PSYC 223 - Bipolar Disorder

8. Know the symptom profile for a manic episode, as well as the difference between Bipolar I and II.

Manic Episode Symptoms (must last at least a week or require hospitalization, with at least 3 of the following):

• Inflated self-esteem/grandiosity

• Decreased need for sleep

• Pressured/racing speech

• Flight of ideas or racing thoughts

• Distractibility

• Increased goal-directed activity

• Reckless/impulsive behavior (e.g., risky sex, spending sprees)

Difference Between Bipolar I and Bipolar II:

• Bipolar I: Requires at least one full manic episode, with or without depression. May also include mixed episodes.

• Bipolar II: Involves at least one major depressive episode and at least one hypomanic episode, but no full manic episodes.

9. Be able to define a hypomanic episode, cyclothymia, and bipolar NOS.

Hypomanic Episode: A milder form of mania. Same symptoms as mania but:

• Lasts at least 4 days

• Does not cause significant impairment in functioning

• No psychosis or hospitalization required

• Cyclothymia: A mood disorder lasting 2+ years, with frequent mood swings between hypomanic symptoms and depressive symptoms, but neither meet full diagnostic criteria for mania or major depression.

• Bipolar NOS (Not Otherwise Specified): Diagnosis used when a patient shows manic symptoms that don’t meet criteria for Bipolar I, II, or Cyclothymia but still show clear signs of dysfunction and need for treatment.

10. Be familiar with the evidence to support genetic and biological factors in bipolar disorder, as well as the specific neurotransmitters likely involved in manic episodes and how they interrelate.

Genetic & Biological Evidence:

• Among the most heritable psychiatric disorders (heritability estimates between 85%–93%)

• Family, twin, and adoption studies confirm genetic risk

• Lithium and anticonvulsants are effective → supports biological etiology

Neurotransmitters Involved:

• Dopamine:

  • Increased during mania

  • Decreased during depression

  • Triggers reward and motivation circuitry

• Serotonin:

  • Regulates mood, appetite, and sleep

  • Low serotonin → greater mood instability and less regulation of dopamine

Interaction: Low serotonin may disinhibit dopamine, leading to manic symptoms.

11. Be familiar with the particular research findings relating different types of life stress to bipolar disorder.

• Life stress precedes both manic and depressive relapses

  • Chronic and severe stress is especially predictive (Hammen & Gitlin, 1997)

• Stress impacts mood episodes equally (Hunt et al., 1992)

• Malkoff-Schwartz (1998): Even minor sleep disruptions can trigger mania

• Kadri et al. (2000): Disruption of daily routines (e.g., Ramadan fasting) → increased manic episodes

12. Be able to differentiate zeitgebers and zeitgebers and understand their role in bipolar disorder.

• Zeitgebers: External cues that help regulate biological rhythms (e.g., regular sleep-wake cycles, meal times, light exposure)

  • Loss of zeitgebers (like job loss) → destabilizes routine → potential trigger for mood episodes

• Zeitstorers: Disruptors of social/biological rhythms (e.g., caring for a newborn, traveling across time zones)

  • Presence of zeitgebers → disrupts circadian rhythms → increased risk of manic episodes