abpsych 3: mania

definition of mania

generally, a state of excitement, overactivity, or psychomotor agitation, often accompanied by overoptimism, grandiosity, or impaired judgement (APA)

manic symptoms

inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, distractibility, increased goal-directed activity or psychomotor agitation, excessive involvement in activities that have a high potential for painful consequences

bipolar disorder

criteria have been met for at least 1 manic episode

bipolar II disorder

criteria have been met for at least one hypomanic episode and at least one major depressive episode; there has never been a manic episode

manic episode

• a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day

• any duration if hospitalization is necessary

• 3 or more manic symptoms

hypomanic episode

• a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy lasting at least 4 consecutive days and present for most of the day, nearly every day

• 3 or more manic symptoms

depressive episode

5 or more depressive symptoms present during the same 2 week period with at least one being either depressed mood or anhedonia

cyclothymic disorder

• hypomanic and depressive symptoms

• no manic, hypomanic, or depressive episodes

• duration: 2 years

• frequency: symptomatic for at least half that time, and has never been without symptoms for more than 2 months at a time

heritability estimates for bipolar disorder

• almost 10 times more likely to develop bipolar disorder with a first-degree relative with bipolar disorder

• heritability as high as 85%

neurotransmitters and bipolar disorder

dysregulation of the creation, release, and metabolism of a number of neurotransmitters associated with bipolar disorder

• dopamine: elevated during periods of mania

• norepinephrine: elevated levels induce mania while decreased levels are associated with depressive symptoms

social zeitgeber theory

disruptions in out social rhythms (e.g., changes in mealtimes, exercise routines, work demands, and social habits) lead to disruption in our circadian rhythms which can trigger depressive or manic episodes in vulnerable individuals

behavioral approach system

• corticostriatal neural circuit sensitivity linked to rewarding properties of stimuli

  • reward circuit regulated approach motivation and goal-directed behavior to attain rewards/punishment

  • BAS activation leads to increased motor behavior, incentive motivation, and goal-striving-related emotions

• theory suggests that the underlying trait of bipolar disorder is a hypersensitivity to rewards

psychopharmacological treatments for bipolar

• mood stabilizers: recommended as the first line of treatment (e.g. lithium)

• antidepressants: can trigger cycling of episodes, typically prescribes with a mood stabilizer

psychoeducation

• strong support

• involved providing patients with information about bipolar and its treatment, with a primary goal being to improve adherence to pharmacological treatment by helping patients understand the biological roots of the disorder and rationale for pharmacological treatments

• also taught the early warning signs for episodes and common triggers for symptoms

cognitive therapy

• modest support

• cognitive restructuring

  • address maladaptive cognitions around manic episodes

  • address maladaptive cognitions contributing to depressive episodes

systemic care

• strong support

• system-level intervention (regular appointments) and group therapy/psychoeducation

• self-management plans