Bipolar and Depression

Question 1

What are the core symptoms of a major depressive episode?

Answer 1

• Affective: Depressed mood, anhedonia
• Cognitive: Poor concentration, indecisiveness
• Somatic: Fatigue, sleep/appetite changes
• Must include 5+ symptoms over 2 weeks, with at least one being depressed mood or anhedonia.

Question 2

What defines a manic episode in Bipolar I?

Answer 2

• At least 1 week of elevated, expansive, or irritable mood
• Increased goal-directed activity or energy
• 3+ symptoms: grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, risky behaviour
• Causes marked impairment or requires hospitalization; may include psychosis.

Question 3

What defines a hypomanic episode in Bipolar II?

Answer 3

• At least 4 days of elevated, expansive, or irritable mood
• Increased goal-directed activity or energy
• 3+ symptoms: grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, risky behaviour
• Noticeable change in functioning, but no marked impairment, no hospitalization, and no psychosis.

Question 4

What is the key diagnostic difference between Bipolar I and Bipolar II?

Answer 4

• Bipolar I: Requires a manic episode; depressive episodes may occur but are not required
• Bipolar II: Requires both a hypomanic episode and a major depressive episode; no manic episodes.

Question 5

What is Cyclothymic Disorder?

Answer 5

• Chronic mood instability with subclinical hypomanic and depressive symptoms
• Symptoms persist for ≥2 years, with ≤2 months of remission
• Does not meet criteria for full manic or depressive episodes
• Causes distress or impairment.

Question 6

What is the prevalence of Bipolar I and II in Australia?

Answer 6

• 12-month prevalence: ~1%
• Lifetime prevalence: ~1.3%
• Bipolar II is more common in women; Bipolar I shows no gender difference
• Onset typically between ages 15–25.

Question 7

What is the typical course of bipolar disorder?

Answer 7

• 10–20 year delay in seeking treatment
• 90% experience recurrent episodes
• Untreated: ~8–10 lifetime episodes
• Treated: 40% relapse within 1 year; 73% within 5 years.

Question 8

What are common comorbidities in bipolar disorder?

Answer 8

• Anxiety disorders: ~50%
• Substance misuse: ~39%
• Suicide risk: 15× higher than general population; ~25% attempt, ~10–20% complete.

Question 9

What biological factors contribute to bipolar disorder?

Answer 9

• Dysregulation of serotonin, dopamine, and noradrenaline in reward systems
• High heritability (~80–85% in twin studies); 10% lifetime risk for relatives.

Question 10

What environmental factors trigger episodes?

Answer 10

• Mania: Sleep disruption, routine changes, excessive goal focus
• Depression: Low social support, poor self-esteem.

Question 11

What psychological traits increase vulnerability?

Answer 11

• Negative cognitive style
• Perfectionism
• Sociotropy (dependence on social approval).

Question 12

What is the Diathesis-Stress Model of bipolar disorder?

Answer 12

• Bipolar disorder arises from an interaction between biological vulnerability and life stressors
• Leads to prodromal (initial) symptoms and eventual mood episodes
• Poor coping and stigma can exacerbate the condition.