Study Notes on Bipolar Disorder

PSY 366 Ch. 7: Bipolar Disorder

Core Features of Bipolar Disorder

  • Definition: Bipolar disorders are characterized by periods of elevated mood (manic or hypomanic) interspersed with either a normal mood (euthymia) or a depressed mood.

Manic Episodes

  • Definition: A manic episode is a period of elevated, expansive, or irritable mood lasting at least one week.
  • Symptoms (According to DSM): Must have 3 or more symptoms, or 4 or more if mood is irritable:
    • Inflated Self-Esteem or Grandiosity: An exaggerated sense of one's own importance.
    • Decreased Need for Sleep: Not insomnia; individuals feel fine after as little as 3 hours of sleep.
    • More Talkative than Usual: Increased pressure to keep talking.
    • Flights of Ideas: Experience that thoughts are racing.
    • Distractibility: Easily diverted from unimportant or irrelevant stimuli.
    • Increase in Goal-Directed Activity: Impulsiveness in work, sexual pursuits, or other areas OR psychomotor agitation.
    • Excessive Involvement in Pleasurable Activities: Engagement in activities with high potential for painful consequences, such as spending sprees, sexual indiscretions, or foolhardy business investments.
  • Impact: Symptoms must cause severe distress or dysfunction and can lead to hospitalization.
  • Psychotic Symptoms: May include hallucinations or delusions and possible aggression.

Hypomanic Episodes

  • Definition: A hypomanic episode has the same symptoms as mania but is less severe and lasts for a minimum of 4 days.
  • Characteristics:
    • Noticeable change to others, may appear simply as being “in a really good mood.”
    • Criteria: Not severe enough to cause marked impairment or require hospitalization.
    • Cannot include psychotic features; if it does, it is classified as a manic episode.

Types of Bipolar Disorder

  • Bipolar I Disorder:
    • Criteria: Must have a history of at least one manic episode.
    • May have hypomanic episodes and depressive episodes, although depressive episodes are not required for diagnosis.
    • Symptoms cannot be better explained by medication, substance use, or other psychiatric disorders.
  • Bipolar II Disorder:
    • Criteria: Must have at least one hypomanic episode and one major depressive episode.
    • A history of manic episodes would classify the individual as Bipolar I instead.
    • Symptoms cannot be better explained by other disorders.
    • Must cause distress or dysfunction due to depression or the consequences of frequent mood changes.
  • Cyclothymic Disorder:
    • Definition includes a history of less severe mood episodes than those seen in bipolar I or II disorders.

Specific Patterns and Specifiers

  • Rapid Cycling: Defined as having at least 4 episodes within a 12-month period.
  • Psychotic Features: Features may be mood-congruent or mood-incongruent during any abnormal mood episode.
  • Mixed Features: Classify episodes based on the presence of depressive features during mania/hypomania or manic features during depression.
  • Severity Specifiers: Must specify if in partial or full remission. The severity of depressive or manic episodes may be mild, moderate, or severe, with severe mania potentially necessitating continual supervision to avoid risk to oneself or others.

Triggers of Episodes

  • Episodes may not need a specific reason to begin but can be triggered or worsened by:
    • Stressors: Specific stressors can include life events and emotional upset, and the acronym HALT can be used: Hungry, Angry, Lonely, Tired.
    • Sleep: Lack of sleep is a significant trigger for mania and hypomania.
    • Substances: Certain antidepressants and illicit substances have the potential to trigger manic episodes.
  • Diagnosis: Episodes are only diagnosable as bipolar if they persist after the medication or substance has been discontinued.
  • Mood Instability: Presence of lability during mania includes rapid shifts in mood across a short period of time, often related to mixed features.

Prevalence and Statistics

  • Bipolar I Disorder Prevalence: 0.6% of the population experiences Bipolar I within a 12-month period.
  • Bipolar II Disorder Prevalence: 0.3% of the population experiences Bipolar II within a 12-month period.
  • Cyclothymic Disorder Prevalence: 0.4% to 1%.
  • Onset: Average onset for mania/bipolar I is around age 18, with 90% of individuals with a manic episode going on to have future episodes.
  • Major Depressive Episodes: 60% of manic episodes are immediately followed by a major depressive episode.
  • Suicide Risk: High risk during both manic and depressive episodes, potentially contributing to 25% of suicides.
  • Gender Ratio: Generally equal; however, females tend to present with more rapid cycling, comorbid eating disorders, and alcohol use disorders.
  • Comorbidity: More than 50% of individuals with bipolar disorders also have anxiety disorders, ADHD, substance use disorders, or conduct disorders, and alcohol use disorder is prevalent in over half of these cases.

Characteristics of Bipolar II Disorder

  • Age of Onset: Average onset occurs in mid-20s, typically starting as a depressive disorder and not recognized as Bipolar II until a hypomanic episode occurs.
  • Number of lifetime episodes tends to be higher than in Bipolar I, experiencing more enduring and disabling depressive episodes that worsen with age.
  • Inter-episode Disruption: Seen in about 15% of cases; 20% transition directly between episodes without normal mood periods in between.
  • Rapid Cycling: Ranges from 5-15 %, defined as having more than 4 episodes within a 12-month span.
  • Gender Differences: Females exhibit mixed states and rapid cycling; childbirth is noted as a potential trigger for hypomania.
  • Suicidal Behavior: Around 35% of individuals with bipolar attempt suicide, but those with bipolar II may complete suicide more frequently.
  • Comorbid Disorders: Approximately 60% have 3 or more comorbid disorders, with 75% having anxiety disorders, 37% having substance use disorders, and 14% having lifelong eating disorders.

Treatment Options for Bipolar Disorder

  • Medication:
    • Primary Treatment: Medication is the first-line treatment and requires lifelong management; patterns of episodes may change with age.
    • Combination Therapy: Often involves a combination of a mood stabilizer, an antipsychotic, and an anticonvulsant.
    • Alcohol Consumption: It is highly discouraged.
Mood Stabilizers
  • Examples: Lithium is commonly used.
  • Common Side Effects: Include weight gain, cognitive impairment, hand tremor, drowsiness, hair loss, increased thirst, and potential thyroid and kidney issues.
  • Rates of Side Effects: Approximately 75% experience minor side effects, with more severe reactions occurring if there is a high blood concentration of the drug; dehydration poses a significant risk.
  • Purpose: Mood stabilizers aim to reduce the severity or frequency of mood episodes.
Antidepressants
  • Usage: Very rarely used alone as they can trigger mania; almost never prescribed without a mood stabilizer.
  • Anxiolytics: Typically used for short-term management.
Antipsychotics
  • Examples: Medications such as Seroquel (Quetiapine), Risperdal (Risperidone), and Geodon may be employed if mood stabilizers do not suffice in managing mania or hypomania.
  • Common Side Effects: Side effects may include blurry vision, dry mouth, drowsiness, muscle spasms/tremors, involuntary facial tics, and weight gain.
Anticonvulsants
  • Examples: Medications like Depakote, Lamictal, and Tegretol are initially developed as anti-seizure medications but have been found to have mood-stabilizing effects.
  • Common Side Effects: May include dizziness, drowsiness, fatigue, nausea, tremor, rash, and weight gain.
  • Side Effects and Benefits: Vary according to the dosage prescribed.