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Differences in DSM-IV and V for Bipolar classification?

DSM-IV: Bipolar part of Mood Disorders chapter
DSM-V: now has its own chapter
BPI & BPII, Cyclothymic, Substance/Med-induced Bipolar etc


Bipolar I: Manic Episode Symptoms (A-D)

A. >1 week of
- Abnormally and persistently elevated, expansive or irritable mood
- Increased goal-directed activity/energy, present nearly daily
B. At least 3 sig/noticeable changes from usual behaviour
- Inflated S-E/grandiosity
- Decreased need for sleep
- Rapid or pressured speech
- Flight of ideas or racing thoughts
- Distractibility
- Increase in goal-directed behav or psychomotor agitation
- Excessive involvement in activities that have high potential for negative conseq
C. Mood disturbance is
- Severe enough to cause marked impairment in functioning (work/social)
- Necessitate hospitalisation to prevent harm to self/others
- Psychotic features (e.g. delusions, hallucinations)
D. Symptoms not due to physiological effects of a substance/med cond


Bipolar Disorder II: Hypomanic Episode symptoms (A-F)

Shorter duration than Manic episodes
A. >4 days of:
- Abnormally/persistently elevated, expansive or irritable mood
- Increased goal-directed activity/energy, present nearly every day
B. Same as Criterion B for BPI: At least 3 noticeable changes from normal behaviour
C. Change is uncharacteristic of the individual
D. Disturbances and changes observable by others
E. Not severe enough to cause marked impairment, hospitalisation, and no psychotic features
F. Symptoms not due to substances/med cond


Depressive episodes: Symptoms (same as MDD)

A. Depressed mood most of the day, nearly daily
B. Markedly diminished pleasure/interest in activities
- Sig weight loss/gain
- In/hypersomnia nearly every day
- Psychomotor Agitation
- Fatigue/loss of energy nearly every day
- Feelings of worthlessness, excessive guilt nearly every day
- Dim ability to conc nearly every day
- Recurrent thoughts of death, suicide, suicide attempts
B. Clinically sig distress/impairment
C. Not attrib to substance use/other med condition


Bipolar I Disorder: Which are the necessary components?

Manic episode must be present.
Depressive or hypomanic episode may be present, but not necessary for diagnosis


Bipolar II Disorder: Which components are necessary for diagnosis?

Depressive AND hypomania must be present.
NO Manic episode



Chronic, less severe form of Bipolar
Oscillating cycles between less severe manic
Depressive episodes for > 2 years
Symptoms are dysfunctional/distressing


Epidemiology of Bipolar Disorders

Lifetime prevalence:


Etiology of Bipolar Disorders - What are the associated risk factors?

Genetic: High heredity (10%: 10x higher than normal population)
Envr/life stressors:
Manic from Disrupted routines/sleep-wake cycles, excessive focus on goal attainment
Depressive from Low social support and low S-E
Psychological: Negative Cognitive style --> vulnerable to manic/depressive episodes
Mania: may be defence mech to counter negative thoughts/feelings underlying negative self-esteem
Temperament: Perfectionism & sociotropy --> sensitive to rejection


Etiology of Bipolar: What are the stages of the diathesis-stress model, and what does it posit as the underlying causes of bipolar?

Life stressors (disrupted routines) --> Biological vulnerabilities --> Prodromal stage (Early symptoms of mood disturbance). When these are poorly managed/coped with --> Episode (Manic/Hypomanic/Depressive).
The stigma associated with episodes and relationship problems contribute further to Life stressors, and the cycle continues


Bipolar: What are the normal treatment options? (Mention four psychological treatments)

Electro-convulsive Therapy
Psychological Therapies:
Interpersonal & Social Rhythm Therapy
Family-focused therapy


What would be involved in the best treatment for patients with Bipolar?

Pharmacotherapy + Psychological interventions


What are the main pharmacotherapy options for Bipolar patients? (5)

1. Lithium - Highly effective in stabilising mood. Treats manic episodes and prevents future episodes
2. Anticonvulsants: Targets cycling nature of episodes
3. Antipsychotics (atypical): Addresses psychotic features in mania
4. Sedative Hypnotics (Benzos): Stabilises mood
5. Antidepressants: prevents mania (at lower & less frequent dosage than unipolar depression)


Electro-convulsive Therapy - when is this used, and what are the associated side effects?

ECT is used when drug options are not viable - perfect for pregnant women
Short-term side effects: Confusion, disorientation, slight memory-loss (resolves within 2 weeks)
Pharmacotherapy still needed to maintain mood stability & prevent relapse


Psychological treatments: what are the components of Psycho-education?

Aim: Educate patients about what the nature of the disorder and treatment, in order to encourage them not to give up (esp for medication)
- Symptoms + Diathesis-stress model of BP disorder
- Identifying early signs of relapse
- Rationale/importance of medication compliance
- Strategies to cope with stressors
- need for routines (sleep-wake cycles)
Delays recurrence and reduces frequency of future episodes


Psych treatments: what does CBT involve?

Aim: Address acute symptoms and prevent relapse
Technique: Cognitive restructuring
- Monitor symptoms
- Challenge hyper-positive cognitions ("I can do no wrong, I don't need medication, I am fine")
- Improve medication adherence
- reduce destructive behaviour
- Foster self-efficacy
Also introduction of wellbeing plan, to outline triggers of relapse and also the consequences of following the plan

Effective in reducing episodes and hospitalisation, increase medication compliance


Psych treatments: what does Interpersonal & Social Rhythms treatment involve?

Establishing regular routines: "therapy by boredom"
Aim: To improve interpersonal functioning and to reduce disruption to routines & sleep-wake cycles
- Identify unstable rhythms
- identify realistic goals for change
- establish/maintain new routines

Effective in reducing relapse


Family-focused therapy - what does that involve?

Improves knowledge about Bipolar
Improve family communication and problem solving skills
Improve family functioning and reduce any criticism/hostility

Effective in reducing relapse rates, hospitalisation and time to relapse


What is the relationship between bipolar and creativity?

17% of a sample of British poets were treated for manic episodes
e.g. Van Gough, Lord Byron, Virginia Woolf, Handel, Schumann