Mood Disorders - Exam 3

Bipolar Disorder (BD) History

First described by Emil Kraepelin as "manic-depression."

DSM Category Order

Schizophrenia/Psychotic → Bipolar Disorders → Depressive Disorders.

Euthymic

The state of being between episodes where the individual is not experiencing symptoms of either mania or depression; chill zone.

Gender Distribution in BD

Unlike Major Depression (which is higher in females), Bipolar Disorder is mostly equal for males and females.

Prevalence of BD

Bipolar I = affects about 0.6% of people (starts around age 18); Bipolar II = ~0.3% of people (mid-20s); Cyclothymia = affects between 0.4% and 1.0% of people (often starts during adolescence).

Mania vs. Depression Length

Manic episodes tend to be 3x shorter than depressive bouts.

Predominant Mood State

Depression is the predominant state in Bipolar Disorder, with a typical 3:1 ratio of

depressive:manic episodes

Bipolar Depressive Episode vs. MDD

BD depression has more mood lability (instability), psychotic features, and psychomotor retardation; MDD has more anxiety and insomnia.

Cardinal Manic Symptoms (3 of 7)

Inflated self-esteem, decreased need for sleep, pressured speech, flight of ideas, distractibility, increased goal-directed activity, and risky behaviors.

Decreased Need for Sleep

Distinguishable from insomnia; the individual feels fully rested and energized after only 3 hours (or zero hours) of sleep.

Manic Episode Duration

Symptoms must last at least 1 week and be present most of the day, nearly every day.

Hypomanic Episode Duration

Symptoms must last at least 4 consecutive days.

Severity in Manic

Causes marked impairment, necessitates hospitalization, or includes psychotic features.

Severity in Hypomanic

NOT severe enough for hospitalization or marked impairment. Disturbance in mood is observable by others as well as uncharacteristic of the individual when not symptomatic.

Psychotic Features in Bipolar

If psychotic features (delusions/hallucinations) are present, the episode is automatically classified as Manic, never Hypomanic.

Mood Lability

This refers to mood swings or shifts, which are much more common in bipolar depression than in regular (unipolar) depression.

Bipolar I Disorder

Requires at least one full-blown Manic Episode in the lifetime. Depressive episodes are common but not strictly required for the diagnosis.

Bipolar II Disorder

Requires at least one Hypomanic Episode AND at least one Major Depressive Episode. Never a manic episode.

Cyclothymic Disorder

At least 2 years (1 for kids/adolescents) of subthreshold hypomanic and depressive symptoms that don't meet full criteria for an episode.

Cyclothymia "Half-Time" Rule

Symptoms must be present for at least half the time over 2 years, with no more than 2 months symptom-free.

Diagnostic Naming Convention

Recorded as 1) Name of disorder, 2) Current/Most recent episode type, 3) Severity/Remission/Specifiers.

With Mixed Features

A "mood smoothie." You have symptoms of mania (like high energy) and depression (like feeling worthless) at the same time

With Rapid Cycling

Having 4 or more mood episodes in a 12-month period. The episodes must be demarcated by either a period of full remission (2 months symptom free) OR a switch to an episode of the opposite polarity. It’s more common in females and people with Bipolar II.

With Mixed Features

In Depression - Increased energy, elevated / expansive mood, talkative. Mania-like but does NOT meet criteria for bipolar disorders. In Manic / hypomania – depressed mood, loss of interest, etc. Depressive-like but does NOT meet criteria for depressive disorder.

With Psychotic Features

Having delusions or hallucinations. If these are present, the episode is automatically Manic, not hypomanic

With Anxious Distress

Feeling keyed up, distressed, anxious. Fear of losing control or something bad might happen. Generally, only specifier to be applied to cyclothymia.

Ultra-Rapid Cycling

switches between states in the magnitude of days-weeks.

Ultra-Rapid Cycling (Ultradian)

switches between states in the magnitude of hours-days.

Biological Bias

For most of the 20th century, Bipolar was seen as purely biological. Because severe mania usually requires hospitalization and medication (like Lithium), researchers didn't focus much on psychological therapy until recently.

Gray’s Reinforcement / Reward Sensitivity Theory

Two motivational systems that work inversely of each other and are responsible for coordinating behavior. Includes BAS and BIS.

Behavioral Activation System (BAS)

The brain's "Go" system that makes you chase rewards and goals. In Bipolar, it’s too sensitive and overreacts.

Behavioral Inhibition System (BIS)

The brain's "Stop" system that makes you avoid threats or punishment.

BAS in Mania vs. Depression

In Mania, the BAS is overactive (too much "Go"), which leads to high energy and risk-taking. In Depression, it is deactivated or shut down (no motivation to "Go"), which leads to anhedonia.

Response Styles Theory

How people respond to their mood state is indicative of the duration and severity of these mood states.

Ruminative Style

A coping style where you get stuck in a loop, repetitively thinking about your symptoms and their causes (makes depression worse).

Distraction Style

Trying to ignore symptoms by staying busy, taking on too many tasks, or spending lots of money.

Risk-taking Style

Dangerous distractions like thrill-seeking, gambling, or abusing drugs/alcohol.

Manic-Defense Model

A theory that mania is actually a "shield" used by the brain to hide or escape from deep, painful feelings of depression.

Hyper-positive Cognitive Distortions

Thinking patterns in mania like "I am invincible," "Nothing can go wrong," or "I'm a genius".

The Barcelona Approach

The "Gold Standard" group therapy that teaches patients about their disorder, the danger of skipping meds, and how to spot early warning signs.

Prodromes

Early warning signs that a mood episode is starting (e.g., needing less sleep before mania, or feeling anxious before depression)