line–> level 2 evidence
how does interpersonal and social rhythm therapy differ from IPT
includes regulation of social and sleep rhythms specifically targeted to the bipolar population
24 individual sessions over 9 months