Lecture 9 Bipolar Disorders

Question 1

Bipolar disorders

Answer 1

• presence or history of manic, hypomanic episodes, depressive episodes
• functional impairment
• suicide risk

Question 2

phases of illness

Answer 2

acute stabilisation–> ongoing maintenance–> relapse prevention

Question 3

treatment differs based on

Answer 3

phase, severity, polarity

Question 4

polarity

Answer 4

normal, manic (high), normal, depressive (low)

Question 5

DSM 5

Criterion A

Answer 5

• abnormally and persistently elevated irritable mood and increased goal directed activity
• present nearly everyday
  Manic ep:
• at least 1 week
• nearly everyday
  Hypomanic ep:
• at least 4 consecutive days
• nearly everyday

Question 6

Criterion B

Answer 6

• inflated self esteem
• don’t rly need to sleep
• rapid, pressured speech
• flight of ideas or racing thoughts
• distractibility
• increase in goal-directed activity
• trying to do stuff that have high chance of negative consequences
  Manic and Hypo eps:
• at least 3 or more
• show noticeable change from usual you

Question 7

Bipolar 1: Manic ep?

Answer 7

Yes

Question 8

Bipolar 1: Hypo?

Answer 8

can be present, but not necessary for diagnosis

Question 9

Bipolar 1: Major depressive ep?

Answer 9

can be present, but not necessary for diagnosis

Question 10

Bipolar 2: Manic ep?

Answer 10

No

Question 11

Bipolar 2: Hypo?

Answer 11

Yes

Question 12

Bipolar 2: Major depressive ep?

Answer 12

Yes

Question 13

Bipolar 1

Answer 13

• distinct periods of manic and depressive eps
• ratio to manic to depressive eps–> 1:3
  Mania
• severity–> impairment, disrupt functioning (work, school)
• hospitalisation often needed
• can be psychotic features at severe end of mania

Question 14

Bipolar 2

Answer 14

Hypomania

• less severe than mania
• uncharacteristic of person
• mood disturbance= noticeable to others
• shorter duration than manic eps
• not severe enough to disrupt functioning
• not severe enough to result in hospitalisation

Question 15

Cyclothymic disorder

Answer 15

• constant
• less severe form of bipolar
• numerous cycles of hypomanic and depressive symptoms
• not severe enough for manic or major depressive eps
• symptoms: for at least 2 years but no more than 2 months without symptoms

Question 16

bipolar treatment depends on…

Answer 16

• illness phase

- predominant polarity

Question 17

goal of acute stabilisation

Answer 17

reduce arousal, agitation, aggression

Question 18

acute stabilisation

polarity: Mania

Answer 18

• treated medically–> hospitalisation
• pharmacotherapy= 1st line treatment
• beh. disturbance= antipsychotic medication
• severe= ELT

Question 19

acute stabilisation

polarity: Depression

Answer 19

• goal: achieve complete and functional remission of depressive symptoms
• suicidal risk
• pharmacotherapy used
  
  • 2nd generation antipsychotics or mood stabilisers

Question 20

acute stabilisation

ECT

Answer 20

• use when medication isn’t working
• effective for treating acute mania and severe depression
• short term effects: confusion, memory loss
• pharmacotherapy– to maintain mood stability and prevent relapse

Question 21

ongoing maintenance

medical

Answer 21

• prophylactic medication– prevents future episodes

Question 22

ongoing maintenance

psychological

Answer 22

• CBT
• interpersonal and social rhythm therapy
• psychoedu
• family-focused therapy

Question 23

ongoing maintenance

pharmacotherapy

Answer 23

• mood stabilisers: ex. lithium
• anticonvulsants
• antipsychotics
• antidepressants

Question 24

ongoing maintenance

monitoring maintenance

Answer 24

• physical examination
• tolerability of side effects
• efficacy of pharmacotherapy to manage symptoms

Question 25

Lithium

Answer 25

• treat mania and depression
• neuroprotective and anti-suicidal properties
• lithium toxicity
  
  • high blood concentrations= toxic
  • need regular monitoring= prevent toxicity

Question 26

CBT aim

Answer 26

manage symptoms and prevent relapse

effective for depressive eps

Question 27

CBT key tech

Answer 27

• more effective for depressive eps and for fewer past episodes
  patient encouraged to:
• monitory symptoms
• challenge/ change unhelpful thinking
• foster self-efficacy
• join it with mindfulness based cognitive therapy
  treatment phases:
  1. individualised formation, treatment goals
• psychoeducation
• identifying and challenging negative thoughts
• beh experiments
  2. cog and beh approaches to symptom managements
• self monitoring
• self regulation
  3. dealing with cog and beh barriers to treatment adherence
  4. anti-relapse tech
• relapse prevention

Question 28

Mindfulness-based cog therapy

Answer 28

aim: teach people to become aware of thoughts and feelings

Question 29

Interpersonal and social rhythms therapy aim

Answer 29

• improve interpersonal functioning
• reduce disruption to daily routine and sleep-wake cycles
• try to maintain social rhythms
  
  • fixing waking up time

Question 30

Psychoeducation aim

Answer 30

improve knowledge about managing condition, prevent relapse

Question 31

Fam -focused therapy

Answer 31

enhance cargivers’ way of managing
involves bipolar person and their fam
- comm skills, problem solving, psychoeducation

Question 32

relapse prevention

Answer 32

• mood monitoring– daily mood chart
• noticing early signs of episode
• relapse prevention plan
• prevent manic thinking