Bipolar Disorder Midterm 2 Review -

Thursday Jan 30, 2025



Bipolar I and Bipolar II 



Symptoms of Manic ep: 

  • Mood changes 

  • Long period of feeling “high”, overly happy/outgoing mood 

  • Irritable mood agitation, jumpy, wired 

  • Behavioral changes: 

  • Very fast talking 

  • Easily distracted 

  • Increase goal-directed activities 

  • restless/not sleeping 

  • Impulsive (high risk behaviors) 



Depression/Depressive Episodes: 

  • Mood changes: 

  • Long period of feeling worried/empty 

  • Loss of interest in activities 

  • Behavioral Changes 

  • Tired “slowed down” 

  • Problems concentrating 

  • Thinking of death/suicide - attempting suicide 



Bipolar 1-

  • Less Mania More Depressed

  • It happens more in males

  • At least ONE manic ep that lasts for 7 days 



Bipolar II- 

  • Depressive ep shifting 

  • Hypomanic eps

  • NO FULL BLOWN manic/mixed eps. 



BP-NOS 

  • Symptoms of illness but NOT ENOUGH to meet specific criteria for BP I OR II



Cyclothymic Disorder, Cyclothymia 

  • Mild form of BP

  • At least 2 years of hypomania eps 

  • Does not meet specific criteria 



Rapid Cycling Bipolar Disorder 

  • When a person has four or more eps of mj depression, hypomania, mixed sympt within a year. 




MANIA STATES: 

  1. Hypmania 

  2. Acute Mania- transition delusion 

  3. Delusional Maia

  4. Delerious Mania 



Schizoaffective Disorder vs. Bipolar 

  • BOTH have PSYCHOTIC symptoms: 

  • Hallucination

  • Delusion 

  • Incoherence 

Schizo is better tolerated by families 



“Unipolar” manic 

  • Depressive is dominant in FEMALES 

  • Mania is dominant in MALES 



The difference between major depression and depressive eps is the fluctuation/shifts 



Risks of Bipolar Disorder: 

  • Spending sprees/business ventures 

  • Hypersexuality 

  • Run in w/ law 

  • Accidents-speed limits

  • Poor relationships 

  • Suicide 10-20%



Atman self-rating mania scale - designed to assess the presence/severity of manic symptoms. 

  • Can be used as a psycho-educational tool to help patients recognize and monitor their own symptoms. 



Lecture 8: 



Changes in ppl w/ Bipolar Disorder 

  • Increased ventricle size 



Corpus Callosum 

  • Decreased white matter associated w/ suicidality 

  • Whiter matter lays in between gray matter. 



Hyperintensity- signals areas of cell death 






Tuesday, February 4 2025



Left side of brain→ more literal, language, analytical thinking 

Right side→ involves more motor control 



Amygdala– helps u determine/read  facial expressions 



Right amygdala activity 

  • Both at-risk and bipolar groups have higher amygdala activity 





Tuesday Feb 11, 2025



Gout - disease of kings 



Henry the VIII– had gout, diabetes, obesity, 6 wives, 2 beheadings 



  • Purines (nitrogenous bases) 



What causes GOUT? 

  • Purines (meats) 

  • Fructose (sugar)




Lithium: → Mood Stabilizer 

  • Discovered in 1817



-7UP lithiated LEMON SODA 

  • 1929-1948

Lower suicide rate, crime and homicide rates 




1949 John Cade 

  • Published a paper on lithium’s calming effects in bipolar patients. 

  • Injected pee from patients into guinea pigs 



Pee from Psychotic patient injected into pig: 

  • Pig got sick and didn’t act normal 



Non- Psychotic patient: 

  • Pig was fine 



Uric Acid crystals– were blocking the needle



The avg level of uric acid → HIGHER in those having manic ep. 



Hypothesis: Higher levels of uric acid = more risk of manic episodes. 



Ex: more sugar u drink per day → INCREASED uric acid 

URIC ACID→ INCREASE INFLAMMATION



Glutamate– #1 excitatory neuron (causes neurons to fire)

  • Too excitable can kill neurons surrounding

  • Causes the amygdala and hippocampus to be excitable 



Too much Dopamine in the frontal cortex → causes psychosis 



Amphetamine/Cocaine

  • Drug increases dopamine-> psychotix 



Antagonists- Drugs that blogs receptors 

  • Can block psychosis if blocking the right receptors. 



Dyskinesias 

  • Caused by long-term use of antipsychotics 



Corticoid steroids– 

  • Hyper-exitation → leads to oxygen radicals



Neuron death- leads to more exitation 

Inflammation → increase glutame → increased excitation→ cell death —-(cycle back) 






Thursday Feb 7, 2025



Bipola Disorder Review 



Enlarged ventricles 

Mania 

Comorbidities govt/ metabolic disorder 

Amygdala & ParaHipgy Hyperactive 

Phases Mania Depression Rapid Cycling 

Lithium 

White matter - axonal projections 

Cortex Grey matter thinning 

Mania→ high uric acid = purines 

Glutamate- #1 Excitatory NT 

Dopamine - Psychosis - frontal cortex 

More neurons firing 




Drug that treats too much glutamine→ anticonvulsive / antiepileptic 



Eating a diet high in purines —> MORE uric acid (greater lvls in men) 

MORE URIC ACID—> Inflammation —> Cytokines that Call the Immune Response → Excitation = Glutamate   —> more neurons firing & Dying 

Neuron Death 

Loss of Brain Tissue 



(Insert notes from lec)



Hyper (methylation)– stop signs 

More methylation– gene is expressed more protein 

Ex: blonde hair gene – more blonde (expressed) 



Discordant—> 1 twin HAS it one DOESN'T





Tues Feb 18th, 2025



  • Drugs used to treat depression→ Reuptake blockers 

Increases serotonin by keeping transmitters longer 




More methylation— less protection (less product) 

Less methylation→ more expression 



COX 2– Inflammatory (bad) 



Rapid Cycling 

  • Dangerous symptoms 

  • Fast shifts between high and lows 

Patients are more at risk for self-harm 



Estrogen – protective of inflammatory