TG

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.