Mood Disorders: Bipolar Disorder

Question 1

Bipolar disorder

Answer 1

Mood disorder marked by manic/hypomanic episodes and depressive episodes (previously called manic depression).

Question 2

Manic episodes

Answer 2

Elevated, expansive or irritable mood with increased goal-directed activity or energy for at least 1 week, plus at least one of the following:
Inflated self esteem or grandiosity, sleep disturbance (decreased), pressure of speech, flight of ideas, distractibility, heightened activity, risk taking.

Question 3

Hypomanic episode

Answer 3

Only requires symptoms to be present for at least 4 days, and symptoms tend to be less severe

Question 4

Bipolar l

Answer 4

‘More mania’
Presence of one or more manic episodes.
Major depression may be present but not required for the diagnosis.

Question 5

Bipolar ll

Answer 5

‘More depression’
At least one episode of major depression.
At least one period of hypomania.
Must not have had a manic episode.

Question 6

Cyclothymic disorder

Answer 6

Symptoms are less severe but more chronic.
Numerous periods of elevated and depressed mood but not severe enough to meet criteria for hypomanic, manic, or major depressive episode.

Question 7

Rapid cycling bipolar disorder

Answer 7

Diagnosis given then an individual has four of more bipolar episodes (mania or depression) within a single year.

Question 8

Problems with underdiagosis and overdiagnosis of bipolar disorder

Answer 8

Patients with bipolar disorder may be misdiagnosed as having schizophrenia (men) or MDD (women).
Schizophrenia: misdiagnosed because similarities between psychotic features of acute mania and schizophrenia (eg delusions and hallucinations)
MDD: misdiagnosed because past episodes of mania or hypomania not explored by clinician.
Brief periods of elevated mood may be wrongly diagnosed as hypomania (common for those with BPD; could mean inappropriate use of mood-stabilising medications).

Question 9

Prevalence of bipolar disorder

Answer 9

Lifetime prevalence of 1.3%.
12-month prevalence of 0.9%.
Men and women are equally likely to meet criteria for bipolar l disorder.
Women more likely to meet criteria for bipolar ll disorder.

Question 10

Age of onset of bipolar disorder

Answer 10

Median age of onset is around 25 years.

If no episodes by 25, usually unlikely to have bipolar disorder.

Question 11

Course of bipolar disorder

Answer 11

Most time is spent in depressive episodes, compared to manic or hypomanic episodes.
Median duration is 15 weeks for bipolar depressive episodes, 7 weeks for manic episodes, and 3 weeks for hypomania episodes.
High rates of relapse - made worse by poor medication compliance and low levels of acceptance of diagnosis.

Question 12

Problems associated with bipolar disorder: anxiety disorders

Answer 12

Nearly one in two individuals with bipolar disorder have a diagnosis of at least one anxiety disorder - high comorbidity.
Anxiety symptoms proceeded, occurred during and followed (hypo)manic symptoms depending on the type of comorbid disorder.
Anxiety may be an initial sign of bipolar.
Anxiety disorders usually treated with antidepressants which may trigger manic symptoms.
Social phobia seems to proceed mania.

Question 13

Problems associated with bipolar disorder: substance misuse

Answer 13

Reported in 39% of people with bipolar disorder.
Drugs are commonly used to self-medicate against emotional disturbances, but unfortunately lead to mood destabilisation.
Manic symptoms may be part of substance intoxication or withdrawal.
Important to delay diagnosis until drugs or alcohol are no longer affecting patient.

Question 14

Problems associated with bipolar disorder: social and economic cost

Answer 14

Following manic episodes, one-third of patients cannot work for 6 months and only one-fifth return to work at their former skill level.
Almost 5 times more likely to have disrupted relationships compared to the general population.

Question 15

Problems associated with bipolar disorder: suicide

Answer 15

Suicide rate is nearly 15 times that of the general population.
25% of patients attempt suicide
10-20% of patients complete suicide

Question 16

Bipolar disorder and creativity

Answer 16

Potential association between bipolar disorder and creativity.
Research findings are inconsistent, but many people with bipolar disorder identify as creative.
Elevated moods may increase quantity of creative output, but not necessarily quality. Thus medication may benefit creative expression.

Question 17

Aetiology of bipolar disorder: biological factors

Answer 17

Lifetime risk in family members of bipolar disorder patients is about 10% compared to about 1-1.5% in general population.
Twin studies suggest a heritability of about 85%.

Question 18

Aetiology of bipolar disorder: stressful life events

Answer 18

Diathesis-stress model: disorders result from interaction between underlying vulnerabilities and stressful life events.
Goal dysregulation model: theory that manic episodes may be triggered by dysregulated goal pursuit, which entails the person being excessively involved in the pursuit of goals.

Question 19

Aetiology of bipolar disorder: psychological factors

Answer 19

Greater negative beliefs about oneself - manic episodes inhibit these thoughts (avoid negative thoughts).
Temperamental differences in people with bipolar disorder.

Question 20

Treatment of bipolar disorder: pharmacological approaches

Answer 20

Mood stabilisers eg. lithium and anticonvulsants

Question 21

Treatment of bipolar disorder: Psychological approaches - psychoeducation

Answer 21

Treatment technique that involves providing patient with information about nature, causes, effects, and treatment of psychology problem.
Providing education regarding importance of identifying early signs of relapse so that preventative action can be taken; medication adherence; minimising risk factors.

Question 22

Treatment of bipolar disorder: Psychological approaches - CBT

Answer 22

Cognitive restructuring: identifying and challenging hyper-positive cognitions and negative underlying beliefs.
Foster self-efficacy

Question 23

Treatment of bipolar disorder: Psychological approaches - interpersonal and social rhythm therapy (IPSRT)

Answer 23

Reducing disruptions in daily routines and sleep/wake cycles that trigger bipolar episodes.
Patients taught to regulate social rhythms and address interpersonal difficulties that may be triggering or maintaining emotional instability.

Question 24

Treatment of bipolar disorder: Psychological approaches - family interventions

Answer 24

Reduce relapse by improving family’s knowledge about bipolar disorder, communication and problem-solving skills.

Question 25

Treatment of bipolar disorder: Psychological approaches - relapse prevention

Answer 25

70-75% of patients have at least one relapse within 4-5 years after recovering.
Medication
CBT: psychoeducation, medicine compliance and establishing a daily routine.
Patients are taught to self-monitor early signs of relapse.
Instability model of bipolar disorder

Question 26

Instability model of bipolar disorder

Answer 26

4 key mechanisms that trigger relapse: biological vulnerability (neurotransmitter disturbance), medication non-adherence, disrupted routines, and dysfunctional interpretations of life events.
These mechanisms can lead to relapse via a common pathway of sleep disruption.

Question 27

Treatment of bipolar disorder: Psychological approaches - hospitalisation

Answer 27

When patients are suicidal or psychotic.

Question 28

Treatment of bipolar disorder: Psychological approaches - new developments

Answer 28

Mindfulness-based cognitive therapy
Internet-based treatments
Focus on quality of life
Self-management for bipolar disorder focusing on wellness and personal recovery.