Mood Disorders: Bipolar Disorder Flashcards
Bipolar disorder
Mood disorder marked by manic/hypomanic episodes and depressive episodes (previously called manic depression).
Manic episodes
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.
Hypomanic episode
Only requires symptoms to be present for at least 4 days, and symptoms tend to be less severe
Bipolar l
‘More mania’
Presence of one or more manic episodes.
Major depression may be present but not required for the diagnosis.
Bipolar ll
‘More depression’
At least one episode of major depression.
At least one period of hypomania.
Must not have had a manic episode.
Cyclothymic disorder
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.
Rapid cycling bipolar disorder
Diagnosis given then an individual has four of more bipolar episodes (mania or depression) within a single year.
Problems with underdiagosis and overdiagnosis of bipolar disorder
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).
Prevalence of bipolar disorder
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.
Age of onset of bipolar disorder
Median age of onset is around 25 years.
If no episodes by 25, usually unlikely to have bipolar disorder.
Course of bipolar disorder
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.
Problems associated with bipolar disorder: anxiety disorders
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.
Problems associated with bipolar disorder: substance misuse
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.
Problems associated with bipolar disorder: social and economic cost
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.
Problems associated with bipolar disorder: suicide
Suicide rate is nearly 15 times that of the general population.
25% of patients attempt suicide
10-20% of patients complete suicide
Bipolar disorder and creativity
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.
Aetiology of bipolar disorder: biological factors
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%.
Aetiology of bipolar disorder: stressful life events
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.
Aetiology of bipolar disorder: psychological factors
Greater negative beliefs about oneself - manic episodes inhibit these thoughts (avoid negative thoughts).
Temperamental differences in people with bipolar disorder.
Treatment of bipolar disorder: pharmacological approaches
Mood stabilisers eg. lithium and anticonvulsants
Treatment of bipolar disorder: Psychological approaches - psychoeducation
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.
Treatment of bipolar disorder: Psychological approaches - CBT
Cognitive restructuring: identifying and challenging hyper-positive cognitions and negative underlying beliefs.
Foster self-efficacy
Treatment of bipolar disorder: Psychological approaches - interpersonal and social rhythm therapy (IPSRT)
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.
Treatment of bipolar disorder: Psychological approaches - family interventions
Reduce relapse by improving family’s knowledge about bipolar disorder, communication and problem-solving skills.
Treatment of bipolar disorder: Psychological approaches - relapse prevention
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
Instability model of bipolar disorder
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.
Treatment of bipolar disorder: Psychological approaches - hospitalisation
When patients are suicidal or psychotic.
Treatment of bipolar disorder: Psychological approaches - new developments
Mindfulness-based cognitive therapy
Internet-based treatments
Focus on quality of life
Self-management for bipolar disorder focusing on wellness and personal recovery.
