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3.4C Affective Disorders > 4.1 Bipolar disorder: A lifespan perspective > Flashcards

4.1 Bipolar disorder: A lifespan perspective Flashcards

1
Q

Waar gaat artikel Carvalho over?

Carvalho et al. (2020)

A

Wat is bipolar disorder (BD)
- BD I, BD II, cyclothymic disorder
- Epidemiology
- Genetics and neurobiological
- Management
- Treatment
- Acute depression

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2
Q

Bipolar disorder (BD)

Carvalho et al. (2020)

A

Mood disorder with abnormal shifts in mood, energy, activity, sleep and cognitive functions during episodes of mania and depression.

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3
Q

When does BD typically begin?

Carvalho et al. (2020)

A

Around 20 years old.

Early onset= associated with poorer prognosis, longer treatment delays, severe depressive episodes and higher prevalence of anxiety and substance use disorders.

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4
Q

(First) pattern of BD

Carvalho et al. (2020)

A

1e episode= depressive

Depressive episodes often last longer than (hypo)manic episodes.

Pattern is often misclassified as MDD.

1/3 of BD patients, the disorder remains undiagnosed until 10 years after onset.

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5
Q

Symptoms BD I

Carvalho et al. (2020)

A

Observable manic episodes with various manifestations, like:
- Heightened confidence
- Grandiosity
- Increased talkativeness
- Extreme disinhibition
- Irritability
- Reduced need for sleep
- Sig elevated mood

75% of manic episodes involve psychotic symptoms such as delusions and hallucinations

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6
Q

Symptoms BD II

Carvalho et al. (2020)

A

Mainly episodes of depression

Alternating with hypomania rather than mania.

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7
Q

Symptoms cyclothymic disorder

Carvalho et al. (2020)

A

Repeated depressive and hypomanic states lasting a minimum of tow years, but these do not reach the diagnostic criteria for a major affective episode.

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8
Q

Prevalentie BD

Carvalho et al. (2020)

A

Differs between countries, from 2.4 till 1.5%

Bipolar I: same in male-female.
Bipolar II: more prevalent in female

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9
Q

Comorbidity

Carvalho et al. (2020)

A
  • ADHD and anxiety –> increase burden and worsen prognosis
  • Chronic medical disorders –> more present among people with BD
  • People with BD have twice the risk of death (suicide, physical diseases)
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10
Q

Heritability

Carvalho et al. (2020)

A

70-90%

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11
Q

Genetic

Carvalho et al. (2020)

A

Enriched gene sets in bipolar populations, including sets involved in the regulation of insulin serotonin and endocannabinoid signaling

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12
Q

Kindler hypothesis

Carvalho et al. (2020)

A

Model explaining how gradual stress sensitization leads to recurring affective episodes.
- 1e episode occurs after exposure to stressor
- Subsequent episode can occur whithout stressor.

Mechanisms behind hypothesis are strengthened if patient:
1. Does not receive care
2. Uses psychoactive substances
3. Lifestyle risks (smoking or sedentary behaviour)

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13
Q

What happens to brain when BD occurs for a long time?

Carvalho et al. (2020)

A

Reduced cortical thickness of brain regions, like PFC (stress regulation)

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14
Q

What are contributors to neuroprogression in BD?

Carvalho et al. (2020)

A
  • Epigenetic mechanisms
  • Dysregulation of mitochondrial function
  • Pathways related to neuroplasticity
  • Inflammation
  • Elevated oxidative and nitrosative stress
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15
Q

Neuroprogression causes:

Carvalho et al. (2020)

A
  • Worsening of cognitive and functional impairments
  • Higher prevalence of coexisting medical conditions
  • Premature death
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16
Q

What happens to response to mood stabilizers medications as BD progresses?

Carvalho et al. (2020)

A

Response to mood stabilizer medication may decrease

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17
Q

3 factors that influence selection of initial treatment

Carvalho et al. (2020)

A
  1. Patient’s preference
  2. Coexisting medical and psychiatric conditions
  3. Previous responses to treatment, including associated side effects
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18
Q

Treatment acute mania

Carvalho et al. (2020)

A
  • If there is no response to med’s after 1 or 2 weeks, different medication may be considered.
  • Antipsychotic agent and mood stabilizer, especially for severe mania
  • Antipsychotic risperidone more effective than lithium, etc.

Treatment used for mania is often used for hypomanic episodes

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19
Q

Which treatment may be effective for refractory mania and aggressive/psychotic symptoms?

Carvalho et al. (2020)

A

Bifrontal electroconvulsive therapy (ECT)

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20
Q

What happens with treatment during acute depression?

Carvalho et al. (2020)

A

During depressive episodes pat’s have greater number of unacceptable side effects of pharmacological treatments.

Oplossing: low initial dose with gradual upward dose adjustment

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21
Q

What is risk of antidepressants in BD?

Carvalho et al. (2020)

A

Risk of switching to mania or hypomania= affective switches

Risk of switches= higher among BD I than II

So: antidepr generally avoided, if necesarry in combi with mood stabilizers

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22
Q

Which adjuvant psychotherapeutic approaches in management of Bipolar depression can be used?

Carvalho et al. (2020)

A
  1. Psychoeducation
  2. CBT
  3. Family-focused therapy
  4. Dialectical behavioural therapy (is for people who experience emotions very intens)
  5. Mindfulness-based CBT
  6. IPT and social rhythm (stability of daily behaviours) therapy
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23
Q

Lithium

Carvalho et al. (2020)

A

Maintenance treatment

Is effective in prevention of both manic and depressive episodes.

Side effects:
- Renal failure
- Tremors en nog veel meer

24
Q

Waar gaat artikel Marangoni over?

Marangoni et al. (2015)

A

ADHD en BD worden met elkaar vergeleken

25
Q

Prevalence ADHD

Marangoni et al. (2015)

In adolescents/adults

A

Adolescents= 1.7-16%
Adults= 1-5%

1/3 persists in adulthood
2/3 still have symptoms in adulthood

26
Q

Children with ADHD have increased risk of

Marangoni et al. (2015)

A

Comorbid BD

27
Q

What are highest comorbidity rates with BD in youth

Marangoni et al. (2015)

A
  • Anxiety disorders (54%)
  • ADHD (48%
28
Q

Similarities BD and ADHD

Marangoni et al. (2015)

3

A
  1. Neurodevelopmental disorders with onset in childhood and early adolescence
  2. Common persistence in adulthood
  3. Often underdiagnosed, misdiagnosed or overdiagnosed
29
Q

Differential diagnosis ADHD and BD

Characteristics ADHD

Marangoni et al. (2015)

5

A
  • Wobbling
  • Restlessness
  • Inefficient and disorganized performance due to inattention
  • Distractibility
  • Forgetfulness
30
Q

Differential diagnosis of ADHD and BD

Characteristics BD

Marangoni et al. (2015)

3

A
  1. Prominent mood
  2. Sleep
  3. Agressive behaviour (especially if impulsive behaviour comes from money, sex and substances)
31
Q

Which are complex comorbidities that makes diagnosis complicated

Marangoni et al. (2015)

A

50% of pat’s with ADHD or BD has:
- conduct disorder(CD)
- Oppositional defiant disorder (ODD)

Symptoms of CD and/or ODD like rage and aggressive behaviour overlap with symptoms of manic or mixed episodes.

32
Q

Differences between ADHD and manic or mixed episodes

Comparison by eliminating overlapping symptoms

Marangoni et al. (2015)

A

BD:
- Elated mood
- Grandiosity
- Hypersexuality
- Decreased need for sleep
- Racing thoughts

Both:
- Hyper-energetic
- Distractibility

33
Q

Differences between ADHD and manic or mixed episodes

Comparison by chronological symptom appearance

Marangoni et al. (2015)

A

Different symptoms at different ages:
- Age 1 to 6 in BD: tantrums, poor frustration tolerance, impulsivity, increased aggression, lower attention span, hyperactivity irritability
- Age 7 to 12 in BD: adult depressive symptoms, mania and psychosis
- More common in BD: nightmares, bed-wetting, inappropriate sexual behaviours, suicidal ideation and physical complaints.

34
Q

Differences between ADHD and manic or mixed episodes

Child behaviour checklist (CBDI)

Marangoni et al. (2015)

A

When a child experiences BD with an increased anxiety/depression, aggressive pattern and attention problem, this distinguishes BD from ADHD

35
Q

Family history BD and ADHD

Marangoni et al. (2015)

A

BD:
- Family history= 90%
- Heritability 58-85%

ADHD:
- Heritability= 60-80%

Family member with ADHD –> also predicts BD with 27-30%
Family member with BD –> predicts ADHD 6%

36
Q

Course ADHD

Marangoni et al. (2015)

A

Symptoms hyperactivity improve, inattentive not.

Chronic and unremitting disorder –> persistent in adulthood in half of cases.

37
Q

Medication BD

Marangoni et al. (2015)

A
  1. mood stabilizers and antipsychotics –> do not work for ADHD
  2. Stimulants cannot be used for BD –> this causes disturbances in sleep and circadian rhythms.
38
Q

Waar gaat artikel Uchida over?

Uchida et al. (2015)

A

To distinguish unipolar and bipolar forms of pedriatic MDD

39
Q

Results

Clinical differences between bipolar and unipolar MDD

Uchida et al. (2015)

A

4 factors overrepresented in bipolar
1. High rates psychiatric comorbidities
2. HIgh rates family history of psychiatric illness
3. Higher severity depression
4. Higher level of impairment

40
Q

Results

Psychiatric comorbidities

Uchida et al. (2015)

A

BD children: behavioural disorders + anxiety disorders

Adolescent BD: substance disorder

41
Q

Results

Famility history psychiatric illness

Uchida et al. (2015)

A

First-degree relatives more likely=
- BD
- MDD
- Behavioural disorders
- ODD
- anxiety disorders
- Mania or hypomania

42
Q

Results

Severity depression

Uchida et al. (2015)

A
  • More depressive episodes
  • More severe depressive
  • More hospitalization
  • More loss of interest
  • More irritable
  • Sleep problems
  • Experience more sadness, hoplessness
  • Suicidal ideation or self-harm
43
Q

Results

Level of impairment

Uchida et al. (2015)

A
  • Difficulties with peers and family
  • More behavioral problems at school
44
Q

Results

Other characteristics associated with BD

Uchida et al. (2015)

A
  • Extreme irritability
  • (Persistent irritability = MDD)
  • Early onset depressive episodes (1.5 years earlier than unipolar MDD)
45
Q

Discussion

Uchida et al. (2015)

A

Bipolar MDD:
- Higher severity
- Greater levels of impairment

Difference in pattern and familiy history.

46
Q

Waar gaat artikel Kowatch over?

Kowatch (2016)

A

Diagnosis BD, voornamelijk vanuit kinderen naar volwassenheid.
- Phenomenology
- Red flags in children
- Differential diagnosis (ADHD,ODD, anxiety, FAS)

47
Q

Diagnosis BD II

Kowatch (2016)

A

MDD episode that last at least 2 weeks.

Hypomanic episode that last at least 4 days

48
Q

Other specified bipolar related disorders

Kowatch (2016)

A

Given to pedriatic pat’s who have bipolar symptoms that do not meet the full criteria for any BD, but that do cause distress or impairment.

Symptoms last 2 or 3 days per week

48
Q

Cycle

Kowatch (2016)

A

Shift from mood and energy from one extreme to another

49
Q

Episode

Kowatch (2016)

A

Longer period of mood dysregulation that also includes multiple cycles in polarity most of the time.

50
Q

Rapid cycling

Kowatch (2016)

A

4 or more episodes in 1 year

51
Q

Adolescents experience more:

Kowatch (2016)

A

Depressive symptoms than manic or hypomanic

52
Q

What is diagnosis of most children under 13?

Kowatch (2016)

A

Other specified bipolar and related disorders, due to lack of symptoms

53
Q

Red flags in pedriatic pat’s

Kowatch (2016)

A
  1. Aggression several times a dat (parents walking on egg shells)
  2. Decreased need for sleep
  3. Spontaneous mood shifts
  4. High risk behaviour
  5. Family history of mood disorders
54
Q

Differential diagnosis

ODD

Kowatch (2016)

A

Pattern of angry and irritable mood with defiant behaviour (lasts for 6 months).

Chronic disorder

People with ODD do’nt have manic symptoms

55
Q

Differential diagnosis

Anxiety disorders

Kowatch (2016)

A

Can cause mood swings and irritability.

Also no manic behaviour.

56
Q

Differential diagnosis

FAS

Kowatch (2016)

A

Prenatal alcohol exposure

Symptoms of poor impulse control, deficits in school performance, mood dysregulation

3.4C Affective Disorders (16 decks)

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