VIII - Mood Disorders II (Bipolar)

Question 1

Bipolar distinction from unipolar

Answer 1

Presence of manic or hypomanic symptoms

Question 2

Manic episode

Answer 2

Distinct period of elevated, euphoric, expansive or irritable mood; abnormal energy 1 week+.

3 of following: (1) grandiosity, (2) decreased need for sleep, (3) more talkative, (4) Racing thoughts, (5) Distractibility, (6) More goal-directed activity, (7) Involvement in high-risk/irrational activities

Significant impairment, psychotic features, or need for hospitalization to prevent harm to self or others

Episode not attributable to medical condition or medication

Question 3

Only manic symptoms

Answer 3

No such thing as manic disorder - still called bipolar

Question 4

Bipolar I Disorder

Answer 4

At least 1 manic or mixed episode (both depressive and manic symptoms for 1+ week). Even if depressive periods not level of major depressive episode, still diagnosis of Bipolar I

Question 5

Bipolar II Disorder

Answer 5

No full-blown manic or mixed episode, but hypomanic instead. Symptoms same for manic as hypomanic, but no hospitalization required. Patient must meet major depression criteria.

Question 6

Hypomanic episode

Answer 6

Basically same criteria as manic episode, but with episodes that are not severe enough to cause impairment in social/occupational functioning or to necessitate hospitalization, no psychosis. However, enough to be observable by others, and there is a change in functioning that is uncharacteristic of individual when not symptomatic.

Question 7

Bipolar Disorder Prevalence and Onset

Answer 7

Equal in men and women

Usually starts in adolescence; young adulthood; av. 22 years.

Question 8

Bipolar disorder rapid cycling

Answer 8

Some individuals experience rapid cycling - at least four episodes (manic or depressive) every year

Question 9

Evolution

Answer 9

In 5-15 percent of cases, Bipolar II -> Bipolar I. Question of whether they are distinct disorders, or whether Bipolar I is just a more sever version of II

Question 10

Cyclothymic Disorder

Answer 10

Cyclical mood swings that are less severe than mood disorder - symptoms like dysthymia and hypomania. Symptoms 2+ years. Lacks severe symptoms/psychosis of bipolar. May be significant periods between episodes that functioning adaptive.

Question 11

Depressive episodes in unipolar vs. bipolar

Answer 11

Bipolar: more lability, psychotic features, psychomotor retardation, substance abuse; more severe.
Unipolar: more anxiety, agitation, insomnia, physical complaints, weight loss.

Question 12

Bipolar biological causal factors

Answer 12

Greater genetic contribution than unipolar. Norepinephrine, serotonin, dopamine involved in mood regulation. Disturbances in hormone regulation. Neurophysiologic and neuroanatomical influences. Disturbances in biological rhythms - cyclical may be due to circadian rhythms, as sleep difficulties core feature

Question 13

Lithium Carbonate

Answer 13

Historically choice drug for bipolar. 1-2 weeks of use eliminates or reduces symptoms in 60-80% of manic episodes w/o causing depression. Less effective for depression, so may be given w/ anti-depressant. Reduces occurrence of future episodes. Treatment may be lifelong necessity.

Question 14

Lithium Carbonate mechanism

Answer 14

Not well understood, but targets serotonin. Hypothesis that it modifies second messenger systems

Question 15

Lithium Carbonate side effects

Answer 15

Lethargy, cognitive slowing, weight gain, decreased motor coordination, GI upset

Question 16

Lithium Adherence Problems

Answer 16

May discontinue use b/c of side effects, failure to experience mood changes at all, loss of mania which may be perceived as period of heightened creativity, productiveness.

Question 17

Bipolar Alternative Drug Therapy

Answer 17

Anti-convulsants, anti-psychotics (if patient experiences psychotic episodes)

Question 18

Bipolar Psychological Causal Factors

Answer 18

Causal factors include: stressful life events (destabilization from stress), personality variables (neuroticism, want lots of achievement), low social support, pessimistic attributional style.