Lecture 9 - Bipolar Disorder

Question 1

What are the characterisations of mood episodes in bipolar?

Answer 1

• Mood associated with an unequivocal change in functioning that is uncharacteristic of the person
• Symptoms cause distress or impairment in social and occupational functioning
• Observable by others

Question 2

What are the symptoms of MAJOR depression?

Answer 2

2 weeks minimum of depressed mood 24/7, diminished interest or pleasure in anything
At least 3 of the following:
- Weight change
- Insomnia or hypersomnia
- Agitation
- Fatigue
- Worthlessness
- Suicidal ideation

Question 3

What are the symptoms of mania (one week) & hypomania (4 days)?

Answer 3

• Abnormally and persistently elevated, expansive or irritable
• Increased activity and energy
  3 or more:
• Inflated self esteem
• Decreased need for sleep
• More talkative
• Flight of ideas
• Distracted
• Excessive involvement in pleasurable activities

Question 4

What are some predictors of relapse?

Answer 4

• Stressful interpersonal life events
• High expressed emotion (hostility or criticism) from family members
• Disrupted social rhythm (sleep)

Question 5

What is Cyclothymia?

Answer 5

For at least 2 years:
- Numerous hypomanic symptoms but not meeting a hypomanic episode
- Numerous periods of depression that does not meet major depression
- Distress or impaired functioning

Question 6

How is BD detected early?

Answer 6

• Familial risk
• State-trait factors
• Standardised Bipolar At Risk (BAR) criteria
• Youth (15-25) experiencing short duration of high mood, low mood, or have first degree relative with BD

Question 7

How much of the pop does BD affect?

Answer 7

1-3%

Question 8

What is the average duration of Bipolar diagnosis?

Answer 8

6-10 years til a proper diagnosis

Question 9

What is the economic impact of BD in the UK (by 2026)

Answer 9

Predicted to be 8.2 billion

Question 10

Evidence of high functioning hypomania

Answer 10

12 individuals 30+, history of hypomanic episodes:
- Never sought treatment
- No history of depression
- No bipolar diagnosis
- High functioning, low catastrophising

Question 11

What is primary care?

Answer 11

Review the treatment and care, medication, offer psychological intervention (CBT, interpersonal therapy)

Question 12

What is secondary care?

Answer 12

If mania or hypomania develops and person is taking anti depressants, consider antipsychotics

Question 13

What are the treatments for bipolar?

Answer 13

• Medication such as lithium, anti depressants, antipsychotics
• Psychological intervention - relapse prevention, family focused therapy and CBT

Question 14

What is Psychoeducation and relapse prevention?

Answer 14

Provide info about BD and how to cope, identify warning signs of relapse (changes in thoughts, feelings, behaviours), work together to find coping strategies

Question 15

What is the efficacy of relapse prevention? - Perry et al. (1999)

Answer 15

7-12 sessions
Over 18 months, longer time to relapse with mania but no effects on depression relapse

Question 16

What is the efficacy of psychoeducation? - Colom et al. (2003)

Answer 16

21 sessions
Reduced rates of mania and depression over 2 years

Question 17

What is family focused therapy?

Answer 17

Work with families
Provide info (psychoeducation)
Identify any hostility or criticism - establish a collaborative environment

Question 18

What is the efficacy of family focused therapy? - Miklowitz et al. (2003)

Answer 18

2 sessions of FFT, psychoeducation and behaviour intervention vs Crisis Management
- Reduced relapse rates and mood symptoms over 2 years

Question 19

How does CBT treat Bipolar?

Answer 19

• Develop problem list
• Identify negative thoughts and challenge them
• Identify coping methods

Question 20

What is the efficacy of CBT for Bipolar? - Lam et al. (2003/5)

Answer 20

20 sessions
Reduced symptoms of depression and longer time to relapse over 2 years, improved functioning

Question 21

What is the STEP trial?

Answer 21

Systematic Treatment Enhancement Programme - Miklowitz et al. (2007)

Question 22

What does the Integrative Cognitive Model of Bipolar consist of? - Mansell et al. (2007)

Answer 22

Triggering event -> change in internal state -> appraised as having extreme personal meaning -> descent or ascent behaviours
Life experiences -> beliefs about self, world, others -> appraised as having extreme personal meaning -> behaviours or change in internal state

Question 23

What does the Integrative Model propose?

Answer 23

Mood swings consequence of personal appraisals in changes in internal states
High energy - imminent success vs mental breakdown (all comes crashing down)
Low energy can be safe and relaxing vs low energy = failure

Question 24

What are appraisals and attributions within the ICM of BD?

Answer 24

Certain cognitive biases that contribute to the onset and persistence of mania and depression

Question 25

What is goal dysregulation within the ICM of BD?

Answer 25

Difficulties in goal setting, fluctuations in goals, rapid shifts between high energy during mania and decreased motivation in depression

Question 26

What is cognitive control within the ICM of BD?

Answer 26

Dysfunctions of cognitive processes - rumination and worry

Question 27

What are contextual factors within the ICM of BD?

Answer 27

Environmental and interpersonal factors - life events, social rhythms, relationships

Question 28

What are ascent behaviours?

Answer 28

Taking on more and risk taking - manic

Question 29

What are descent behaviours?

Answer 29

Withdrawing - depression