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Flashcards in Bipolar (Related) Disorders Deck (14):
1

What are the DSM criteria for a Manic episode?

A: 1+ weeks of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy

B. 3+ symptoms of creativity, mysticism, irritability or disinhibition such as:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- Rapid or pressured speech
- Flight of ideas or racing thoughts
- Distractibility
- Increase in goal-directed activity or psychomotor
agitation
- Excessive risky behaviour

C. Involves marked impairment (occupation, psychotic features or need of hospitalisation)

D. Not due to drugs or other medical condition

2

What is a hypomanic episode?

A. At least 4 days of: abnormally & persistently elevated, expansive or irritable mood, and increased goal directed activity/energy, present nearly daily

B. 3+ symptoms of creativity, mysticism, irritability or disinhibition such as:
- Inflated self esteem or grandiosity
- Decreased need for sleep
- More talkative/pressured speech
- Flight of Ideas; racing thoughts
- Distractibility
- Increased goal-directed activity or psychomotor agitation
- Excessive involvement in risky behaviours

C. NOT severe enough to cause marked impairement, hospitalisation, NO psychotic features

D. not due to drugs or other medical condition

3

What is the difference between Bipolar 1, Bipolar 2 and Cyclothymic disorder?

Bipolar 1: Presence of Manic episodes. (depressive and hypomanic episodes can be present but are not necessary for diagnosis)

Bipolar 2: No manic episodes, but presence of both depressive and hypomanic episodes

Cyclothymic disorder: chronic, less severe form of bipolar disorder. Numerous cycles of hypomania symptoms and sub-threshold depression symptoms. Persists 2+ years without break of over 2 months.

4

What is the epidemiology of Bipolar disorders?

Statistics
- Lifetime prevalence (Australia): Bipolar I 1%, Bipolar II ~5%.
- No gender differences
- Onset: peak at 15-25 years (for both genders)

Course
- 10-20 years delay in seeking treatment,
- Untreated: 8-10 lifetime episodes of mania & depression
- Treated: 40% relapsing within 1-year; 73% within 5-years
- Predominantly depressive (BP1 32% to 9% mania, BP2 50% to 1% hypomanic)

Comorbidity
- 50% anxiety disorders
- 39% substance misuse (self medication)
- 25% attempted suicide, 10-20% successful

5

What are the main diagnostic issues around Bipolar disorders?

- Undetected/Undiagnosed
- Over-diagnosed (i.e. Borderline Personality Disorder)
- Misdiagnosed as Schizophrenia or Unipolar Depression

6

What are the main aetiological factors in bipolar disorders?

Genetic factors: BP heritability rate of about 85% in twin studies, 10% : 1% chance for families

Stressful Life events:
- manic episodes preceded by: abnormal sleep patterns, focus on goal attainment, routine interruption
- depressive episodes preceded by: low social support, low self esteem

Psychological Factors
- A negative cognitive style enhances vulnerability
- Temperament factors: perfectionism & sociotropy
- Mania may be a defense to counter underlying negative self-esteem

7

What is the Diathesis-Stress model?

A theory of bipolar that shows a cycle between 4 factors:

Life Stressors: causing sleep or social deprivation
trigger ---> biological vulnerability

Biological Vulnerability; i.e. Circadian rhythm
instability triggers -->

Prodromal Stage: (Early symptoms of mood disturbance)
+ poor coping strategies triggers --->

Episode: manic, hypomanic, depressive
+ stigma or relationship problems triggers --> Life stressers

8

What are the main considerations when choosing a course of treatment for Bipolar disorders?

- illness stage (acute, maintenance)
- predominant polarity (depressive, hypo/manic)
- patient preferences (Treatment adherence depends on the value patients place on treatment efficacy versus side-effect burden)

9

What are the main medical treatments for bipolar disorders?

Drugs
- Lithium: mood stabiliser & main component of standard care. Treatment of manic episodes & for preventing future episodes. 50% patients relapse within 5 months of ceasing
- Antidepressants: doses lower & duration shorter than for unipolar depression, combined with mood stabiliser to prevent inducing mania
- other (antipsychotics, anticonvulsives, sedatives)

Electroconvulsive therapy
- Used when medication is not viable
- Effective for treating both manic & depressive episodes, but not in preventing relapse
- Short-term side effects: confusion, disorientation,
memory loss

10

What is the psycho-education model of treatment for bipolar disorders?

Most commonly in a group setting

Providing information about:
- Symptoms of BP disorder
- Diathesis-stress model of BP disorder
- Identifying early warning signs of relapse
- The rationale/importance of medication compliance
- Strategies to cope with stressors
- Need for routines & sleep-wake cycles

Delays recurrence + reduces frequency of future episodes:

11

What is the CBT model for treatment of bipolar disorders?

Aims to to manage acute symptoms & prevent relapse
through cognitive restructuring by

Strategies
- Monitor symptoms
- Challenge hyper-positive cognitions
- Improve medication adherence
- Foster self-efficacy
- wellbeing plans; plans of action and permission for others to take action

CBT effective in reducing episodes and hospitalisations,
improving medication compliance within 6-months post-treatment

12

What is the Interpersonal and Social Rhythm therapy model of treatment for bipolar disorder?

Aim: to improve interpersonal functioning and to
reduce disruption to routines & sleep-wake cycles

strategies
- identify unstable rhythms
- Identify realistic goals for change
- Establish and maintain new routines

particularly effective in reducing relapse

13

What is the Family focused model of treatment for bipolar disorder?

Aims to improve:
- knowledge about Bipolar disorder
- family communication and problem solving skills
- family functioning; reducing any criticism or hostility

Support for family interventions found in reducing
relapse rates, hospitalisations & time to relapse

14

What are the risk factors for relapse?

- Biological/genetic vulnerability
- Medication non-adherence
- Dysfunctional attitudes & beliefs
- Disrupted routines (& sleep-wake routine)