Mood Disorders - Bipolar Disorders Flashcards
1
Q
DSM-5 criteria for bipolar I
A
- at least one manic episode
- hypomanic episodes often occur, but not necessarily
- major depressive episode usually occurs, but not necessarily
2
Q
DSM-5 criteria for bipolar 2
A
- at lest one hypomanic episode
- no history of manic episode
- at least one major depressive episode
3
Q
DSM-5 criteria for manic episode
A
- at least 3 of these (change from baseline)
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. talkative, pressured speech
4. flight of ideas, racing thoughts
5. distractible
6. increase in goal-directed activity or psychomotor agitation
7. excessive sensation-seeking/risky activity
8. irritability (*4 if this is one of them) - present most of the day for at least 1 week
- causes significant impairment in functioning or necessitates hospitalization
4
Q
DSM-5 criteria for hypomanic episode
A
- at least 3 of these (change from baseline)
1. inflated self-esteem or grandiosity
2. decreased need for sleep
3. talkative, pressured speech
4. flight of ideas, racing thoughts
5. distractible
6. increase in goal-directed activity or psychomotor agitation
7. excessive sensation-seeking/risky activity
8. irritability (*4 if this is one of them) - present most of the day for at least 4 days
- symptoms do not cause marked impairment in social or occupational functioning
5
Q
range of mood symptoms in bipolar disorders
A
- manic
- hypomanic
- normal
- dysthymic
- major depressioin
6
Q
DSM-5 criteria for cyclothymic disorder
A
- milder hypomanic symptoms and milder depressed mood
- lasting at least 2 years
- no history of hypomanic, manic, or major depressive episode
7
Q
mixed features diagnosis
A
- meets criteria for MDE and mania at least 1 week, nearly everyday
- refer to graph in notebook
8
Q
rapid cycling
A
- 4+ mood episodes in given year
- poorer long-term prognosis
- about 1/3 with bipolar exhibit both mixed features and rapid cycling
9
Q
evaluating mood symptoms//
A
- diagnosis = complicated
- brief depressive and hypomanic symptoms can occur in individuals without a mood disorder
- depression and irritability occur both in depressive and bipolar disorders
- people often fail to report hypomanic symptoms
10
Q
prevalence of bipolar disorders: lifetime prevalence
A
- bipolar 1 = 0.4-1%
- bipolar 2 = 0.6-1.1%
- cyclothymia = 0.4-1%
11
Q
prevalence of bipolar disorders: peak age of onset
A
- late adolescence
- early adulthood
12
Q
prevalence of bipolar disorders: gender differences
A
- generally no sex difference for bipolar 1 and cyclothymia
- mixed data for bipolar 2
- rapid cycling and mixed features more common among women
13
Q
prevalence of bipolar disorders: manic and hypomanic recurrence
A
- 50% of cases have recurrence within 1 year
- more than 50% of cases have 4 episodes
14
Q
prevalence of bipolar disorders: comorbidity with SUD and anxiety
A
- women: higher rates of comorbid eating disorders and anxiety
- men: higher rates of comorbid SUD
15
Q
prevalence of bipolar disorders: suicide and unemployment
A
- suicide risks of people living with bipolar are 20% higher than found in general population
- higher rates ofunemployment
16
Q
etiology: biological
A
- heritability
- dysregulation in reward sensitivity
- neurotransmitter dysfunction
- functional and anatomical brain changes
17
Q
heritability
A
- concordance rate: MZ=72%, DZ=14%
- 65% of the variability in bipolar is genetic
- complex genetic basis involving interactions among multiple genes
1. bipolar 1 share genetic vulnerabilities with schizophrenia
2. bipolar 2 strongly related to depressive disorders
18
Q
dysregulation in reward system
A
- higher reward sensitivity + responding, leads to mania
- excessive activation of the behavioural activation system
- tendency to show anger and irritability in response to obstructed goals
19
Q
neurotransmitter dysfunction
A
- higher glutamate level
- certain drugs can trigger manic symptoms, suggesting neurotransmitters may play a role (SSRIs)
20
Q
functional and anatomical brain changes
A
- less activation in emotion regulation areas
- higher activation in emotional responsiveness areas
- reduced hippocampal volume and neurocognitive impairment
21
Q
etiology: psychological
A
- coping with stress
- prone to rumination
- cognitive deficits
22
Q
coping with stress
A
- individuals tend to cope with stress by disengagement
- tend to have limited adaptive coping and problem-solving skills
23
Q
cognitive deficits
A
- problems in psychological flexibility in response to feedback
- difficulty resricting irrelevant info when trying to achieve a goal
- difficulty holding and manipulating info in mind
24
Q
etiology: social and sociocultural
A
- early life stressors may lead to alterations in neurological functioning that increases vulnerability
- loss of social support or strained social relationships can trigger onset of hypomanic/manic/depressive symptoms
25
treatment goals
- therapy attempts to support recovery and eliminate symptoms as much as possible
- prevention of future episodes
26
treatments
- mood-stabilizing meds
- psychotherapy
- psychoeducation
27
mood-stabilizing meds
1. lithium
- most effective for bipolar disorder
- harmful side effects (kidney + thyroid function)
2. anticonvulsants (new)
- i.e. depakote, 50-60% response rate
3. antipsychotics (new)
- i.e. zyprexa
28
non-adherence rate for meds is ____
high
29
psychotherapy goal
- prevent relapse and hospitalization
- medication compliance
- enhance psychosocial functioning
30
psychotherapy: what is taught
- psychoeducation about symptoms and causes and treatments
- increase med compliance
- identify signs of impending mood episode
- teach communication and problem-solving skills to patient and family
- practice emotional regulation techniques
- understand dangers of substance abuse
