PSYC 301 Final - Dysfunction Associated with Psychiatric Disorders 3

Bipolar Disorder

What are the 3 main states of bipolar disorder?

• Depressive

• Hypomanic

• Manic

Describe the DSM-5 criteria for a major depressive episode

New or worsened, daily, for two weeks in a row. 5+ of: 

• Depressed mood 

• Loss of interest or pleasure in almost all activities 

• Changes in weight or appetite

• Sleep changes 

• Psychomotor changes (agitated or slowed) 

• Tiredness, fatigue, low energy

• Sense of worthlessness or guilt 

• Impaired ability to think 

• Recurrent thoughts of death, suicidal ideation, or suicide attempts

Describe the DSM-5 criteria for hypomania

1. Abnormal/persistent/elevated/irritable mood + increased goal-directed activity/energy most of the time for at least 4 days 

2. Some of the following: 

• Increased energy and activity 

• Persistent mild elevation of mood 

• Feelings of well-being and both physical + mental efficiency 

• Increased sociability and talkativeness (or increased irritability in some) 

• Increased sexual energy 

• Decreased need for sleep 

None to the extent that they lead to severe disruption of work/result in social rejection, + no hallucinations/delusions (ex. psychosis)

Describe the DSM-5 criteria for a manic episode

1. Abnormal/persistent/elevated/expansive + increased goal directed energy, most of the time, for at least 1 week 

2. 3+ of the following to a significant degree: 

• Inflated self esteem or grandiosity 

• Decreased need for sleep 

• More talkative than usual/pressure to keep talking 

• Flight of ideas/subjective experience that thoughts are racing 

• Distractibility 

• Increase in goal-directed activity or psychomotor agitation

• Excessive involvement in activities that have a high potential for painful consequences

Causes marked impairment in social or work life, necessitates hospitalization, or includes psychosis (hallucinations and/or delusions)

Bipolar I vs. Bipolar II

• Bipolar I: Involves at least 1 manic episode (1 week/requires hospitalization)

• Bipolar II: Hypomania + depressive episodes

In general, individuals with bipolar spend more time in deprressive than manic state

• can have a combination of manic and depressive states (ex. risky behaviour + low mood)

What are the prevalences of the different types of BD?

• 0.6% for Bipolar I 

• 0.4% for Bipolar II 

• Commonly begins in young adulthood 

• Potential high impact for either form 

  • Ex. high risk of suicide attempts 

  • Large changes in quality of life/socialization

Life course:

• BD diagnosable after clear alternating waves of mania and depression

Reward Hypersensitivity Model of BD

Being hypersensitive to reward = trait that predisposes someone to developing BD

• Goal attainment can lead to excessive reward states + ultimately (hypo)mania 

• Goal nonattainment can lead to excessive reward deactivation and a depressive state

What evidence is there for the Reward Hypersensitivity Model?

• Euthymic (‘normal’ state) individuals with BD

  • Show excessive activity in frontal-striatal reward-related areas in response to reward related cues

  • Make more risky choices on controls (ex. Gambling tasks)

• Prodromal Features

  • Hypomania + mania: Excessive goal setting + increased success expectancies 

  • Depressive Episodes: Decreased motivation + goal setting and low self confidence 

• Teenagers (14-19) who score high on reward sensitivity → more likely to develop bipolar disorder in a prospective study

What are some structural brain changes associated with BD?

• Structural reductions in gray matter (similar areas to functional, ex. PFC, limbic) 

• Driven by time spent in manic episodes 

• Associated with neuroinflammation, stress hormones, etc. that lead to structural changes 

What are some functional brain changes associated with BD?

• Increased responsiveness in limbic + Paralimbic areas (in red) 

  • Amygdala 

  • VLPFC (ventrolateral prefrontal cortex) 

  • Ventral ACC (anterior cingulate cortex) 

• Decreased responsiveness in areas associated with cognitive control (in blue) 

  • Dorsal ACC

  • DMPFC

  • DLPFC

What are some treatments for bipolar disorder?

• Mood Stabilizers

  • Lithium

  • Alone or combined with atypical antipsychotics 

• Atypical Antipsychotics

• Psychotherapy - CBT

  • Health education/family-focused treatments all have some evidence 

• Antidepressants alone are not recommended

• > 50% of patients do not adhere to treatment