Bipolar Disorders Flashcards
What are bipolar and related disorders (DSM-5)?
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Substance/Medication-Induced Bipolar and Related Disorder
Bipolar and Related Disorder due to another medical condition
Other Specified Bipolar and Related Disorder
Unspecified Bipolar and Related Disorder.
What is euthymia?
Good/normal mood (placed in the center of a mood chart. Above is hypomania and mania, and below is dysthymia and depression. If have tendency for above it is a risk factor for bipolar disorders, if have tendency for below it is a risk factor for depressive disorders.
What is a manic episode?
At least one of the following: elevated, expansive mood/irritable mood, or abnormal and persistent goal-directed activity of energy - targeting energy toward achieving a particular goal.
At least 3/4 for the following: Inflated self-esteem or grandiosity, decreased need for sleep, excessive talkativeness, flight of ideas/racing thoughts – mass of great ideas, distractibility, increased goal-directed activity or agitation – fidgety, risky behaviour (shopping, sex, business, etc.). Need to be present consistently for a week or more
What does a manic episode cause?
Marked impairment in social or occupation functioning, often do not perceive that they are ill/resist efforts to be treated, and cognitive impairment is an important aspect but not part of the criteria.
What is an hypomanic episode?
Less severe and of shorter duration than a manic episode. 4 days or more. There is change in functioning noticeable by others but does not cause marked impairment in social or occupational functioning.
What is a mixed episode?
Meets criteria for both a manic episode and a major depressive episode. Display both symptoms at the same time.
What is bipolar I disorder?
Manic or mixed episode and major depressive episode - do not happen at the same time, usually there is a major depression preceding manic episode.
What is bipolar II disorder?
Major depressive disorder accompanied by a hypomanic episode. Less intense symptoms. Feature of impulsivity (suicide), average onset in mid-20s, usually begins with depressive episode which leads to false diagnosis in about 12%. Anxiety, eating, substance disorders may precede. Greater chronicity of illness and spend more time in the depressive state which can be severe and disabling.
What is cyclothymic disorder?
Milder combination of bipolar I and II disorders. Altering between a hypomanic episode and a dysthymic episode. Longer term - 2 years for adults and 1 year for children.
What are key facts about bipolar disorder I?
Heterogeneous disorder characterised by mood instability and cognitive dysfunction. Onset in early adulthood. Psychotic symptoms seem in minority. High comorbidity with anxiety and substance-related disorders in about 1/2 of BD patients (also cardiovascular disease and diabetes mellitus and thyroid dysfunction). High morbidity associated with the depressive episodes – 5-17% suicide rate. Life expectancy is reduced by 10 years or more – because of comorbidity and suicide rate. Poor prognosis – high rates of relapse, cognitive impairments and low quality of life.
What are bipolar disorders?
Prevalence of about 1-4% - spectrum of bipolar disorder, depends how many criteria a person display. Diagnosing difficulties mainly due to the manic episodes – lack of dysphoria. Rapid cycling – more than 4 episodes of either mania or depression within 1 year. If untreated – typically gets worse due to cycle acceleration. The frequency of episodes increases due to shortening of the length of symptom-free intervals.
What is the kindling hypothesis?
At beginning disorder may be triggered by environmental events, and once we experience that episode, if this happens again the symptoms may be triggered alone, in the absence of environmental events.
What are episode-free intervals?
Still decreased social functioning and decreased cognitive abilities - not symptom free. Many misconceptions and focus on the episodes. Although many return to a fully functional level, 30% show severe impairment which prevents them from working. Lag between recovery from symptoms and functional recovery.
What is disruptive mood dysregulation disorder (DSM-5 - depressive disorders)?
In children there has been an over diagnosis of BD. In an effort to deal with it, a new diagnosis of disruptive mood dysregulation given up to 12 years. Characterised by persistent irritability (in males) and frequent episodes of extreme behavioural dyscontrol. Typically develop depressive disorders rather than BD in adulthood.
What are gender-related features in BD?
Although considered to be equally common, there are some differences: in women more likely to be depressive, more suicide attempts, mixed mania and rapid cycling, more thyroid dysfunction, more comorbid anxiety. Comorbid substance use more frequent in men. Postpartum period is a high-risk time for onset of depressive, manic, mixed and psychotic episodes.
What is the switch ‘circular insanity’ (Falret, 1854)?
Unique feature of BD which distinguishes it from other disorders and makes it difficult to study - a sudden transition from 1 mood episode to another of opposite polarity - usually from depression to mania. The neurobiology of it is poorly understood. Has not been achieved in animal models yet.
What triggers the switch?
Switching from depression to mania can occur spontaneously but can also be precipitated by stress, sleep deprivation, antidepressants, ECT, and substance use. Switching from mania to depression is more rare and is associated with poorer outcome.
What is monopolar depression?
Usually after 25 years. Preceded by a long period where symptoms progressively get worse. There is no history of mania or hypomania.
What is bipolar depression?
Usually before 25 years. Sudden occurrence in a few hours or days. Could be seasonal. High heritability (family history of the patient). History of behavioural problems, decreased need for sleep etc. are indicative of the presence of BD.
What proportion of mood disorders are bipolar?
Traditional paradigm - shifting paradigm. View it as a spectrum of bipolar disorder - shifting in the prevalence. In the past 86% diagnosed as MDD, now 50%.
What are environmental factors behind BD?
Childhood adversity, chronic stress and trauma. Mood instability (affective lability) during euthymia - a relatively new finding thanks to smartphones and apps. Being easy to shift your mood during euthymia (normal mood) – more shifts in mood than normal. Sleep disturbances, irregular sleep timing, reduction in sleep duration or travelling across time zones triggers manic episodes. Treatment with antidepressants.
What are sleep features of BD?
Shortened sleep is associated with greater severity of symptoms. Sleep abnormalities (too short or too long) associated with poor quality of life. Disruption in sleep continuity. Increased time spent in stage 1 sleep, shortened REM latency – very quickly go into REM, very shallow stage of sleep, increased REM sleep density – how many movements eyes are making.
What are genetics of BD?
Mutations of CLOCK in mice results in decreased need for sleep, increased motor activity, low anxiety – comparable to mania and it is restored by lithium. PER3 gene – linked to the early onset of BD I (before 18y) associated with: More psychotic features and higher frequency of mixed episodes, poorer prognosis. There is a genetic basis - 10 times more likely to develop BD if the parent has it (also increased risk if schizophrenia is found in the family). Not Mendelian genetics – multiple loci involved (GWAS).
What did Gandal et al. 2018 find about the genetics of BD?
Nothing unique about BD but common loci with ASD and SCZ, i.e. CD4: astrocyte-related module and glial cell differentiation. CD1, CD10 and CD13: neuronal/mitochrondrial (neuronal firing rate, energetic balance, and synaptic transmission).
