Bipolar Disorder Flashcards Preview

000 Serper Final > Bipolar Disorder > Flashcards

Flashcards in Bipolar Disorder Deck (35):
1

Cyclothymia (or Cyclothymic Disorder), general

Cycle for 2 years in adults, or 1 year in children, between hypomania and PDD

Pattern is irregular and unpredictable

Low and high mood swings never reach the severity of major depression or full mania.

Hypomania or depression can last for days or weeks. In between up and down moods, a person might have normal moods for more than a month -- or may cycle continuously from hypomanic to depressed, with no normal period in between

2

Manic Episode, Sign vs Symptom

Sign = what can be seen
e.g. flight of ideas

Symptom = what is reported
May include delusions and hallucinations, racing thoughts

3

Manic Episode
DSM-5 Criteria

A:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting AT LEAST 1 WEEK and present most of the day, nearly every day

*If hospitalization is necessary, duration is irrelevant

B:
During period of mood disturbance,3 or more of the following (4 if mood is only irritable):

1. inflated self-esteem or grandiosity

2. Decreased need for sleep

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or subjective experience that thoughts are racing

5. Distractibility (reported or observed)

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (purposeless non-goal-directed activity)

7. Excessive involvement in activities that have a high potential for painful consequences
*e.g. unrestrained buying sprees; sexual indiscretion; foolish business investments

4

Bipolar with psychotic features vs. schizophrenia (SZ)

In SZ, delusions/hallucinations occur in the absence of mood symptoms for more than 2 weeks

5

Anxious Distress Specifier
DSM 5

High levels of anxiety have been associated with higher suicide risk, longer duration of illness, and greater likelihood of treatment nonresponse

Intended to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria

1. Feeling keyed up or tense

2. Feeling unusually restless

3. Difficulty concentrating because of worry

4. Fear that something awful might happen

5. Feeling that the individual might lose control of himself or herself

6

Bipolar II Disorder

At least one episode of hypomania: must last 4 days min.

At least one episode of major depression

Dx :
Individual must never have experienced a full manic episode

~25% of all bipolar cases

Rapid cycling pattern is associated with a poorer prognosis

7

Hypomania

Sustained state of elevated or irritable mood

Less severe than mania

Does not significantly impact quality of life

Unlike mania, hypomania is not associated with psychosis

8

Bipolar I vs. Bipolar II
Depressive Episodes

Bipolar II:
*More common in females
(BP-I 50/50)

*More frequent depressive episodes and shorter intervals of well-being than BP-I

*More chronic and consists of more frequent cycling than the course of bipolar I

*Associated with a greater risk of suicidal thoughts and behaviors than bipolar I or unipolar depression

*Although bipolar II is commonly perceived to be a milder form of Type I, this is not the case.

*Types I and II present equally severe burdens

9

Pharmacotherapy: Tricyclics

Effective as SSRIs but with more side effects

anticholinergic effects = blurred vision, constipation, weight gain

toxic in high quantities

dangerous with suicidal patients, easy to overdose

10

Pharmacotherapy: SSRIs effectiveness

No more effective than tricyclics

~30% success rate

11

Pharmacotherapy: Lithium

The lethal and therapeutic dosage are not that different: risk of toxicity

12

Pharmacotherapy: Anticonvulsants

Depakote – most commonly prescribed anticonvulsant for bipolar disorder
• Prescribed if an individual does not respond well to lithium

Lamictal is also commonly prescribed, but may cause Steven-Johnson syndrome (A lethal rash)

13

Pharmacotherapy: Antipsychotics

Typically, a second-line of defense

Used to balance mood

These drugs work well, but are accompanied by a range of side effects

14

Mayberg: research predictive pharmacotherapy efficacy

Bromin’s area 25

More activation, medication leads to a better outcome

Less activation, CBT works better than meds

15

ECT

Electroconvulsive Therapy

Typically used in elderly, non-responsive, populations

Seizure is therapeutic

Applied to the non-dominant hemisphere

Treatment should be apparent in 2-4 weeks

Side effects:
*transient amnesia
*general confusion

16

ECT Most effective Course

Meds before ECT

CBT or drugs after
• Helps decrease relapse rate of depression

May help promote neurogenesis and increase serotonin

17

Transcranial Magnetic Stimulation (TMS)

Not as effective as ECT in treating depression with psychotic features

Treatment focuses on the dorsolateral prefrontal cortex

18

Vagus Nerve Stimulation

Involves sending small electric pulses to the neck

19

Bipolar Spectrum: Onset

Early 20s

Earlier onset than typical for depression (mid to late 20s)

20

Bipolar Spectrum: Duration mania vs depression

For ALL bipolar diagnoses:
depression lasts 3x longer than mania

Applies to both genders

21

Bipolar Spectrum: Genetics

Bigger role than in depression

MZ twins:

Depression, 4x greater chance

Bipolar, 80% chance

22

Bipolar Spectrum: Neurotransmitters

Interaction and combination of:
serotonin
dopamine
norepinephrine

Transmitters linked with MOTIVATION AND CONCENTRATION

23

Bipolar Spectrum: Permissive Hypothesis

Decrease in serotonin leads to the deregulation of norepinephrine and dopamine

24

Bipolar Spectrum: Disruption of Sodium Ions

Malfunctioning ion channels due to faulty proteins:

Decrease of Na+ ions leads to sluggish behavior

Increase of Na+ ions leads to mania

*potentially resolved via regulation of potassium

25

Bipolar Spectrum: Thyroid

Thyroid Deregulation

Greater link to bipolar than unipolar

26

Hypomania
DSM-5 Criteria

* Episode is not severe enough to cause marked impairment in social or occupational functioning

*If psychotic features, the episode is by definition manic

A:
A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, LASTING AT LEAST 4 CONSECUTIVE DAYS and present most of the day, nearly every day

B:
During period of mood disturbance,3 or more of the following (4 if mood is only irritable):

1. inflated self-esteem or grandiosity

2. Decreased need for sleep

3. More talkative than usual or pressure to keep talking

4. Flight of ideas or subjective experience that thoughts are racing

5. Distractibility (reported or observed)

6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (purposeless non-goal-directed activity)

7. Excessive involvement in activities that have a high potential for painful consequences
*e.g. unrestrained buying sprees; sexual indiscretion; foolish business investments

27

Bipolar II
DSM-5 Criteria

Hypomanic Episode (current or past--at least 4 days)

AND

Major Depressive Episode (current or past--at least 2 weeks)

28

Cyclothymic Disorder
DSM-5 Criteria

A:
At least 2 years (1 year children/adolescents)

Numerous periods with hypomanic symptoms that do not meet criteria for hypomanic episode

AND

Numerous periods with depressive symptoms that do not meet criteria for a major depressive episode

B:
Hypomanic and depressive periods have been present for at least 1/2 the time

Individual has not been without the symptoms for more than 2 months at a time

*criteria for a major depressive, manic, or hypomanic episode have never been met

*most children with cyclothymic disorder are more likely to have comorbid ADHD

29

Bipolar Spectrum: Neuroanatomical Correlates

Asymmetrical hemispheric blood flow in bipolar disorder

Decreased gray matter

Altered activation patterns

Alterations to:
PFC
ACC
Hippocampus
Amygdala

30

Bipolar Spectrum: Suicidality

Biggest risk: when depression just starts to alleviate
• Individuals are still depressed but have more energy

Loss of abstract thinking

Lack of cognitive flexibility

Concrete thinking only

31

Mixed states

In a mixed state, the individual has co-occurring manic and depressive features, which can occur either simultaneously or in very short succession.

Dysphoric mania is primarily manic

Agitated depression is primarily depressed

The mixed state can put a patient at greater suicide risk

Depression
+ Increased energy
+ Agitation
+ Impulsivity
= higher risk of dangerous behavior, self-injury or suicide.

32

Cyclothymia: Prevalence

Lifetime: 0.4% -- 1%
equal male/female

In Mood disorder clinics: 3%--5%
Females more commonly present for tx

Usually
A diagnosis of Cyclothymia increases the chance of later being diagnosed with bipolar disorder

More difficult to discover Cyclothymia than bipolar

Individuals with Cyclothymia can still function in daily lives

33

Cyclothymia: Course

15%--50% risk of developing Bipolar I or II later in life

34

Bipolar Spectrum: Cortisol

Cortisol is elevated during both mania and depression phases, similar to unipolar

35

DSM-5 Changes

Emphasis on changes in activity and energy as well as mood for hypomanic and manic episodes

Anxious to stress specifier