Bipolar disorders

Bipolar Disorders Overview

Definitions

• Bipolar I Disorder:

  • Characterized by at least one manic episode.

  • Prevalence: 1% in the U.S.

• Bipolar II Disorder:

  • Involves at least one hypomanic episode and one depressive episode.

  • No history of manic episodes.

• Cyclothymic Disorder:

  • Duration: Minimum of 2 years.

  • Symptoms include mild manic-like and depressive-like symptoms (not meeting full criteria).

  • Prevalence: ~4%.

Manic Episode

Criteria (Duration: 1 week or less if hospitalized)

• Mood:

  • Distinctly elevated, expansive, or irritable.

• Activity:

  • Persistently increased goal-directed activity.

Additional Symptoms (At least 3 required)

• Rapid speech.

• Flight of ideas/racing thoughts.

• Decreased need for sleep.

• Increased self-esteem (grandiosity).

• Distractibility.

• Excessive involvement in activities likely to lead to painful consequences (e.g., spending sprees, sexual indiscretions, unrealistic business ventures).

Exclusions

• Symptoms must not be attributable to substance use or a medical condition.

Hypomanic Episode

• Symptoms:

  • Milder than manic episodes.

  • No significant impairment due to hypomanic episode.

• Impairment:

  • Depressive episodes may cause substantial impairment.

The Manic-Depressive Spectrum

• Categories:

  • Bipolar I

  • Bipolar II

  • Cyclothymic

  • Normal mood variation

Etiology of Bipolar Disorder

Heritability

• Estimates as high as 93% for Bipolar I Disorder and also significantly high for Bipolar II.

Neurotransmitter Factors

• Potential issues include:

  • Overly sensitive dopamine receptors.

  • Dysregulation of norepinephrine.

Psychosocial Contributions

• Factors influencing manic episodes:

  • Shifts in sleep cycle.

  • Increased activity and accomplishments.

  • Increased reward sensitivity.

Treatments for Bipolar Disorder

Medications

• Common Medications:

  • Lithium.

  • Mood stabilizers (e.g., Depakote).

  • Antipsychotics (e.g., Zyprexa).

Psychological Treatments

• Approaches include:

  • Psychoeducation for the patient and family.

  • Symptom identification.

  • Activity regulation through Interpersonal and Social Rhythm Therapy.

  • Promotion of medication adherence.