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bipolar disorders

mood disorders marked by alternating periods of depression and mania/ hypomania (manic episodes)

Depression

extremely low, miserably unhappy mood, along with other physical and cognitive symptoms

Mania

excited, extremely euphoric (happy) mood in which a person feels excessively and unrealistically positive and energetic

Hypomania

a milder form of mania (less disabling), if hospitalization or any type of emergency intervention is required it's not this

to be diagnosed with mania you must have

at least 3 of the following 7 symptoms most days for 1+ week

Bipolar disorder gender differences

Equally common in men and women
First episode in men tends to manic
First episode in women tends to be depressive

onset age for bipolar disorder

late teens - early 20s

bipolar 1 disorder

a disorder characterized by at least 1 SEVERE, full blown manic episode, usually accompanied by at least 1 major depressive episode

Bipolar II Disorder

a disorder characterized by at least 1 hypnotic episode (NO full blown mania), and at least 1 major depressive episode

cyclothymic disorder

a disorder characterized by milder mood swings occurring for 2+ years, but not severe enough to qualify for major depression or full blown mania, alternating states of being

lifetime prevelance of bipolar disorders in the U.S.

4%

which bipolar disorder is more disabling?

depression

comorbidity rate of bipolar disorders

75% have another disorder
ex. anxiety disorders, especially panic attacks

bipolar disorder w/ mixed features

3+ depressive symptoms during a manic episode or 3+ manic symptoms during a depressive episode

bipolar disorder w/ psychotic features

delusions or hallucinations are present during the mood episode

Bipolar disorder w/ rapid cycling

4+ mood episodes (depression, mania, and/or hypomania) occur within a 1 year period, more disabled, harder to regulate

bipolar disorder w/ seasonal pattern

a regular seasonal pattern of at least one type of mood episode

heritability estimate for bipolar disorders

70 to 80%, high

Concordance rate for bipolar disorders with twins

50%

What body system contributes to bipolar disorders?

endocrine system, prolonged activation of HPA axis (caused by stress) may contribute, or at least worsen course/ outcomes

Disturbances in the level, functioning, or regulation of what neurotransmitters leads to bipolar disorders

low levels of serotonin
increased dopamine receptors
increased serotonin receptors (different for depression vs mania)

lower levels of norepinephrine leads to

depression

higher levels of norepinephrine leads to

mania

orbitofrontal cortex

reduced volume of this part of the brain that helps with emotion regulation leads to bipolar disorders

Striatum

altered activity of this part of the brain that deals with goal directed activity contributes to mania

Prefrontal cortex and amygdala

abnormal functional connections leads to bipolar disorders

Psychoanalytic theories for bipolar disorder

manic episodes as a defense against (or escape from) depression has a small connection

Reward sensitivity for bipolar disorders

pursuit of incentives (goal striving) leads to obtained reward and heightened mood (overreaction) after reward causes manic or hypotonic symptoms
(overexcited)

emotional creativity

BPD is more common in people with more extreme emotions (both + & -)

Cognitive Deficits

thought, speech, learning, memory, & attention linked with BPD ( also with schizophrenia)

Extreme drive for achievement and perfectionism

amplifies genetic predisposition for both mood states of bipolar disorder

early trauma and abuse has happened in what % of bipolar patients

30-50%

social factors that contribute to BPD

early trauma and abuse
conflicts in interpersonal relationships
recent negative life events
disrupted roles/ routines
lack of social support, high social strain, & high expressed emotion

sexual abuse + genetic risk for BPD

higher risk and earlier onset

Front line treatment for BPD

medication

Lithium Carbonate

a chemical used to counteract mood swings of bipolar disorder, effects in 5-7 days

What are the 2 problems lithium carbonate had/ have

was banned from 1940s-1979 because of side effects and didn't understand it
there is low compliance (50%) due to side effects and miss the highs

Anticonvulsants for BPD

equally safe and effective compared to lithium

Antipsychotics for BPD

best option for short term effects on mania

Anti depressants for BPD

only in combination with antimanic meds

Psychotherapy for BPD

no psychotherapy is effective at treating mania

interpersonal and social rhythm therapy

IPT ( for depression) + routines/ rhythms (sleep) prevents relapse

family focused therapy

4 phase approach

• engagement
  -psycho education
• communication training
• problem solving training

Risk of suicide with MDD % for men and women

7% for men, 1% for women

Risk of suicide with BPD % for men and women

8% for men, 5% for women

Rates of suicide is higher among what nationalities

native americans & caucasians

Suicide is the ____ leading cause of death in the US

10th

Suicide is the ____ leading cause of death among 15-24 year olds

2nd

Suicide attempts are more common in females or males

3x more common in females

Suicide deaths are more common in females or males

3-4x more common in males b/c their method is usually more fatal

Joiner's Risk Factors for suicide

-Thwarted belongingness (can't fit in)

• perceived burdensomeness (feeling like a burden)
  -capability for suicide (access to lethal means)

Heritability estimate for suicidal thoughts

38%

Heritability estimate for suicidal attempts

55%

suicide and serotonin

low levels of this is correlated (not a cause) w/ suicidality

Object relations & interpersonal theories & suicide

family dysfunction leads to lower ability to cope with stress & negative moods & sustain relationships which leads to social conflict & isolation

cognitive theory and suicide

early negative experiences causes hopelessness during times of stress

Durkheim types of suicide

1.Altruistic Suicide

2. Anomic Suicide
   3.Fatalistic Suicide

altruistic suicide

suicide committed by people who believe that taking their own life will benefit society, putting groups goals ahead of of ones own survival
ex. suicide bombers

anomic suicide

feeling lost or abandoned following social upheaval
ex. killing yourself after getting out of prison because don't want to leave the place they've always known

fatalistic suicide

type of suicide that occurs when people see no possible way to improve their oppressive circumstances
ex. prisoners or slaves, isolated with no hope

Social support and suicide

reduces risk

social isolation/ exclusion and suicide

increases risk

Lower rates of suicide occur among what ethnicity

Hispanics

Social stressors that lead to suicide

UNEMPLOYMENT, divorce/ marital problems, legal problems, war

crisis intervention (preventing suicide)

assessment of risk followed by appropriate response (hospitalization, 24 hour caregiver supervision) goal is to restore hope by reducing suicidal impulses

gatekeeper training

A suicide prevention strategy in which mental health providers train school personnel to recognize risk factors and to appropriately help students gain access to treatment

no-suicide contract

A formal written or verbal contract between the client and the crisis worker in which the client makes a commitment to speak to the counselor before harming himself or herself. It is considered an effective intervention for low- and middle-risk clients.

• effectiveness not proven but works for some

Medications for suicide

antidepressants but not immediately effective & ketamine produces more rapid effects but is still being tested

cognitive interventions for suicide

eliminate factors that contribute to suicide ( hopelessness, pessimism, tunnel vision)

suicide contagion

term for the copying of suicide attempts after exposure to another person's suicide
-common in adolescent suicide

Common method for adolescent suicide

firearm or suffocation (85%)

Having a psychiatric diagnosis and suicide

90%, a key risk factor for suicide