Bipolar

manic episode: elevated expansive or irritable mood, heightened energy or activity

bipolar 1: full manic episodes, may also have depression

bipolar 2: hypomanic episodes and major depressive episodes

cyclothymia: hypomanic episodes and subclinical depression

psychosis is common in manic episodes: mood-congruent: themes of expansiveness, love, intimacy and spirituality

prevalence:

• worldwide 1-2.8%

• late onset- age 15-44, peak onset 25-30

mixed features:

• depressive or manic episodes includes 3+ symptoms of the other type of episode

• ex. depressive episode but talks so fast ppl can’t keep up, started crazy project, been gambling (risky activities)

• 40% of cases- more clinically complex

bipolar cycling:

• most time span asymptomatic

• half time mood state- more commonly in depressive state and less in mania

• 4+ a year is rapid cycling- full episodes, not unstable, usually temporary

genetics:

• 80% heritable

• many small genetic effects (polygenic)

• interacting with environment (gene x environment interactions)

neurotransmitters: similar to depression, low serotonin activity, low norepinephrine when depressed

• different from depression- norepinephrine high when manic, increased dopamine can trigger manic episode

ion channels

• signals pass in and out of neurons through ion channels

• ion channels seem unusually sensitive/easy to open in bipolar

medication:

mood stabilizers

• slow down neural signaling via ion channels

• first lithium- higher risk, toxic at high levels

• newer antiseizure drugs (safer) ex. lamotrigine (lamictal)

antipsychotics

• inhibit dopamine that can trigger manic episodes

psychotherapy

• usually combined with medication

• focus on medication compliance, social skills, solving functional problems

interpersonal and social rhythm therapy (IPSRT)

• people with bipolar tend to have irregular routines

• irregular circadian rhythms make neurotransmitter levels unstable

• creating more regular social rhythms to prevent mood disorders