Psychoses Pt. 3: Bipolar Disorders (BD)

In terms of BD, common psychiatric comorbid diagnoses (DSM-5) include:

Anxiety, Substance-use disorders, ADHD, personality disorders

In terms of BD, common NON-psychiatric comorbid diagnoses (DSM-5) include:

migraine, cardiovascular/endocrine disorders

List some symptoms that are similar btwn BD and ADHD

distractibility, high energy, and impulsivity, likely due to overlapping dopamine-related brain dysfunction

Physiological Differences in BD

HPA axis dysregulation, circadian rhythm disruption

People with BD tend to have _____ circadian rhythms

longer

In people with BD, HPA axis dysregulation is related to their

stress reactivity

BD structural brain changes

hippocampus, amygdala, thalamus, cortical thickness

In BD, structural brain changes tend to be (in terms of studies)...

small but reliable

BD cognitive changes

reductions in executive function and cognitive issues with emotional stimuli

In terms of BD cognitive changes, some prospective studies indicate that [blank] can be used to predict the onset of a bipolar disorder in those at risk

diminished executive function

Non-pharmacological Treatments for BD

CBT and psychoeducation

In terms of cycling and mania/hypomania, CBT is...

not very useful

Psychoeducation

educating people about what lifestyle changes they can make to manage their condition

Psychosocial Interventions of BD

psychoeducation, reduce drug misuse, increase acceptance of illness, adherence to treatment, ability to cope with stressors, stability of sleep cycles, engagement with relationships/roles

Mood stabilizer

a drug that has antimanic and/or antidepressant effects; prevents cycling

Pharmacological Treatments for depression phase of BD

antidepressants

Pharmacological Treatments for mania and hypomania phases of BD

antipsychotics

Examples of Mood Stabilizers

lithium, anticonvulsants, atypical antipsychotics

Mood stabilizer when you want equal antimanic/depressant effects

lithium

Mood stabilizer when you want good antidepressant effects

lamotrigine (anticonvulsant)

Mood stabilizer when you want good antimanic effects

aripiprazole (antipsychotic)

Lithium was discovered as a treatment to BD and other manic disorders by

John Cade

5 benefits of lithium

1. protects against further mood episode

2. neuroprotective

3. increase BDNF expression

4. Fast-acting anti-suicidal agent

5. Anti-inflammatory

In terms of being neuroprotective, lithium is seen to accumulate in regions of the brain that produce

new neurons; ex. hippocampus

In terms of being anti-inflammatory, lithium inhibits

pro-inflammatory cytokines

Why is lithium tough to dose correctly?

therapeutic dose is very close to toxic dose

Some people develop [blank] as a consequence of taking lithium

tremors

Describe the kindling model of BD

repeated stressors lower the threshold for mood episodes, which become more frequent and severe over time

Neuroprogression in BD

Chronic stressors → high cortisol → cell death/reorganization → neuroanatomical changes → decreased ability to cope with stressors and more severe mood episodes (loop repeats from here)

Reward Hypersensitivity Model of BD

vulnerability to bipolar disorders is the result of a hypersensitive reward system

Goal/reward attainment pathway of BD Reward Hypersensitivity Model

approach activation-relevant event → excessive reward activation state → hypomanic/manic episode

Goal/reward NONattainment pathway of BD Reward Hypersensitivity Model

approach deactivation-relevant event → excessive reward deactivation state → depressive episode

Individuals with BD exhibit more ambitious

goal striving and achievement motivation

In terms of gambling, euthymic individuals with BD make [blank] choices than controls

riskier

Prodromal features of hypomania and mania include

excessive goal setting and increased success expectancies

In individuals with BD, structural imaging studies report

decreases in the prefrontal cortex and increases in striatal volume

In individuals with BD, PET (activity) studies show

increased metabolism in the striatum

In individuals with BD, fMRI (function) studies report

increases in frontal-striatal reward-related activation

For depression, Kyaga et al found that in terms of creativity...

There is no evidence that depression is associated with creative professions

For schizophrenia, Kyaga et al found that in terms of creativity...

There is no evidence that schizophrenia is associated with creative professions

For BD, Kyaga et al found that in terms of creativity...

There is evidence that BD is associated with creative professions

For close relatives, Kyaga et al found that in terms of creativity...

Close relatives of individuals with schizophrenia and bipolar disorders are more likely to hold a creative profession