Bipolar Disorder Flashcards
List the 5 disorders in the bipolar spectrum
- Major depression
- Sub-syndromal depression
- Sub-syndromal elevated mood
- Hypomania
- Mania
What disorders are included in Bipolar Disorder Type 1?
- Major depression
- Sub-syndromal depression
- Sub-syndromal elevated mood
- Hypomania
- Mania
What disorders are included in Bipolar Disorder Type 2?
- Major depression
- Sub-syndromal depression
- Sub-syndromal elevated mood
- Hypomania
What disorders are included in Cyclothymia?
- Sub-syndromal depression
- Sub-syndromal elevated mood
How do we know if the symptoms of a disorder are ‘normal’ subjectively?
List 3 questions we would normally ask
- Have I had them?
- Have my friends had them?
- Do they seem ‘normal’?
How do we know if the symptoms of a disorder are ‘normal’ objectively?
List 4 questions we would normally ask
- Are they on a continuum, i.e. part of a ‘normal’ distribution?
- Do people without a disorder experience them?
- Can a person experience them and function effectively?
- Can they be explained by within ‘normal’ accounts of cognitive functioning?
Describe of Udachina & Mansell’s (2007) study on Self-reported History of Hypomanic Symptoms in a Student Population
List 2 points
- Mood Disorder Questionnaire is a self-report inventory that screens for a lifetime history of (hypo)manic experiences
- Study sample (n = 167 first-year psychology undergraduate students)
What is a Mood Disorder Questionnaire?
A self-report inventory that screens for a lifetime history of (hypo)manic experiences
A self-report inventory that screens for a lifetime history of (hypo)manic experiences
This is known as…?
Mood Disorder Questionnaire
What are the 3 characterisations of mood episodes in bipolar disorder?
- The mood episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance in mood and change in functioning is observable by others
Mood episodes in bipolar disorder is associated with …?
An unequivocal change in functioning that is uncharacteristic of the person when not symptomatic
What are the symptoms of major depression?
List 3 points
- At least 2 weeks of:
Depressed mood, most of the day, nearly every day
and/or
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Plus at least three symptoms:
- Significant change in appetite or weight
- Insomnia or hypersomnia
- Psychomotor agitation / retardation
- Fatigue or loss of energy
- Feelings of worthlessness and/or inappropriate guilt
- Diminished ability to think of concentrate
- Recurrent thoughts of death, suicidal ideation, suicide attempt, or a specific plan for committing suicide
What are the symptoms of mania?
List 4 points
- At least 1 week of abnormally and persistently elevated, expansive or irritable mood
And
- Abnormally and persistently increased activity or energy
- Plus at least three or more of:
- Inflated self esteem / grandiosity
- Decreased need for sleep
- More talkative than usual, pressure of speech
- Flight of ideas, thoughts racing
- Distractibility
- Increased in goal-directed activity/physical agitation
- Excessive involvement in pleasurable activities that may have high potential for painful consequences
- Mania must lead to marked impairment in social or occupational functioning, hospitalisation, or psychosis
Mania must lead to…?
List 3 things
- Impairment in social or occupational functioning
- Hospitalisation
- Psychosis
Leads to:
- Impairment in social or occupational functioning
- Hospitalisation
- Psychosis
Which disorder does this apply to?
Mania
What are the symptoms of hypomania?
List 3 points
- At least 4 days of abnormally and persistently elevated, expansive or irritable mood
And
- Abnormally and persistently increased activity or energy
- Plus at least three or more of:
- Inflated self esteem / grandiosity
- Decreased need for sleep
- More talkative than usual, pressure of speech
- Flight of ideas, thoughts racing
- Distractibility
- Increased in goal-directed activity/physical agitation
- Excessive involvement in pleasurable activities that may have high potential for painful consequences
A milder version of mania that typically lasts for a shorter period
This is known as…?
Hypomania
What are the 4 predictors of relapse in bipolar disorder
- Stressful interpersonal life events
- High ‘Expressed Emotion’ (hostility, overprotectiveness, criticism) in family members
- Disrupted social rhythm events including sleep changes
- Goal-attainment Events *manic symptoms and not depression
- Stressful interpersonal life events
- High ‘Expressed Emotion’ (hostility, overprotectiveness, criticism) in family members
- Disrupted social rhythm events including sleep changes
- Goal-attainment Events *manic symptoms and not depression
What do these predict?
Relapse in bipolar disorder
What are the symptoms of cyclothymia?
List 3 points
- For at least 2 years:
numerous periods of hypomanic symptoms not meeting threshold for hypomanic episodes - Numerous periods of depressed mood / loss of interest that do not meet depression
- The symptoms cause clinically significant distress or impairment in:
- Social
- Occupational
- Or other important areas of functioning
What are the symptoms of other specified bipolar disorder?
List 8 points
- Short-duration hypomanic like episodes (2-3 days) and major depressive episodes
- Hypomanic-like episodes with insufficient symptoms and major depressive episodes
- Hypomanic episodes without prior major depressive episode(s)
- Short-duration cyclothymia
- Short-duration manic-like episodes
- Unable to determine whether bipolar or related disorder is primary
- Other (describe)
- Unspecified
What is the Bipolar At Risk (BAR) Criteria?
List 3 points
- Early detection of BD has focused on familial risk & identification of state-trait factors
- Standardised Bipolar At Risk (BAR) criteria developed by Bechdolf & colleagues (2010):
Youth (15-25) experiencing:
- Short duration (and/or less symptoms) high mood
- Short duration (and/or less symptoms) high & low mood
- First degree relative with BD plus low mood
- BAR criteria has predictive validity, can be reliably assessed in an NHS context, & holds clinical utility
Early detection of BD has focused on ____ and ____
- Familial risk
- Identification of state-trait factors
Early detection of ___ has focused on:
- Familial risk
- Identification of state-trait factors
Bipolar disorder
Who developed the Standardised Bipolar At Risk (BAR) criteria?
Bechdolf & colleagues (2010)
Describe the Standardised Bipolar At Risk (BAR) criteria developed by Bechdolf & colleagues (2010)
List 3 points
Youth (15-25) experiencing:
- Short duration (and/or less symptoms) high mood
- Short duration (and/or less symptoms) high & low mood
- First degree relative with BD plus low mood
True or False?
Bipolar At Risk (BAR) Criteria does not have predictive validity
False
Bipolar At Risk (BAR) Criteria has predictive validity
It can be reliably assessed in an NHS context and holds clinical utility
Bipolar disorder affects __% of the population
a. 10-15%
b. 8-12%
c. 4-7%
d. 1-3%
d. 1-3%
What is the average duration of illness (DUI) for bipolar disorder?
6-10 years, or longer for onset in adolescence
Longer average duration of illness (DUI) for bipolar disorder is associated with ___ and ___
- More mood episodes
- Higher risks of suicide
What is associated with:
- More mood episodes
- Higher risks of suicide
Longer average duration of illness (DUI) for bipolar disorder
Which disorder has the average duration of illness (DUI) of 6-10 years?
Bipolar disorder
The economic impact of Bipolar Disorder in the UK is projected to be £____ by 2026
a. £8.2 billion
b. £4.9 million
c. £14.7 million
d. £5.1 billion
a. £8.2 billion
Economic impact of what disorder in the UK is projected to be £8.2 billion by 2026?
Bipolar disorder
What are the 3 biological factors contributing to bipolar disorder?
- High heritability
- Separate heritability of mania & depression
- Genes for mania may involve reward pathways, i.e. dopamine function
- High heritability
- Separate heritability of mania & depression
- Genes for mania may involve reward pathways, i.e. dopamine function
These are the biological factors of which disorder?
Bipolar disorder
According to the NICE guidelines, what 2 steps are involved in primary care of bipolar disorder?
- Review treatment & care, including medication (e.g. antidepressant medication)
- Offer choice of an evidence-based psychological intervention developed for BD (e.g. Cognitive Behavioural Therapy, Interpersonal Therapy, or Family Focused Therapy)
According to the NICE guidelines, what 2 steps are involved in secondary care of bipolar disorder?
- Pharmacological interventions:
If mania or hypomania develops and the person is taking antidepressants, consider stopping the antidepressant and offer an antipsychotic
- Offer evidence-based psychological intervention
According to the NICE guidelines, when should we implement secondary care for bipolar patients?
When the patient experiences deterioration in depressive symptoms, signs of hypomania, or mania (refer urgently)
When the patient experiences deterioration in depressive symptoms, signs of hypomania, or mania (refer urgently), what type of care is needed?
a. Primary care
b. Secondary care
c. None of the above
b. Secondary care
Offer choice of an evidence-based psychological intervention developed for BD (e.g. Cognitive Behavioural Therapy, Interpersonal Therapy, or Family Focused Therapy)
What type of care does this apply to?
a. Primary care
b. Secondary care
c. None of the above
a. Primary care
Pharmacological interventions
What type of care does this apply to?
a. Primary care
b. Secondary care
c. None of the above
b. Secondary care
If mania or hypomania develops and the person is taking antidepressants, consider stopping the antidepressant and offer an antipsychotic
What type of care does this apply to?
a. Primary care
b. Secondary care
c. None of the above
b. Secondary care
Review treatment & care, including medication (e.g. antidepressant
medication)
What type of care does this apply to?
a. Primary care
b. Secondary care
c. None of the above
a. Primary care
Offer evidence-based psychological intervention
What type of care does this apply to?
a. Primary care
b. Secondary care
c. None of the above
b. Secondary care
What are the 2 types of treatments for bipolar disorder?
- Medication
- Psychological treatments
What medication do patients of bipolar disorder typically receive?
List 3
- Mood stabilisers (e.g. lithium)
- Anti-depressants
- Anti-psychotics
True or False?
Bipolar patients who receive adequate medication experience low relapse rates
False
Bipolar patients who receive adequate medication experience high relapse rates
What are the 3 types of psychological treatments for bipolar disorder?
- Psychoeducation/ Relapse Prevention
- Family Focused Therapy
- Cognitive Behavioural Therapy
What are the 3 stages to Psychoeducation/ Relapse Prevention of bipolar disorder?
- Provide
- Identify
- Work
What treatment for bipolar disorder involves these 3 stages:
- Provide
- Identify
- Work
a. Psychoeducation/ Relapse Prevention
b. Family Focused Therapy
c. Cognitive Behavioural Therapy
a. Psychoeducation/ Relapse Prevention
In Psychoeducation/ Relapse Prevention of bipolar disorder, what happens in the ‘Provide’ stage?
The treatment provides information about bipolar disorder and how people with bipolar disorder learn to cope better
In Psychoeducation/ Relapse Prevention of bipolar disorder, what happens in the ‘Identify’ stage?
Identify warning signs – also called ‘prodromes’ or ‘relapse signature’
- Changes in thoughts, feelings, behaviours
- Quantified and grounded in personal experience
- Judge early, middle and late strategies
In Psychoeducation/ Relapse Prevention of bipolar disorder, what happens in the ‘Work’ stage?
Work collaboratively to identify effective coping strategies, e.g. relax, postpone behaviour, get feedback from family members
Psychoeducation/ Relapse Prevention of bipolar disorder identifies warning signs
These are also known as…?
List 2 points
‘Prodromes’
or
‘Relapse signature’
Psychoeducation/ Relapse Prevention of bipolar disorder identifies warning signs
List the 3 types of warning signs
- Changes in thoughts, feelings, behaviours
- Quantified and grounded in personal experience
- Judge early, middle and late strategies
Which treatment for bipolar disorder provides information about bipolar disorder and how people with bipolar disorder learn to cope better?
Psychoeducation/ Relapse Prevention
Which treatment for bipolar disorder identifies warning signs – also called ‘prodromes’ or ‘relapse signature’?
Psychoeducation/ Relapse Prevention
Which treatment for bipolar disorder encourages patients to work collaboratively to identify effective coping strategies?
Psychoeducation/ Relapse Prevention
Describe the results of Perry et al.’s (1999) study on the efficacy of Psychoeducation/ Relapse Prevention
List 2 points
- 7-12 sessions of individual relapse prevention vs. treatment as usual
- Over 18 months, longer time to relapse with mania but no effects
on time to relapse with depression
According to Perry et al. (1999), Psychoeducation/ Relapse Prevention resulted in longer time to relapse with …?
Mania
According to Perry et al. (1999), Psychoeducation/ Relapse Prevention had no effects in time to relapse with…?
Depression
Describe the results of Colom et al.’s (2003) study on the efficacy of Psychoeducation/ Relapse Prevention
List 2 points
- 21 sessions of group psychoeducation versus treatment as usual
- Reduced rates of relapse of mania and depression over 2 years
According to Colom et al. (2003), Psychoeducation/ Relapse Prevention resulted in reduced rates of relapse of ____ and ____ over 2 years
Mania and Depression