Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Mental health and Wellbeing > Week 9 Lecture 9 - bipolar disorder > Flashcards

Week 9 Lecture 9 - bipolar disorder Flashcards

1
Q

What is the Mood Disorder Questionnaire?

A

a self-report inventory that screens for
a lifetime history of (hypo)manic experiences

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What did a study by Udachina, A., & Mansell, W. (2007) investigating Self-reported History of Hypomanic Symptoms
in a Student Population find?

A

most students had experienced at least 1 symptom of hypomania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the characterisations of mood episodes in bipolar disorder?

A
  • The mood episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The disturbance in mood and change in functioning is observable by others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the symptoms of major depression?

A

At least 2 weeks of:
-Depressed mood
and / or
-Markedly diminished interest or pleasure in activities

Plus at least three symptoms:
-Significant change in appetite or weight
-Insomnia or hypersomnia
-Psychomotor agitation / retardation
-Fatigue or loss of energy
-Feelings of worthlessness and/or inappropriate guilt
-Diminished ability to think or concentrate
-Recurrent thoughts of death, suicidal ideation, suicide attempt, or a specific plan for committing suicide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of mania and hypomania?

A

Mania (at least 1 week )
Hypomania (at least 4 days) of:
- abnormally + persistently elevated, expansive or irritable mood
and
- abnormally & persistently increased activity or energy

Plus at least three or more of:
- Inflated self esteem / grandiosity
- Decreased need for sleep
- More talkative than usual, pressure of speech
- Flight of ideas, thoughts racing
- Distractibility
- Increased in goal-directed activity
- Excessive involvement in pleasurable activities - may have high potential for painful consequences

Mania must lead to marked impairment in social or occupational functioning, hospitalisation, or psychosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are some predictors of relapse in mood disorders?

A
  • Stressful interpersonal life events
    -High ‘Expressed Emotion’ (hostility, overprotectiveness, criticism) in family members
    -Disrupted social rhythm events including
    sleep changes
    *Goal-attainment Events *manic symptoms and not depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is cyclothymia?

A

For at least 2 years:
- numerous periods of hypomanic
symptoms not meeting threshold for
hypomanic episodes
- Numerous periods of depressed mood /
loss of interest that do not meet depression

The symptoms cause clinically significant
distress or impairment in:
- Social
- Occupational
- Or other important areas of functioning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the different types of other specified bipolar disorder?

A
  • Short-duration hypomanic like episodes (2-3 days) and major depressive episodes
  • Hypomanic-like episodes with insufficient
    symptoms and major depressive episodes
  • Hypomanic episodes without prior major
    depressive episode(s)
  • Short-duration cyclothymia
  • Short-duration manic-like episodes
  • Unable to determine whether bipolar or
    related disorder is primary
  • Other (describe)
  • Unspecified
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the Bipolar at Risk (BAR) criteria?

A

Standardised Bipolar At Risk (BAR) criteria developed by Bechdolf & colleagues (2010):
- Youth (15-25) experiencing:
- Short duration high mood
- Short duration high & low mood
- First degree relative with BD plus low mood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What did early detection of BD focus on?

A

familial risk and identification of state-trait factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Does BAR criteria have predictive validity?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Can BAR criteria be used to reliably assess someone in an NHS context?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Does BAR criteria hold clinical utility?

A

yes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the importance of early identification in BD?

A
  • Bipolar disorder affects 1-3% of the population
  • Average duration of untreated illness (DUI) is 6-10 years, or longer for onset in adolescence
    -Longer DUI is associated with more mood
    episodes & higher risks of suicide
    -Economic impact of Bipolar Disorder in the UK is projected to be £8.2 billion by 2026
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are some biological factors of mood disorders that should be taken into account?

A
  • high heritability
  • separate heritability of mania and depression
  • genes for mania may involve reward pathways i.e., dopamine function
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Seal et al. (2008) investigated “resistance” to BD.

Who were the ppts?

A
  • 12 individuals aged 30+, most with a history of diagnosable hypomanic episodes
  • Never sought treatment
    -No history of clinical depression
    -No diagnosis of bipolar disorder
17
Q

Seal et al. (2008) investigated “resistance” to BD.

What were the key findings?

A
  • High levels of functioning
  • Lower levels of catastrophising about
    changes in internal states
  • Reported ‘awareness’ of behaviour and
    social impact when feeling high
18
Q

what are the NICE guidelines for treating BD?

A

Primary Care:
- Review treatment & care, inc medication
- Offer choice of an evidence-based psychological intervention
developed for BD

Secondary Care (for deterioration in depressive symptoms, signs of hypomania, or mania (refer urgently)):
- Pharmacological interventions:
* If mania/hypomania develops & person is taking antidepressant, consider
stopping the antidepressant and offer an antipsychotic
- Offer evidence-based psychological intervention

19
Q

What are the treatments for BD?

A
  • medication
  • psychological treatments
20
Q

What are the medications for BD?

A
  • mood stabilisers (e.g. lithium) but also anti-depressants, and ant-psychotics
  • However high relapse rates despite adequate medication
21
Q

What are the psychological treatments for BD?

A
  • relapse prevention or psychoeducation
  • family focused therapy
  • CBT
22
Q

What does psychoeducation/ relapse prevention provide?

A

Provide information about bipolar disorder and how people with bipolar disorder learn to cope better

23
Q

What does psychoeducation/ relapse prevention identify?

A

Identify warning signs – also called ‘prodromes’ or ‘relapse signature’
- Changes in thoughts, feelings, behaviours
- Quantified and grounded in personal experience
- Judge early, middle and late strategies

24
Q

Who does psychoeducation/ relapse prevention work with?

A

Work collaboratively to identify effective
coping strategies, e.g. relax, postpone
behaviour, get feedback from family members

25
Q

Give 2 examples of studies on the efficacy of relapse prevention

A

Perry et al. (1999)
Intervention:
- 7-12 sessions of individual relapse prevention vs. treatment as usual
Results:
- Over 18 months, longer time to relapse with mania but no effects on time to relapse with depression

Colom et al. (2003)
Intervention:
- 21 sessions of group psychoeducation versus treatment as usual
Results:
- Reduced rates of relapse of mania and depression over 2 years

26
Q

Who does Family Focused Therapy work with?

A

Work with families or groups of families

27
Q

What does Family Focused Therapy provide?

A

Provide psychoeducation to improve their
understanding of bipolar – non-blaming

28
Q

What does Family Focused Therapy identify?

A

Identify hostility, criticism and
overprotectiveness & help build up more
collaborative, positive communication

29
Q

Give 2 examples of studies on the efficacy of FFT

A

Miklowitz et al. (2003)
Intervention:
- 21 sessions of family-focused psychoeducation and behavioural intervention vs crisis management
Results:
- Reduced relapse rates and mood symptoms over 2 years

Rea et al. (2003)
- Compared FFT to individual psychoeducation
Results:
- lower rates of rehospitalisation

30
Q

What is CBT for BD?

A
  • Develop problem list with client
  • During depression, identify ‘negative
    automatic thoughts’ & challenge; activity
    scheduling
  • During hypomania, identify coping strategies
  • During remission, engage in relapse
    prevention
  • May develop a personalised formulation of client’s ‘schemas’ – problematic personal rules & test with behavioural experiments
  • E.g. ‘I must be a complete success or my life is worthless’ – experiment with ‘less than perfect’ work
31
Q

Give 2 examples of studies on the efficacy of CBT

A

Lam et al., (2003, 2005)
Intervention:
- 20 sessions Individual CBT vs treatment as usual
Results:
- Reduced symptoms of depression, longer time to relapse over 2 years, improved functioning

STEP trial – Systematic Treatment Enhancement Programme (Miklowitz et al., 2007)
- 15 sites across USA
- Equal efficacy of 30 sessions of FFT, interpersonal therapy and CBT vs. minimal care
- Intensive psychological therapies are all effective in community settings

  • But effect sizes are modest, and focus is on prevention of relapse rather than current symptoms and recovery
32
Q

What is an integrative Cognitive Model (BD)

A
  • Mood swings are a consequence of multiple, conflicted, extreme, personal appraisals of changes in internal state
  • Leads to internal struggle trying to exert extreme control over internal states rather than active, successful ways of pursuing goals

e.g.,
feelings of high energy = imminent success
vs. feelings of high energy = mental breakdown

33
Q

What are the subscales of the Hypomanic and Positive Predictions Inventory (HAPPI)(Mansell et al. 2006)?

A

rate how much you believe statements on a scale of 1-100

  • Social Self Criticism –> reflecting self-critical beliefs and beliefs that others were critical, particularly in a social context
  • Increasing Activation To Avoid Failure –> beliefs about needing to remain ‘on the go’ and active in order to avert failure provide another predisposing factor for striving to experience highly activated states
  • Success Activation & Triumph Over Fear –> beliefs about extreme optimism and self-confidence, invincibility and desirability
  • Loss of Control –> includes items pertaining to losing control of moods and thoughts
  • Grandiose Appraisals of Ideation –>extreme social aspirations and positive appraisals of idea generation reflected a cognitive style consistent with an ‘achievement striving’ personality
  • Regaining Autonomy –> includes beliefs about ignoring advice from others and striving for autonomy
34
Q

What does TEAMS therapy involve?

A
  • Focused on present problems, e.g. depression, anxiety
  • Working through the principle of safety – engagement –experience – formulation – change
  • Identify core personal goals and values
  • Explore and monitor internal states on a continuum and identify their various appraisals
  • Facilitate reappraisals and broaden ‘bandwidth’ in internal states that are tolerated and acceptable
  • Form a flexible ‘healthy self’ that achieves goals that are less dependent on internal states
35
Q

Give a brief summary of what TEAMS therapy involves

A
  • goal identification –> Expressing needs is a major factor in recovery
  • exploring internal states –> Feelings are a normal and important part of life
  • plotting a continuum –> thinking in “shades of grey” is more effective than black and white
  • pros and cons –> all moods have both advantages and drawbacks
36
Q

From bottom to top, what is the pyramid of therapy principles that is followed in the TEAMS therapy?

A
  • safety
  • engagement
  • experiential processing
  • awareness of formulation
  • change and recovery
37
Q

What is the next research priority for BD?

A
  • treatments for Bipolar at risk
  • CBT may be effective for people at-risk of BD
  • early intervention in psychosis showed health and economic benefits
  • if applied to BD and those at risk of BD, this could yield £29 million in savings in the UK

Mental health and Wellbeing (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions