Prelim 1- Bipolar disorder

Bipolar disorder

• presence of manic and hypomanic episodes

Manic Episode

• persistently elevated expansive or irritable mood

• persistently increased activity or energy

• represent noticeable change from usual behavior

• at least 1 week and present for most of the day

Hypomanic episode

same criteria as the manic episode except:

• not severe enough to cause impairment or to necessitate hospitalization

• shorter duration (4 days)

• no psychotic features

Mixed episode

• full criteria for a manic or hypomanic disorder + at least 3 symptoms of a MDD

• particularly common when bipolar disorder begins during childhood or adolescence

BP1

• must have 1 or more manic / mixed episodes

• up moods

BP2

• must have had 1 hypomanic episode and 1 MDD

• down moods

what is a misconception?

• rarely go from manic or hypomanic episode straight to a depressive one and then back to mania/ hypomania

• mood episodes are interspersed with Euthymia

Euthymia

long periods of stable moods that are neither depressive/ manic/hypomanic

Prodrome

set of sub threshold symptoms or signals predicting the onset of a disease before that disease ever occurs

Bipolar Prodrome

• most with BPD experienced subtle mood problems months/years before clear episode of depression, mania. or hypomania

• often display heightened anxiety or emotional lability— emotions that change rapidly

rapid cycling

• experiencing 4 or more separate episodes of depression/mania/ hypomania in a year

Gruber’s positive emption persistence

• show more positive emotions where most would experience positive emotions

• show less negative emotions where negative affect is expected

• type of positive emotions are pride and joy

Sleep and mania/hypomania are…

• bidirectional

• sleep disturbances result from mania/hypomania, but can also trigger it

perinatal mood

• mothers with BPD experience mood changes in the perinatal period with mixed/manic episodes more common than depression

• some fathers with BPD experience mood changes postpartum

Circadian Rhythms and BPD

• CLOCK regulates sleep cycles

  • mutations result in decreased sleep and increased energy, award, and activity seeking

  • meds help

Antecedents of BPD

• genetics— neurotransmitters and CLOCK

• volume of amygdala and ACC

• stressful life events

Pharmacological Treatments

• mood stabilizers to maintain euthymic state

• SSRIs can trigger manic/hypomanic/ mixed episodes

lithium

• mood stabilizing effects

• ½ respond and 70% relapse

interpersonal social rhythm therapy

emphasizes importance of daily routine, paying attention to circadian rhythm, cues and building strong interpersonal relationships

Cyclothymic disorder

• chronic periods of hypomanic symptoms that never develop

• rarely euthymic