bipolar disorders

Question 1

placement of bipolar disorders category in DSM-5 & reasoning

Answer 1

bipolar disorders section placed between psychotic & depressive disorders due to shared similarities w/ symptoms, family history, & genetics

Question 2

bipolar disorder subtypes

Answer 2

bipolar I, bipolar II, cyclothymic disorder, substance/medication induced bipolar & related disorder, bipolar & related disorder due to another medical condition, other specified bipolar & related disorder, unspecified bipolar & related disorder

Question 3

bipolar I disorder diagnostic criteria

Answer 3

(1) At least 1 lifetime manic episode EITHER lasting 1 week or longer OR severe enough to require hospitalisation, w/ symptoms of: irritability, euphoria, decreased need for sleep, grandiose ideas, increased activity, impulsive behaviour, flight of ideas, racing thoughts, talkativeness

Mania alone is significant for diagnosis but may not present alone:

(a) may be experienced as a mixed episode (alongside depression)
(b) may be preceded or followed by
(b. i) a hypomanic episode (distinct episode of less severe mania lasting at least 4 days w/o causing severe impairment) OR
(b. ii) a major depressive episode

Question 4

hypomanic episode

Answer 4

distinct episode of less severe mania lasting at least 4 days, without causing severe impairment

Question 5

bipolar II disorder diagnostic criteria

Answer 5

(1) at least 1 lifetime hypomanic episode WITH
(2) at least 1 major depressive episode, including 2 or more weeks of: intense sadness, loss of interest, fatigue, insomnia, psychomotor agitation/retardation, weight change, cognitive dysfunction, feelings of worthlessness, suicidal ideation/attempts

Question 6

approximate conversion rate from BD-II to BD-I

Answer 6

~11%

Question 7

cyclothymic disorder diagnostic criteria

Answer 7

2 or more years of fluctuations between hypomanic & depressed symptoms (as in bipolar-II) without reaching the full criteria for either hypomania or depression

Question 8

lifetime prevalence for bipolar-I & bipolar-II

Answer 8

3.9% for both

Question 9

lifetime prevalence for cyclothymic disorder

Answer 9

4.2%

Question 10

lifetime prevalence when including manic episodes resulting from antidepressant use

Answer 10

10%

Question 11

median onset for bipolar disorders

Answer 11

median onset at 25 years, but 25% experiencing onset at 17 years

Question 12

implications of earlier onset of bipolar disorders

Answer 12

earlier onset associated w/:

(1) poor outcomes: higher suicide rates, more depressive & manic episodes w/ greater severity, higher comorbidity & more psychotic features, greater likelihood of rapid cycling (4 or more episodes per year) in adulthood

Question 13

common comorbidities with bipolar disorders

Answer 13

highest comorbidity w/ ADHD; also common w/ anxiety disorders, esp. panic disorder; substance abuse, esp. alcohol

Question 14

percentage rates of illness recurrence over any 1 year, and over 2 years, of those diagnosed

Answer 14

37% of those diagnosed have at least 1 episode of depression of mania; rises to 60% over 2 years

Question 15

symptoms between episodes

Answer 15

most experience mild/moderate symptoms between episodes

Question 16

persistence of manic vs depressive symptoms

Answer 16

depressive symptoms persist longer than manic symptoms

Question 17

attempted & completed suicide rates for bipolar disorders

Answer 17

suicide rate higher than w/ any other psychiatric disorder:

attempted suicide = 50%; 15x higher than typical population & 4x higher than depressed patients

completed suicide = 11%

Question 18

risk factors for suicide in bipolar disorders

Answer 18

as w/ other populations: family history of illness, substance abuse, social isolation, anxiety, impulsivity; earlier onset/diagnosis

Question 19

lithium & suicide in bipolar disorders

Answer 19

suicide rates are reduced by lithium

Question 20

disability with bipolar disorders

Answer 20

(1) bipolar disorder ranked 6th leading cause of disability worldwide
(2) 57% of those diagnosed report being unable to work

Question 21

prior effects of manic episodes

Answer 21

effects of a manic episode on work, social, & family disturbances can be observed up to 5 years prior

Question 22

genetic susceptibility overlap for bipolar disorder & schizophrenia (twin studies)

Answer 22

monozygotic twins of schizophrenic patients = 8% increased risk for mania

monozygotic twins of manic patients = 13% increased risk for schizophrenia

Question 23

neural atypicalities in bipolar disorder (2)

Answer 23

(1) lesions to left frontal cortex & left basal ganglia implicated w/ depression; right frontal cortex & right basal ganglia implicated w/ mania
(2) atypical prefrontal activation esp. in decision making implicated in manic episodes

Question 24

role of dopamine in bipolar disorders (2)

Answer 24

(1) dopamine can induce mania in healthy individuals
(2) sleep deprivation can interfere w/ normalising dopamine receptors; mania can follow after only 1 night of sleep deprivation in bipolar patients

Question 25

role of serotonin in bipolar patients

Answer 25

as w/ depression, bipolar disorder has been associated w/ decreased sensitivity of serotonin receptors

Question 26

role of cannabis in risk of manic symptoms

Answer 26

around 6 studies have associated cannabis use w/ a 3x increased risk for new onset of manic symptoms

Question 27

problem with developing bipolar mediactions

Answer 27

biological mechanisms underlying bipolar disorder are unclear, so medications not theoretically driven but developed by trial/error

Question 28

stages of bipolar medication administration (2)

Answer 28

(1) acute - to resolve episodes | (2) maintenance - to prevent, delay, or reduce severity of subsequent episodes

Question 29

mood stabilisers for treating bipolar disorder

Answer 29

mood stabilisers (ex: lithium) used to treat / prevent episodes w/o triggering opposite polarity, as seen w/ some antidepressants

Question 30

lithium remission & relapse rates

Answer 30

around 60-70% remission but 40% relapse w/ lithium

Question 31

antidepressants for treating bipolar disorder

Answer 31

antidepressants effective in reducing depression but may trigger mania, so often used in conjunction w/ lithium / other mood stabilisers

Question 32

antipsychotics for treating bipolar disorder

Answer 32

antipsychotics sometimes used to block dopamine receptors; most effecting in combination w/ mood stabilisers

Question 33

anticonvulsants for treating bipolar disorder

Answer 33

sometimes but rarely used due to sever side effects, incl. low white blood cell count

Question 34

predictors of depression (3)

Answer 34

(1) negative cognitive style w/ tendency to attribute negative events to stable, long-term causes, global causes, or internal causes inherent to the individual (2) stressful life events (3) low social support

Question 35

expressed emotion & role in relapse

Answer 35

EE: criticism, hostility, & over involvement from care-giver & family EE predicts higher relapse w/in shorter time periods in patients post-hospitalisation; studies show that distress in response to criticism rather than criticism itself predicted depression, mania, & days in recovery

Question 36

manic-defence hypothesis

Answer 36

based on psychodynamic ideas of defence against negative feelings about the self; says that negative thoughts/feelings in conscious mind are distracted against by a flurry of thoughts/activity, possibly leading to more positive thoughts/feelings

Question 37

predictors of mania (3)

Answer 37

(1) reward sensitivity & goal dysregulation w/ excess focus on goals & high impulsivity disregarding social consequences (2) possible positive interpretation bias suggested by some evidence (3) sleep disruption due to life events or social influences

Question 38

psycho-education

Answer 38

a psychological intervention to inform about bipolar disorder & how treatments work

Question 39

FFT - family focused therapy

Answer 39

psychological intervention to help families support individuals w/ BD, esp. after treatment, by improving knowledge around BD, reducing expressed emotion, & enhancing communication

Question 40

typical bipolar disorder assessment timeline (3)

Answer 40

(1) referred from primary care (2) psychometric tests like 'MINI' (mini interpersonal neuropsychiatric interview) screening tool covering 17 psychiatric diagnoses including BD (3) full psychiatric assessment in secondary care, incl. full history of symptoms/mood, social/personal functioning, potential comorbidity, treatment history; family member often encouraged to attend to corroborate history

Question 41

assessment complexities (2)

Answer 41

(1) fluctuating course of BP can lead to different impressions of difficulties (2) effects of medications