Flashcards in 12 Bipolar disorders Deck (61):
What category did Bipolar Disorder shift from (and to) from DSM-IV to DSM-5?
Was in Mood Disorders (DSM-IV)
Now in Bipolar and Related Disorders (DSM-5)
What are the three main disorders in the Bipolar and Related Disorders in the DSM-5?
1) Bipolar I
2) Bipolar II
3) Cyclothymic disorder
What pattern of episodes is necessary for diagnosis with Bipolar I?
Bipolar I Disorder
A. At least one Manic Episode
B. Presence of a Major Depressive Episode not necessary but common.
What pattern of episodes is necessary for diagnosis with Bipolar II?
A. At least one Major Depressive Episode (MDE)
B. At least one hypomanic episode
What are the symptoms of a Major Depressive Episode (MDE)?
A. At least 5 of below. Either 1 or 2 necessary.
1. Depressed mood most of the day, nearly every day
2. Markedly diminished pleasure/interest in activities
3. Significant weight loss or weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation
6. Fatigue/loss of energy nearly every day
7. Feelings of worthlessness, excessive guilt nearly every day
8. Diminished ability to concentrate nearly every day
9. Recurrent thoughts of death, suicide, suicide attempts.
What are the B and C criteria for a Major Depressive Episode (MDE)?
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a substance or another medical condition. Duh.
What is criterion A of a Manic Episode?
A. At least one week of abnormally and persistently elevated, expansive or irritable mood and increased goal-directed activity lasting one week and present nearly daily.
Is mood consistently euphoric during a manic episode?
No, episodes move quickly from an elated mood to an irritable mood or can fluctuate between elation and irritability.
What are the 7 symptoms in the B criterion for a Manic Episode?
At last 3 or more present to a significant degree and represent a noticeable change from usual behaviour.
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. Rapid or pressured speech
4. Flight of ideas or racing thoughts
6. Increase in goal-directed behaviour or psychomotor agitation
7. Excessive involvement in activities that have a high potential for negative consequences (e.g. buying sprees, sexual indiscretion)
What are the C and D criteria for a Manic Episode?
C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition.
What is the A criterion for a Hypomanic Episode?
At least 4 consecutive days of abnormally and persistently elevated, or irritable, mood.
What are the 7 symptoms in the B criterion for a Hypomanic Episode?
3 or more of the following:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative/pressured speech
4. Flight of ideas; racing thoughts
6. Increased goal-directed activity or psychomotor agitation
7. Excessive involvement in pleasurable activities which have a potential for negative consequences
What other 4 criteria (C-F) must be fulfilled for a Hypomanic Episode diagnosis?
C. The change must be uncharacteristic of the individual
D. The disturbance in mood and change in functioning are observable by others
E. The episode is not severe enough to cause marked impairment or hospitalisation – and no psychotic features
D. Not due to substances/medical condition. Duh.
What distinguishes a hypomanic episode from a manic episode?
A hypomanic episode has
- shorter duration
- is less intense
- does not cause same degree of impairment in functioning
- does not necessitate hospitalisation
Is a manic episode necessary for a Bipolar II diagnosis?
No, but you need at least 1 hypomanic episode.
Is an MDE necessary for Bipolar I diagnosis?
Not necessary, but common. May be just manic episodes.
Is a hypomanic episode necessary for Bipolar II diagnosis?
What is the key difference between bipolar I & II?
Manic episodes present only in bipolar I
What is cyclothymic disorder?
A less severe form of bipolar disorder with cycles of hypomania and depression symptoms – not severe enough to meet criteria for mania or MDE.
So euphoric highs and boosts of energy, less sleep – then severe swing into depression and negativity with no apparent reason.
What is a key feature of the mood swings in cyclothymia?
They occur without a visible trigger.
For how long must symptoms be present for a Cyclothymia diagnosis?
At least two years with no more than two months without symptoms.
What are bipolar disorders often misdiagnosed as?
What's the lifetime prevalence of Bipolar I?
.4% to 1.6%
What's the combined Bipolar I and II lifetime prevalence?
What's the lifetime prevalence for major depression?
What's the gender split in bipolar?
Equally distributed between men and women. Compared to unipolar, which has a 2:1 female:male
Is rapid mood cycling more common in men or women?
What's the peak onset period for bipolar disorders?
Between 15 and 25
How common is bipolar in children?
Rare before 12 years.
How many cycles of mania & depression does a bipolar individual usually have in a lifetime?
What percentage of individuals with bipolar have recurrent episodes?
40% relapse one year after treatment
60% within two years
73% within five years
What drug can be used to protect from relapse?
Lithium protects 25-50% from relapse – but issues with medication tolerance and compliance.
How does bipolar cycle length (onset of one episode to the next) change across lifetime?
1st-2nd – approx 36 months
2nd-3rd – approx 24 months
3rd- nth – approx 12 month
After 3-5 episodes, rate plateaus
What proportion of the time do individuals spent depressed/manic in bipolar I and II?
Bipolar I: 32% of time depressed; 9% manic
Bipolar II: 50% of time depressed; 1% hypomanic
What is the median length of episodes in bipolar disorders?
Depression: 15 weeks
Manic: 7 weeks
Hypomanic: 3 weeks
What percentage of sufferers have 4 or more episodes per year (rapid cycling)?
What is the rate of comorbidity between bipolar and anxiety disorders?
What percentage of bipolar sufferers have substance abuse disorders?
What 4 negative consequences are associated with ANXIOUS bipolar sufferers?
1. More suicide attempts
2. More alcohol use
3. Poorer response to Lithium
4. Longer time to remission
What percentage of people with bipolar attempt (and complete) suicide?
25-50% at least once - more common among bipolar II sufferers (more depressive episodes). 11%-19% complete suicide.
Do suicides occur in manic or depressive phases of bipolar?
What factors are associated with poorer outcomes for bipolar sufferers?
- Delay in seeking treatment
- Medication non-compliance
- Presence of psychotic symptoms
- Alcohol and drug use
- Comorbid PD
- Impaired family interactions
- Limited social support
What is lifetime risk of bipolar for family members of those with the disorder?
6-9%, compared to less than 1% in general population.
Data from twin studies suggest that bipolar has a heritability rate of ___?
If bipolar is untreated, the risk of suicide increases by what factor?
30 times. Against 6 times if treated.
Manic episodes are more likely to be preceded by life events involving what 2 stressors?
1. Disruption to routines and sleep-wake cycles
2. Excessive focus on goal attainment
Manic episodes are more likely to be preceded by life events involving what?
Low social support and low self-esteem.
How could a cognitive diathesis stress model account for bipolar?
A negative cognitive style increases vulnerability to manic and depressive episodes when paired with stressful events.
How might mania and self-esteem be related?
Mania may be a defense to counter the negative thoughts and feelings relating to low self-esteem. This is bullshit.
What temperamental factors are associated with bipolar?
Perfectionism and interpersonal sensitivity.
What is the first-line treatment for bipolar?
What kinds of medication are recommended for bipolar?
- Lithium as a mood stabiliser
- Antipsychotics (Risperidone) for psychotic symptoms
- Benzos and anti-convulsants for control of agitation. Valproate especially useful for rapid cycling and impulsivity.
Are normal antidepressants effective?
Can be used at low doses, but must be combined with mood stabiliser to prevent risk of switching depression to mania.
When and by whom was Lithium discovered as a psychiatric treatment?
By John Cade in the 1940s.
What percentage of patients relapse within 5 months of ceasing Lithium?
When is ECT used for bipolar?
When medication isn't viable, such as during pregnancy. Effective for both mania and depression.
What is psychotherapy used for in bipolar?
Counter desire to maintain manic symptoms
Psychoeducation about disorder
- identifying warning signs
- strategies to cope with stressors
- need to maintain regular routines
What evidence is there for the effectiveness of psychoeducation?
Perry et al. (1999) compared 12 sessions of psychoeducation with a waitlist control.
Relapse after 17 weeks for control group; 65 weeks for treatment group.
Evidence for what 5 psychotherapies has been found for bipolar?
2. CBT - e.g. challenging beliefs in mania
3. Interpersonal and social rhythm therapy - e.g. reduce disruption to routines
4. Family therapy
5. Relapse prevention
What four key factors for risk of relapse were identified by Sorenson et al. (2007)?
- Biological vulnerability
- Medication non-adherence
- Dysfunctional attitudes and beliefs
- Disrupted routines