Bipolar and Related Disorders

bipolar disorders

mood disorders characterized by the presence of manic or hypomanic episodes, typically preceded or followed by depression

manic episode (mania)

• abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy, lasting at least 1 week (unless hospitalization is required)

• the presence of at least 3 of the following symptoms during the episode

  • inflated self-esteem/grandiosity, less need for sleep, more talkative or pressure to talk, flight of ideas, distractibility, psychomotor agitation, excessive involvement in activities that have a high potential for painful consequences

• causes impairment

• not due to substance effects

bipolar I

the presence of a manic or mixed episode that causes clinically significant distress or impairment

bipolar II

the presence of one or more depressive episodes and one or more hypomanic episodes causing significant distress or impairment

cyclothymic disorder

2 years of numerous periods of depressive and hypomanic symptoms

bipolar I disorder

• criteria have been met for one or more manic episodes

• the occurrence of the manic and major depressive episodes is not better explained by schizophrenia spectrum conditions or another psychotic disorder

bipolar II disorder

• criteria have been met for one or more hypomanic episodes and one or more major depressive episodes

• never had a manic episode

• the occurrence of the hypomanic episodes and major depressive episodes is not better explained by schizophrenia spectrum or another psychotic disorder

• causes significant distress or impairment

mixed episode

• meets criteria for both manic and depressive episodes nearly every day for a 1 week period

• causes significant impairment in functioning

• not due to the effects of substance

cyclothymic disorder criteria

• numerous periods of hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods of depressive symptoms that do not meet criteria for a major depressive episode over the past 2 years (1 year for children)

• during the above two year period, the hypomanic and depressive periods have been present for at least half the time and there’s no >2 month period without symptoms

• criteria for major depressive, manic, or hypomanic have never been met

• not better explained by a schizophrenia spectrum or psychotic disorder

• not attributable to any substance

• causes clinically significant distress or impairment

clinical presentation of bipolar disorder

• average age of onset is 18-22

• lifetime prevalence: 2-3% for either bipolar I&II ; 4% for cyclothymia

• no gender difference in prevalence

• fundamental cognitions: “everything is great“, “i can do anything“, etc

• may engage in risky behavior or sexual promiscuity

• even if person is only exhibiting manic symptoms, it is assumed that a depressive episode will eventually occur

features of bipolar disorder

• duration of manic and hypomanic episodes tends to be shorter in duration than depressive episodes

• people with bipolar disorder show more mood lability, psychotic features, psychomotor retardation, and substance abuse than people with unipolar depression

• major depressive episodes are on average more severe in people with BPD

• people with BPD suffer on average more episodes during their lifetimes than people with unipolar disorders

• people with BPD spend about 20% of their lives in an episode, despite availability of medications

bipolar I: among the most severe forms of mental illness

• hospitalization

• suicide

• unemployment

• medical issues

heritability estimate of BPD

59-87%

disturbances in balance of ____

serotonin, norepinephrine, and dopamine

psychological causal factors in BPD

• stressful life events frequently precipitate episodes

• low social support

• personality and cognitive variables

pharmacology for mood disorders

• SSRIs for range of depressive symptoms

• other antidepressants

  • MAOIs: effective but riskier for side effects

  • Tricyclics (TCAs): toxic in large doses and more side effects than SSRIs

• mood stabilizers for both depressive and manic episodes of BPD

bipolar treatment: psychological

• meds are necessary to treat BPD

• psych treatment is used as a supplement

• psychoeducational approach

• family-focused treatment

cognitive therapy for depression: identify and change

• automatic thoughts

• early maladaptive schemas

• negative misattributions

behavioral therapy for depression

• behavioral activation

  • engage in rewarding activities

  • reduce avoidance withdrawal

• develop support networks

• role-play, activity schedules

interpersonal therapy (IPT) for depression

• focus on current relationship issues

• help client develop effective strategies for dealing with maladaptive interaction patterns that maintain depression

• IPT has also been adapted for treatment of BPD

interpersonal and social rhythm theory

• theory: unstable biological rhythms may by due to the loss of social rhythms, and these unstable biological rhythms lead to mood episodes

• treatment: help patients stick to regular sleeping, eating, and medication patterns

bright light therapy for depression

• originally used to treat seasonal affective disorder

• recently shown to also be effective in treating non-seasonal depression

alternative biological treatments

• electroconvulsive therapy (ECT)

• transcranial magnetic stimulation (TMS)

• deep brain stimulation