LEC 5: BIPOLAR & RELATED DISORDERS

what do people with bipolar disorder experience?

both the lows of depression & highs of mania ("emotional roller coaster")

what is the manic episode criteria?

distinct period of elevated, expansive, or irritable mood and goal directed activity/energy at least 1 week; 3 or more of DIGFAST (distractibility, indiscretion, grandiosity, flight of ideas, activity/agitation, sleep, talkativeness; marked impairment, hospitalization, or psychotic features)

what is the hypomania episode criteria?

like mania EXCEPT: duration last throughout at least 4 consecutive days & less than one week

Intensity: set of symptoms is the same but intensity is less

what are the 5 main categories of symptoms of mania?

emotional, motivational, behavioral, cognitive, physical symptoms

what are the emotional symptoms of mania?

active, powerful emotions (euphoric, feeling on top of the world)

what are the motivational symptoms of mania?

need for constant excitement, involvement, companionship

what are the behavioral symptoms of mania?

Very active - move quickly; talk loudly or rapidly

what are the cognitive symptoms of mania?

show poor judgment & prone to poor (or no) planning, acting very impulsively

what are the physical symptoms of mania?

high energy level- often in the presence of little or no rest

what is the major depressive episode criteria?

5 or more of symptoms during the same 2 week period & @ least 1 symptom must be 1 or 2:

1. depressed mood

OR

2. loss of interest or pleasure in most activities

-sig weight loss/gain

-insomnia/hypersomnia nearly every day

-psychomotor agitation or retardation

-fatigue or loss of energy nearly every day

- feelings of worthlessness or excessive guilt

-diminish ability to think or concentrate nearly every day

-recurrent thoughts of death/suicide w/o specific plan

what is bipolar I disorder?

full manic & major depressive episodes ( most experience alternation & some experience mixed episodes)

what is bipolar II disorder?

hypomanic episodes and major depressive episodes

what is cyclothymia?

rapidly cycling; frequent mood swings b/w high and low mood (oscillating b/w hypomania & a state nearing depression)

what is there a higher frequency of in cyclothymic disorder than in bipolar disorder?

slightly higher frequency of mood swings

what else can we see w/ cyclothymia?

may be no periods of stable mood b/w episodes. and period of stable mood will last <2 months

how long do depressive symptoms last w/ cyclothymia?

at least 2 years or 1 year for children/teenagers

when do bipolar disorders tend to peak?

b/w ages 20-30

when are bipolar disorders typically dx & tx and why?

typically delayed for 5-10 years bc they don't seek help, can be misdiagnosed, cultural reasons, some don't want tx bc it feels good

what happens with bipolar disoders as the person gets older?

they will cycle more frequently & start feeling more exhausted

when do most manic episodes tend to occur?

immediately before a major depressive episode

why is mortality increased with bipolar disorder?

due to comorbid medical & substance abuse disorders as well as suicide (20-30x greater risk)

what does bipolar disorder have an increased comorbidity of?

heart attack, metabolic syndrome, migraines, alcohol use disorders

what is the 1st line tx of bipolar disorder?

MEDICATION (psychosocial tx are not sufficient enough alone_

what can be dangerously destabilizing with bipolar disorder?

overuse of antidepressants especially if given w/o a mood stabilizer

what is considered to be the gold standard of long term maintenance tx of bipolar?

lithium

what are newer & more popular agents being used for bipolar as mood stabilizing agents?

anticonvulsants & antipsychotics