bipolar disorder

What is the defining feature of bipolar disorders?

Alternating periods of mania and depression; historically called “manic depression.”

What mood/energy change and duration define a manic episode?

A distinct period of abnormally and persistently elevated/expansive/irritable mood and increased goal-directed activity or energy lasting ≥ 1 week, most of the day, nearly every day (or any duration if hospitalisation is necessary)

List the symptom criteria (need ≥3, or ≥4 if mood only irritable). GDMF DIE 

• Grandiosity/inflated self-esteem

• Decreased need for sleep

• More talkative/pressured speech

• Flight of ideas/racing thoughts

• Distractibility

• Increased goal-directed activity or psychomotor agitation

• Excessive risky involvement (e.g., buying sprees, sexual indiscretions, poor business investments)

How does hypomania differ in duration and impairment from mania?

Duration ≥4 consecutive days; no marked impairment, no hospitalisation, no psychotic features, but mood/energy change is unequivocal and observable.

Clinically, what differentiates mania from hypomania?

Severity/impairment and psychosis: mania involves marked impairment/hospitalisation or psychosis; hypomania does not. Duration: ~7+ days vs 4+ days

three DSM-5 bipolar-spectrum diagnoses introduced re bipolar

Bipolar I - manic episodes alternate typically with major depressive episodes Bipolar II - hypomanic episodes MUST alternate with major depressive episodes, Cyclothymia - hypomanic symptoms alternate with hypodepressive symptoms (moody person)

How heritable is bipolar disorder?

Highly heritable; among the highest of any mental disorder; each gene has a small effect cf huntington’s disease

causes of bipolar disorder

genetics - highly heritable 
neurochemical difference -

circadian-rhytm abnormalities

neurochemical differences for bipolar

Bipolar depression → low serotonin-transporter levels; mania → increased dopamine sensitivity.
Findings are inconsistent

Summarise Harvey’s (2008) circadian-rhythm hypothesis

Abnormal circadian rhythms underlie bipolar disorder: manic patients sleep very little, depressed patients sleep a lot; sleep deprivation improves bipolar depression but can trigger mania.
Bipolar rhythms become detached from zeitgebers (light, meals etc.) and cycle over weeks rather than days

What class of drugs is the cornerstone of treatment?

Mood stabilisers Lithium (gold standard; ancient origin from alkali springs; mechanism unclear).
Anticonvulsants (e.g., sodium valproate, blocks Na⁺ channels).
Atypical antipsychotics (e.g., olanzapine, dopamine antagonist)

CBT principles for bipolar disorder

Promote stability and routine, ensure medication compliance, identify early warning signs (e.g., reduced sleep, racing thoughts, irritability).
For bipolar depression → behavioural activation and pleasant-event scheduling (with caution to avoid triggering mania).
For mania → motivational interviewing to support medication use and “urge surfing” to resist impulses