Bipolar and Related disorders

Question 1

Provide a definition and some key features/facts about Bipolar and related disorders (BRD).

Answer 1

• BRD = MOOD disorders
• Disturbance in mood, psychomotor activity and cognitive functioning
• Classified as a severe mental illness
• Marked change in regular functioning
• Tend to be episodic and recurrent

Question 2

Discuss the epidemiology of BRD.
(Gender/sex, age, genetics)

Answer 2

• M:F = 1:1 (generalised including all disorders)
• F overrepresented in BD2
• 20 y/o common age of onset
• M have 4-5 y earlier onset than women
• HIGHLY INHERITABLE

Question 3

What are some social factors that correlate to the epidemiology of BRD?

Answer 3

• Marital status - single/separated = risk for depression / or a consequence of depressive/manic psychopathology
• Socioeconomic factors:
• Mood disorders can lead to unemployment, low income resulting in social regression
• Pts. with BD1 and BD2 tend to belong to high social classes and are overrepresented in socially active, creative people

Question 4

What are some psychosocial factors that correlate to the epidemiology of BRD?

Answer 4

• Social stressors
• Social support
• Comorbidities = substance use disorder, anxiety disorders, OCD
• High risk of suicide

Question 5

BD1 / BD2:
Discuss the neurobiology of BD1 and BD2.

Answer 5

BD1 = dysfunction in key emotional control networks - decreased connectivity between the PREFRONTAL CORTEX and the LIMBIC SYSTEM.

BD2 = disrupted inhibition of stress response bu the LIMBIC SYSTEM.

*** Neuroimaging can show abnormalities in cortical and subcortical structures such as the temporal lobe, basal ganglia, and amygdala.

Question 6

List the diagnostic criteria for a MANIC episode.

Answer 6

MANIC EPISODE = A distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy, last at LEAST 1 WEEK and present most of the day, nearly every day.

3 or more of the following symptoms present (4 if the mood is only irritable):
* Inflated self esteem or grandiosity
* Decreased need for sleep
* More talkative than usual or pressure to keep talking
* Flight of ideas or subjective that thoughts are racing
* Distractibility
* Excessive involvement in activities that have a high potential for painful consequences
* Increase in goal directed action (school/sexual) or psychomotor agitation

The mood disturbance is sufficiently severe to cause a marked IMPAIRMENT in social or occupational functioning, or necessitate HOSPITALISATION to prevent harm to self or others, or there are PSYCHOTIC features.

(Psychotic features are not a core feature but are only possible present in manic episodes NOT hypomanic episodes)