Week Three - Neurobiology of Bipolar Disorder

Question 1

what are the four diagnostic features of a manic episode

Answer 1

1. distinct period of abnormality and persistent elevated mood, goal directed energy. Eating more than one week, and present most of the day
2. mood disturbance must bee accompanied by at least three of:
   - inflated self esteem.
   - decreased need for sleep
   - flight of ideas
   - distractibility
   - increased involvement in goal directed activities
   - excessive involvement in activities of painful consequences
3. causes impairment in social or occupational functioning
4. not attributed to any other causes e.g. substance abuse

Question 2

List the 6 diagnostic features of a hypomanic episode

Answer 2

1. a distinct period of abnormally elevated mood, increased energy for 4 days and most of the day
2. mood disturbance must be accompanied by at least three of:
   - inflated self esteem
   - decreased need for sleep
   - more talkative
   - flight of ideas
   - distractibility
   - increased involvement on goal directed activities
   - excessive involvement in activities with likelihood of painful consequences
3. change is uncharacteristic
4. observable by others
5. not severe enough to cause marked impairment in social or occupational functioning or require hospitalisation
6. not attributed to any other causes

Question 3

list the three diagnostic features of a major depressive episode

Answer 3

1. five or more of the following within a 2 week period
   - depressed mood
   - loss of interest
   - significant weight loss
   - insomnia or hypersomnia
   - psychomotor agitation or retardation
   - fatigue
   - feeling of worthlessness or excessive inappropriate guilt
   - diminished ability to think or concentrate
   - reccurrent thoughts of death and suicide ideation

• mood disturbance must be sufficiently severe to cause marked impairment in social or occupational functioning
• not attributed to any other causes

Question 4

Define Bipolar 1

Answer 4

• at least one manic episode

- occurrence of major manic and major depressive episodes not caused by other conditions e.g. schizophrenia

Question 5

Define Bipolar 2

Answer 5

• at least one hypomanic episode and at least one major depressive
• never a manic episode
• no other causes
• symptoms cause distress and impact functioning

Question 6

causes of bipolar

Answer 6

• genetics (80% contribution)

- external stressors

Question 7

what area of the brain is under active for individuals with bipolar disorder

Answer 7

under activated inferior frontal cortex and putamen

Question 8

what area of the brain is over active for individuals with bipolar disorder

Answer 8

• parahippocampal gyrus
• hippocampus
• amygdala
• basal ganglia

Question 9

what neurotransmitters are damaged or imbalanced

Answer 9

• noradrenaline (NA)
• Dopamine (D)
• Serotonin (5HT)
  Cholingergic pathways - Acetyl Choline (Act)

Question 10

list the pharmacological treatments for bipolar disorder

Answer 10

• Lithium (mood stabiliser)
• Valproate (Anticonvulsant)
• Antidepressents (used in conjunction with mood stabilisers)
• Antipsychotics

Question 11

list psychological interventions for bipolar disorder

Answer 11

• CBT
• Acceptance and Commitment Therapy
• Interpersonal therapy
• Schema therapy