Bipolar Disorders Flashcards
Early Representation of Bipolar Disorder
Phillipe Pinel
- described disorder where episodes of manic and melancholic states appeared to cycle with periods of insanity in between
- led Pinel to call it melancholia with delirium
DSM-5 Criteria of Bipolar Disorder
- manic episodes last at least a week
- hypomanic state lasts at least 4 days and symptoms are usually less severe
- little sleep without feeling tired
- atleast three symptoms must be seen to an abnormal degree
symptoms include: - inflated self-esteem
- decreased need for sleep
- excessive talkativeness
- racing thoughts
- distractibility
- increase in goal-directed behaviour
- psychomotor agitation
- excessive involvement in high-risk behaviour
- when early episodes subside the person enters inter-episodic period with full remission of symptoms (becomes rarer as time goes)
- preceded with a stressful life event
Misdiagnoses of Bipolar Disorders
requires high understanding of patient history over long periods of time, people that go to a psychologist in a depressive episode will be underdiagnosed/misdiagnosed with MDD
Development of Bipolar Disorders
usually develops in early adulthood, some risk factors can be identified in childhood and adolescence
these may include:
- anxieties
- moodiness
- flattened emotion
- anhedonia
- apathy
- social withdrawal
appropriate support can restrict its development, early detection is important because it is a progressive disorder
Stages of Bipolar Disorder
Stage 0: person is well but have family history of bipolar, usually first-degree relative
Stage 1: person starts experiencing episodic anxiety/sleep disorders
- risk factors start to show in children and adolescents
Stage 2: person experiences first depressive or sometime their first manic episode
- usually happens during adolescence or adulthood
Stage 3: person is experiencing recurrent episodes of depression and mania but there are still periods of complete symptom remission in between
- more spontaneous
Stage 4: experiences same manic and depressive episodes but no have residual symptoms
- in the form of cognitive or functional decline, issues keeping a job, problems with interpersonal relationships or difficulties maintaining financial independence
- high rates of comorbidity
Biological Intervention
- use of lithium; mood stabilising medication
- 80% success rate especially with early diagnosis
- patients who don’t respond usually have psychotic features
Psychosocial Intervention
- help with interpersonal and practical problems (e.g. managing finances)
- relapse and recurrent episodes are common in the long-term, treatment focuses on maintenance
When are the best treatment outcomes achieved?
a combination of psychosocial and biological treatment
Bipolar Depression
characteristic features including biological differences (brain-derived neurotrophic factor or BDNF)
- BDNF supports growth and health of nerve cells
- Levels are different in unipolar depression and bipolar depression
Intervention in Stage 0
understanding risk factors and applying generic interventions including:
- encouraging self-help strategies
- counselling
- encouraging safe use of substances
- educating people for awareness of early symptoms
Intervention at Stage 1
usually include CBT and family counselling
Intervention at Stage 2
- research becomes non-agreeable
- specified by DSM that bipolar diagnosis requires at least one manic or hypomanic episode however people usually experience depressive episodes first
- targeted treatment following first episode
Intervention at Stage 3
- consists of lithium and CBT
- often will need treatment for other comorbid conditions, substance abuse particularly
Intervention at Stage 4
unrelenting state of depression or mania
- aggressive and targeted treatment
- ECT intervention may be recommended despite risks as the alternative may be worse
Unipolar Mood Disorder
individuals suffer from episodic depression or mania
- rare as many later develop depression
