Mania and Bipolar disorder

Question 1

Mania definition:

Answer 1

1. Distinct, abnormal, elevated, expansive (or IRRITABLE MOOD) for AT LEAST 7 days;
   Need AT LEAST 3 symptoms for at least 7 DAYS!!!:
2. Distractible (during MANIC state)
3. Talkative (faster and almost pressured speech)
4. Racing thoughts
5. Hyperactive (can get more done)
6. Impulsive
7. Grandiose/high self-esteem (I just made a currency and it will END POVERTY!!)
8. Hyposomnic
   DTRHIGH!!!!!

MUST cause distress/dysfunction and CANNOT be due to another disorder, medical condition, or substance misuse

Question 2

Hypomania: how is this defined?

Answer 2

1. Milder mania (“half-mania”)
2. AT LEAST 4 days or more
3. Same symptoms as mania
4. Symptoms must provide UNEQUIVOCAL change in function, personality and be clearly noted by others
5. Not severe enough to cause MARKED IMPAIRMENT (not causing as much distress/dysfunction as e.g. full mania);
   Still must not be attributable to another cause (like mania)

Question 3

MDE is what? What does it accompany?

Answer 3

Pervasive SAD, down, irritable mood (at least 2 WEEKS); need at least four other symptoms accompanying!!
again, same caveats as mania in terms of what it must cause and what it cannot be due to!!

Question 4

Affect range from the bottom to the top?

Answer 4

1. Depression (pervasive sadness)
2. Dysthymia (“half-depressed”)
3. Euthymia (normal mood)
4. Hypomania (“half-mania”)
5. Mania

Question 5

If anyone is at half depression or mania, there is increased risk of

Answer 5

relapse (don’t want them stuck in this zone!!)

Question 6

A mixed state is

Answer 6

when you’re manic and also enduring full blown depression (MDE)

Question 7

In bipolar 1, what must be present? What is a risk that comes along with one of these particular episodes?

Answer 7

MANIA must be there (could or might not have MDE unless you have e.g. mixed episodes);
in the case of a mixed episode, if you know you might endure MDE, there is a high suicide risk as you go from full mania to even hypomania!!

Question 8

In bipolar 2, what must be present?

Answer 8

You hit HYPOMANIA but never mania (there is an accompanying depressive episode)

Question 9

In cyclothymia, what are you stuck with?

Answer 9

You have MILD depression and you are stuck at HYPOmania for at least 2 years (once you hit MANIA you no longer have cyclothymia!!)

Question 10

Other characteristics associated with bipolar disorder? 11

Answer 10

1. Increased SEXUAL activity (appetite)
2. Increase in SEDUCTIVE, flashy dress and increased accessorizing (neon dress)
3. Increase in anger and escalation (don’t want self-esteem to take a hit)
4. Increased energy, more creative, thinking out of box
5. Potential for PSYCHOSIS (delusions, hallucinations, thought disorder)
6. Greater likelihood of job loss, relationship issues, legal problems
7. More time depressed than manic
8. Depressed phase = more disabling; manic phase = catastrophic
9. Can take a DECADE and FOUR doctors to obtain right diagnosis
10. About .5 of patients don’t remember/report previous mania
11. Average patient could spend 6 months EUTHYMIC!!

Question 11

Biological factors for bipolar disorder? Occurrence? Some psychological factors potentially?

Answer 11

Altered NT activity (more NE, SR, NE); monamine receptor deficiency theory (too much NT, little receptor), genetics (high association), kindling hypothesis (too much neuronal firing in limbic system and use anti-epilepsy drugs to block Na channels!!

Think same in women and men for bipolar 1, more women than men in bipolar 2

Psychosocial: low self esteem, catastrophic loss (mom dying), demeaning parents = potential denial; STRESS can lower compliance, disrupt sleep, increase SUBSTANCE ABUSE!!

Question 12

Use antidepressants for bipolar depression?

Answer 12

Try to avoid them!! If you must use them, use mood stabilizer FIRST, followed by antidepressant (antidepressant alone could mean increased mania and instability)

Question 13

Instead, what can you use to treat bipolar disorder?

Answer 13

Atypical antipsychotics (block DA-2 receptor to treat mania or prevent it; also block 5HT2a receptors to treat depression), and some of these have SSRI and NRI properties

Antimanic agents/mood stabilizers:
Think LITHIUM (provide Ca membrane stability and promote neuronal health and protective factors), but could hurt kidney and thyroid and increase WBC;
Divalproex (increase GABA activity/tone), but hurt platelets);
Carbamazepine (block Na channels and promote neuronal health), but APLASTIC ANEMIA risk!!

Question 14

Does psychotherapy have place for treating bipolar disorder?

Answer 14

NOT FOR THE DEPRESSED PHASE; can help during maintenance phase and EDUCATE patient!!