Bipolar

Question 1

The initial stages of a manic episode are…

But then, as the thinking wheel gets faster…

Answer 1

a lot of fun - your self-esteem goes up, you feel important and confident (heightened wellbeing)
you get to the stage of euphoria and mania - ideas start coming quickly - people become agitated and irritable

Question 2

Often in a manic episode, you will fluctuate between…

Answer 2

elation and irritability

Question 3

Manic episode must last at least

Answer 3

one week

Question 4

The new sub-criterion within Criterion A of Bipolar I states that the individual…

Answer 4

has increased goal-directed activity/energy, present nearly daily

Question 5

During a manic episode, the individual can function very well on _______

Answer 5

~ 2 hours sleep

Question 6

Manic patient is often involved in _______ behaviours

Answer 6

high-risk, dangerous

eg gambling, promiscuity

Question 7

After a manic episode, the individual often feels

Answer 7

guilt/regret as to the damage they caused to their career, family etc

Question 8

Criterion C of Bipolar I states that the mood disturbance is:

Answer 8

• sufficiently severe to cause marked impairment in occupational functioning or in usual social activities
• OR to necessitate hospitalisation to prevent harm to self/others
• OR there are psychotic features (hallucinations/delusions)

Question 9

up to ____ of people with Bipolar I will attempt suicide

Answer 9

half

Question 10

A hypomanic episode lasts at least ___ days

Answer 10

4

Question 11

What is the difference between a hypomanic episode and a manic episode?

Answer 11

symptoms are the same.
Difference is in Criterion C
- While the disturbance & changes are observable to others, they are not sufficiently severe to cause marked impairment in occupational functioning/necessitate hospitalisation/no psychotic features
- highs are not as high (can still function)

Question 12

Is a major depressive episode necessary for Bipolar I/II?

Answer 12

No for Bipolar I

Yes for Bipolar II

Question 13

For Bipolar II, you need to have had

Answer 13

at least one MD episode and one hypomanic episode. No manic episodes.

Question 14

Cyclothymic disorder is characterised by

Answer 14

numerous cycles of hypomanic symptoms and depressive symptoms that are not severe enough to meet criteria for manic or MD episode

= the chronic, less severe form of Bipolar

constantly oscillating

Question 15

Duration of cyclothymic disorder?

Answer 15

Symptoms for at least 2 years, no more than 2 months without symptoms

Question 16

why is dangerous to misdiagnose Bipolar as Unipolar Depression?

Answer 16

Antidepressants can trigger mania

Question 17

Are there gender differences in bipolar?

Answer 17

no, except that rapid cycling seems to be affecting women more

Question 18

often people with Bipolar will not receive treatment/be diagnosed correctly until

Answer 18

10-20 years after onset

Question 19

Even when treated, ____ will relapse within 1-year, ___ within 5 years

Answer 19

40%, 73%

Question 20

The course of bipolar is predominantly ________

Answer 20

depressive (Bipolar II more so than Bipolar I)

Question 21

Bipolar patients do spend a significant portion of their lives feeling normal/well. This is called

Answer 21

euthymia

Question 22

rapid cycling is …

Answer 22

4+ episodes a year - affects 5-15% of sufferers

Question 23

Bipolar is often comorbid with..

Answer 23

Anxiety disorders (50%)
Substance abuse (39%)

Question 24

What are the 3 aetiological factors of Bipolar?

Answer 24

1. Genetic/biological factors
2. Environmental and Life stressors
3. Psychological factors

Question 25

If one parent has Bipolar the chance of their child developing it is ___. If both parents have bipolar the chance goes up to ____.

Answer 25

10%, 40%

Question 26

Bipolar is a neurobiological disorder, largely due to the malfunction of three neurotransmitters:

Answer 26

serotonin, dopamine and noradrenaline

Question 27

These biological vulnerabilities to bipolar may lay ______. Can be activated ________ or triggered by environmental/life ________.

Answer 27

dormant spontaneously stressors

Question 28

Manic episodes are likely preceded by...

Answer 28

- disruption to routines and sleep-wake cycles | - excessive focus on goal attainment (over-invested in one thing)

Question 29

Depressive episodes are likely preceded by...

Answer 29

- low social support | - low self-esteem

Question 30

What are the psychological factors that contribute to Bipolar?

Answer 30

- negative cognitive style (esp. when paired with stressful events) - mania = overcompensation for low self-esteem - cognitions go in opposite direction

Question 31

Which personality traits are implicated in bipolar?

Answer 31

- perfectionism | - sociotropy = over-investment in social relationships, don't take rejection well

Question 32

According to the Diathesis-Stress model, what is the order of events to elicit Bipolar?

Answer 32

Life stressors causing poor social routines and/or sleep deprivation -----> and you have biological vulnerability i.e. Circadian rhythm instability -----> prodromal stage (early symptoms of mood disturbance) -------->if you use poor coping strategies to deal with these early symptoms-------> Full-blown episode which can lead back to causing stress vicious cycle

Question 33

Best treatment outcomes are achieved when...

Answer 33

We combine pharmacological treatment with (adjunct) psychological intervention. But pharmacological treatment will always be the primary treatment

Question 34

Treatment needs to be tailored to the patient - depends on...

Answer 34

``` Illness stage (acute, maintenance) Predominant polarity (depressive, hypo/manic) ```

Question 35

____ of patients relapse within ____ months of ceasing lithium

Answer 35

50%, 5

Question 36

Anticonvulsants are used for people who..

Answer 36

have rapid cycling, increased levels of irritability

Question 37

Sedative hypnotics (benzos) are given to help with

Answer 37

sleep

Question 38

How are antidepressants administered to Bipolar patients?

Answer 38

Lower doses, shorter duration | - combined with mood stabilisers so they're not at risk of inducing mania

Question 39

____ is used when medication is not viable

Answer 39

ECT

Question 40

What are the two main types of psychotherapy for Bipolar?

Answer 40

CBT and psycho-education | - equally effective

Question 41

Atypical antipsychotics such as Olanzapine are used to counter the

Answer 41

psychotic features that may be present during a manic episode

Question 42

Psycho-education is most commonly conducted...

Answer 42

in a group setting

Question 43

Psycho-education provides info on...

Answer 43

- symptoms of BP - strategies to cope with stressors - need for routines ---> minimise disruption of sleep-wake cycles - identifying early signs of relapse - diathesis-stress model of BP - the rationale/importance of medication compliance

Question 44

Psycho-education effects?

Answer 44

1. delays recurrence | 2. reduces frequency of future episodes

Question 45

The key technique in CBT is ___. CBT is effective in...

Answer 45

cognitive restructuring - challenging and changing unhelpful thinking reducing episodes and hospitalisations, improving medical compliance

Question 46

Recent studies show benefits of ...

Answer 46

MBCT in assisting the patient to manage both anxiety and depressive symptoms primarily between episodes

Question 47

Male patients with bipolar are often misdiagnosed as having ____________, female patients with bipolar are often misdiagnosed as having ______________.

Answer 47

schizophrenia | unipolar depression

Question 48

Lithium fully protects only ________ percent of patients against further episodes

Answer 48

25-50

Question 49

What is the Goal Dysregulation Model?

Answer 49

Mania is the result of excessive goal engagement. Even when not in an episode, individuals with a history of bipolar I disorder have been found to place a higher emphasis on rewards and to be excessively engaged int he pursuit of achieving goals compared to those without the disorder

Question 50

Johnson et al. (2000) found that specifically ____________ life events, and not __________ life events, were associated with elevations in subsequent manic symptoms. In contrast, ___________

Answer 50

goal-directed general positive goal attainment was not associated with changes in depression

Question 51

Studies have found that symptom severity in bipolar is significantly associated with ....

Answer 51

sociotropy, negative interpersonal events and the interaction of the two

Question 52

Why is mood monitoring an important intervention in the early stages of therapy?

Answer 52

Encouraging clients to keep structured mood diaries helps in identifying the triggers to mood shifts and the associated changes in thoughts and feelings

Question 53

What is Interpersonal and Social Rhythm Therapy?

Answer 53

aims to reduce disruptions in daily routines and sleep/wake cycles that trigger bipolar episodes - regulate social rhythms - address interpersonal difficulties

Question 54

The instability model of bipolar disorder relapse assumes four key mechanisms that trigger relapse in bipolar disorder. What are they?

Answer 54

1. biological vulnerability 2. medication non-adherence 3. disrupted routines 4. dysfunctional interpretations of life events 2,3 and 4 ----> sleep disturbance mania/depression