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psychopathology > Mood Disorders - Bipolar I & II > Flashcards

Mood Disorders - Bipolar I & II Flashcards

1
Q

menmonic for bipolar symptoms

A

DIGFAST

Distractibility 
Insomnia
Grandiosity
Flight of ideas
Activities
Speech 
Thoughtlessness
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2
Q

DSM IV criteria for manic episode

A

A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).

The symptoms do not meet criteria for a Mixed Episode.

The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

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3
Q

DSM iV crtieria for a mixed episode

A

The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.

The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.

The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

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4
Q

DSM IV crtieria for hypomanic episdoe

A

A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.

The disturbance in mood and the change in functioning are observable by others.

The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.

The symptoms are not due to the direct physiological effects of a substance or a general medical condition.

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5
Q

DSM crtieria for BP I

A

Presence of at least one Manic or Mixed Episode

Manic/Mixed Episode(s) are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS

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6
Q

DSM IV certeria for BP II

A

Presence (or history) of one or more Major Depressive Episodes.

Presence (or history) of at least one Hypomanic Episode.

There has never been a Manic Episode or a Mixed Episode.

The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

not due to substamce or GM

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7
Q

DSM criteria for cyclothymia

A

For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.

During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.

No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.

The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.

not substance or GMC

clinically sig distress or impairment

Note: In children and adolescents, the duration must be at least 1 year.

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8
Q

differential diagnosis with BP

A

MDD – carefull assessment for manic symptoms (collateral information, second opinion)
Substance-related mood d/o
mood d/o due to GMC
sz/szaffective d/o (chronic vs. episodic)
personality d/o (chronic vs. episodic)
ADHD (chronic vs. episodic; AAO, ADHD is typically earlier than BP)

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9
Q

variations of BP D/o

A

Bipolar I Disorder: 1 or more manic/mixed episode

  • Single Manic Episode
  • Most Recent Episode: Hypomanic, Manic, Mixed, Depressed, Unspecified

Bipolar II Disorder: 1 or more MDE, 1 or more hypomanic, no mania/mixed episodes
-Most Recent Episode: Hypomanic, Depressed

Cyclothymia: 2 or more years, periods of hypomanic & depressive sxs, no full criteria for MDE, Manic, Mixed episode

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10
Q

lifetime prev rates for BP I

A

.4-1.6%

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11
Q

difference in prev rates based on race?

A

no

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12
Q

difference in prev rates based on gender?

A

no

though onset and course for women is characteried by more MDEs than men

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13
Q

what proportion of Px’s with BP commit suicide?

A

10-15%

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14
Q

can aggressive and violent bx occur during a manic or mixed episode?

A

yes

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15
Q

what percentage of Px’s with BP experience more than one manic episode?

A

90%

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16
Q

if untreated, on average, how many manic episodes does an individual have in 10 yer?

A

4

17
Q

regarding relapse, for Px’s who comply with med tx…

A

1/3 relapse within 3 years

18
Q

regarding relapse, in naturlistic studies with varying levels of tx compliance…

A

2/3 relapse within 2 years

19
Q

BP is the ____ leading cause of disability (both physical and psych)

A

6th

20
Q

in 1999, estimated fiscal cost for americans with BP

A

45 million

21
Q

where does the info on the last four cards come from?

A

Johnson et al., 2000

22
Q

describe the etiology of BP

A

Evidence for genetic component from adoption and twin studies – 50 to 80%

Neurotransmitter dysfunction

  • Dopamine dysregulation (and serotonin)
  • Don’t fully understand the mechanisms here

Brain regions

  • Elevated activity in amygdala
  • Diminished activity in prefrontal cortex

Milkowitz and Johnson, 2006

23
Q

Broadly, what does the research say about LE’s and BP

A

Research has found that stressful life events play a role in the onset of and recovery from episodes of depression and mania

Hlastala, et al., 2000

24
Q

What are some findings from cross section research on LE’s (gen) and BP; what are the limitations

A

LE’s more common before bipolar episodes than they are in general population
–56% of px’s with BP report a major role loss before a major episode

LE’s more likely to occur before a bipolar relapse (i.e., new episode) than after

Severe LE’s 4X as common in the month before relapse and 2X as common in the 2 months before relapse compared with control periods

Limitations: causal inferences (temporal precedence); self-report (longterm/emotional recall, emotionally laden material, social desirability)

25
Q

What are some findings from prospective studies on BP and LE’s (gen)

A

Severe, negative, independent LE’s found to predict a 4-fold increase in risk of relapse and a 3-fold increase in time to recovery

LE’s appear to be equally common before bipolar and unipolar depressive episodes

26
Q

What are the findings around neg LE’s (specifically) and mania?

A

don’t have the evidence to make confident inferences either way

Few cross-sectional studies find a link between negative LE’s and mania

No prospective study has found that negative LE’s directly predict manic symptoms

Johnson, et al. 2004 found that people who were already mildly hypomanic before a negative LE were more likely to become manic after it

27
Q

What are some findings about other specific kinds of LE’s and BP

A

LE’s that involve sleep disruptions appear to occur before manic episodes
-E.g. shift work, travel, generally accepted

LE’s involving goal attainment predict increases in manic symptoms

  • When someone attains a goal their rewrd sensitiveiy is likely increased. And peple with Bp are elvetated to start with
  • At least two prospective studies: goal attn. LE predicted manic episode w/ 2 mos.
28
Q

name two different models for BP

A

Gray’s BIS/BAS model (johnson et al. 2000)

CT model (Newman et al., 2002)

29
Q

Describe the BIS

A

Sensitive to environmental cues of punishment
Regulates inhibition/avoidance of these cues
Related to anxiety

30
Q

describe the BAS

A

Sensitive to environmental cues of reward
Regulates approach behaviors
Related to feelings of hope, elation, and happiness

31
Q

The main idea of Johnson’s BIS/BAS model of BP & supporting evidence from research on goal attainment and BP

A

Goal-attainment positive events predict mania, but not depression in bipolar disorder

Supports previous studies that have found that broadly defined positive events are not related to mania

Bipolar individuals do not differ from “normals” in terms of the nature of their goal-attainment events but in their ability to regulate motivation and affect following these events

32
Q

Clinical implication of this model/research?

A

Therapy is about goal attainment, careful balance between treatment progress and triggering a manic episode

33
Q

CT conceptualization

A

Schemas develop from negative experiences early in childhood

Schemas are activated by significant life events which result in affective changes

Schemas influence information processing by “mental filtering” (e.g. attentional biases)

Schemas contribute to people using faulty compensatory strategies that reinforce and perpetuate the problems that support the formation of the schemas

Bipolar patients seem to maintain consistent maladaptive schemas that shift polarity

A negatively valenced schema is activated during the depressed phase

A positively valenced schema is activated during the manic phase

I’m worthless to I’m worth more than one could imagine

CBT is an effective adjunctive treatment (treatment frontline tx) – but doesn’t mean the mdoel based on this thoery is correct

34
Q

med treatments for BP

A

Lithium: control acute episode, prevent future episodes

Anticonvulsants: onset of action is faster

Antipsychotics: tx associated symptoms

Benzodiazepines: behavioral control, sleep

35
Q

Psychosocial tx’s for BP

A

Family Focused Treatment

  • Focus on expressed emotion within family
  • amount of criticalness expressed
  • some families are overly intrusive
  • these things are risk factors for relaspe
  • include psyched, communication training, etc.

Interpersonal and Social Rhythm Therapy

  • Focus on life events that may trigger episodes
  • tends to focus on the LE’s
  • psychoedu (gaining insight into own trigggers),
  • also behaviorally focused at minimizing disruptions (e.g. in sleep cycle)
  • show to be effective for increasing the time until the next episode

CBT

  • Focus on beliefs & cognitions related to medication compliance
  • focus on cogs that activate depression/mania
  • focus on med compliance (experiences)
  • some support, not all that impressive, better for people in earlier stages of the disorder
36
Q

How do you choose between treatment options?

A

Thorough hx, individual characteristics, past successful treatment,
-can always provide multiple options and allow for client to choose between them – my increase engagement in treatment

psychopathology (6 decks)

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