psychopathology ~ bipolar disorders

mania

Duration: at least 7 days or until hospitalization

• a distinct period of abnormally and persistently elevated, expansive, or irritable mood

• abnormally and persistently goal-directed behavior or energy

Additional Symptoms (3 or more)

• inflated self-esteem or grandiosity

• decreased need for sleep

• more talkative than usual (pressured speech)

• flights of ideas/racing thoughts

• distractibility

• increase in goal-directed activity/psychomotor agitation

• impulsive hedonistic activities (shopping sprees, gambling)

bipolar I disorder

• at least 1 manic episode (7 days of symptoms or hospitalization)

• symptoms cause social/occupational distress or impairment

• a history of depressive episodes is not required for diagnosis

• Lifetime Prevalence: 1%

• Onset: ages 20-30

bipolar II disorder

• at least 1 major depressive episode

• at least 1 hypomanic episode (does not cause impairment to the person, less severe than a manic episode)

• patient can not have any manic episodes

• significant change in function but not severe enough to cause impairment in functioning or require hospitalization

• Lifetime Prevalence: 1.1%

• Onset: mid 20s

hypomania

Duration: at least 4 consecutive days (wouldn’t result in a hospitalization)

a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently goal-directly behavior or energy

• inflated self-esteem or grandisoity

• decrease need for sleep

• more talkative than usual

• flight of ideas and accomplishes much

• distractibility

• impulsive pleasure-seeking activities

• self-confident and riskier behaviors

why is hypomania hard to identify?

• few people complain of hypomania because it can be adaptive and enjoyable

• hard to differentiate from personality traits

• high rates of misdiagnosis

gender differences in bipolar disorder

women:

• higher rates of depression

• higher rates of depression with psychosis

• higher rates of suicidal behavior

men:

• higher rates of comorbid substance abuse

bipolar outcomes

• high risk of arrest or trouble with the law

• may be due to comorbid conditions: substance use, risky decision making, psychosis (bipolar I: 63%, bipolar II: 22%)

• psychosis in bipolar is related to suicidal ideation and/or attempts

pediatric bipolar

• disagreement around how symptoms should be interpreted —> diagnosed

• 1-3% among youth

• more diverse in presentation

• more rapid fluctuations between mood episodes in younger children

• increased risk of substance use, suicidality, legal problems, and use of mental services

cyclothymic disorder

Duration: at least 2 years (1 year for children), at least half the time:

• numerous periods of hypomanic and depressive symptoms that are subthreshold

• without 2 month break

• symptoms cause significant distress or impairment

genetic factors (etiology)

• concordance rates: MZ = 67-78%, DZ = 20-29%

• if you have a first-degree relative with BP, your chances to have BP are 5-12%

  • 20-25% to have any mood disorder

• one parent with bipolar: 15-30% greater risk

• two parents with bipolar: 50-75% greater risk

neurological factors (etiology)

• decreased serotonin, increased dopamine, elevated glutamate

• changes in amygdala, prefrontal cortex, basal ganglia

amygdala

regulating emotions

prefrontal cortex

difficulty with attention, planning, remembering, impulse control

basal ganglia

hypersensitivity to rewards, contributes to manic symptoms is regard to goal-directed behavior

psychosocial factors (etiology)

goal dysregulation

• reward/incentive sensitivity

• life events involving goal attainment

sleep and schedule disruption

• sleep deprivation 

• disruption of daily circadian rhythms

medication

• lithium: stabilizes mood shifts, toxic in high doses

• antipsychotics, mood stabilizers, anti-seizure medication

• 40-60% of patients are noncompliant with medication

psychotherapy

• cognitive behavioral therapy

• psychoeducation

• interpersonal and social rhythms therapy 

• dialectical behavioral therapy

• all focused on symptom monitoring and relapse prevention

psychoeducation

educating family members about the disease, how to cope with the symptoms

interpersonal and social rhythms therapy

identifying social irregularities and maintaining a good schedule

dialectical behavioral therapy

type of CBT, especially beneficial for people with suicidal thoughts and behaviors