Bipolar

Question 1

Genetics in BAD

Answer 1

Genetics
- 10x in 1st deg
- 1 parent = 25%
- 2 parents = 50-75%
- MZ twins = 40-70%

1st degree relative: 5-10%

Genes (a few): BDNF, COMT, CLOCK

Question 2

Risk factors bipolar

Answer 2

RF
- Genetics
- High income country
- High SES
- Separated / divorced
- Stressful events prior to 1st episode

Question 3

Comorbidity bipolar

Answer 3

Children
- ADHD 85%
- ODD <90%
Teens
- ADHD / SUD
Adults
- Anxiety 75%
- SUD 67% - EtOH, cocaine, nicotine
- Medical 30% - metabolic, epilepsy, migraine
- Eating d/o / BPD

Question 4

Poor prognostic factors bipolar

Answer 4

• Male
• Poor premorbid fcn
• Mixed
• Rapid cycling
• Mood incongruent psychotic features
• Interepisode sx
• Starts w/ MDE
• Comorbid SUD / obesity / PD / anxiety

Question 5

Course

Answer 5

• 90% have recurrent episodes
  o 10% single, 45% many, 40% chronic
  o 10% rapid cyclers
• Untreated mania lasts 3 mo
• Time b/w episodes decreases as illness progresses (generally 6-9 mo)
• 30% severe impairment in work fcn
• 30% employed full-time
• Lower SES
• Suicide 15%