Bipolar

Question 1

Manic episode

Answer 1

A. ≥ 1 week manic: Elevated, expansive, irritable mood and abnormal goal-directed activity
B. 3+ of:
1. ↑ SE or grandiosity
2. ↓ sleep (rested <3 hrs.)
3. ↑ talkative/pressured speech
4. Flight of ideas/racing thoughts
5. Distractibility
6. ↑ goal-directed activity
7. ↑ involvement in potentially risky activity
C. impairment or need for hospitalisation
D. Not due to substance

Question 2

Bipolar Disorder 1

Answer 2

• Manic episode
• Not better explained by schizophrenic /psychotic disorder

Question 3

Hypomanic epsiode

Answer 3

Mania but just 4+ days and not as severe

Question 4

Bipolar Disorder II

Answer 4

• 1+ hypomanic episode and 1+ Major depressive episode
• There has never been a manic episode
• not better explained by schizophrenia spectrum or psychotic disorder

Question 5

Cyclothymic Disorder

Answer 5

A.
* At least 2 years (never 2 months without symptoms)

• Numerous periods of sub-threshold hypomanic and depressive symptoms
• Symptoms for both present at least half the time

Question 6

Epidemiology
(prevalence, age, gender, prognosis, cultural differences)

Answer 6

2-4% general population lifetime prevalence
* Average age of onset 18.4 - 20.0
* 1:1males and females
* managing - doesnt have cure
* no cultural difference

Question 7

Differentials

Answer 7

1. Psychosis
2. Depression
3. ADHD
4. BPD- Bipolar more episodic, BPD more chronic and more rapid cycling (mood changes over minutes/hours rather than months with Bipolar)

Question 8

Assessment

Answer 8

RISK
- Risk to self and others (driving, sexual, financial, physical, violence - think children and spouse)
- self-harm and suicide (20% higher than in the general population,

• Collateral info
• Differentiating from Dx (duration of mood changes)
• Identify triggers of ascent/descent behaviours

Question 9

Psychometrics

Answer 9

Young Mania Rating Scale - GOLD STANDARD
- Parent Version of the Young Mania Rating Scale (5-17yrs)
- Beck Depression Inventory
- Beck Hopelessness Scale

Question 10

Psychosocial causes

Answer 10

Negative family environment:
- frequent criticism and hostility = predictor of relapse.

family stressors interact with rhythm dysregulation and mood symptoms, when added to underlying neurobiological vulnerability, a manic episode or MDE is triggered

Stressful life events and - low social support

Goal attainment life event (possible underlying excessive reward sensitivity)

Question 11

Biological causes

Answer 11

GENETICS
important, Twin studies – monozygotic twin 57% more likely, dizygotic 14% more likely.
- Risk of children among bipolar parents 4 x higher than normal.

NEUROLOGICAL
Neurotransmitter Dysregulation: excess of serotonin, norepinephrine, and dopamine.

SLEEP
Disruption of social rhythms:
Sig life events =
disrupt circadian rhythms =
further neurotransmitter dysregulation = behavioural changes & bipolar symptoms

Question 12

Integrative Cognitive Model

Answer 12

BD is maintained by several factors that follow a trigger event.

1. Trigger =
2. Change in the internal state (their mood, physiology or cognitions).

• If appraised as having extreme personal significance/ an imminent catastrophe =
  3. exaggerated attempts to control their internal state eg ascent or descent behaviours.
• beliefs, life experiences and affect regulation also impact whether they engage in ascent or descent behaviours.

4. Ascent = decreased sleep and risk-taking behaviour = have the effect of increasing the state of activation.
   OR
5. Descent behaviours = withdrawal, sleep, = decrease the state of activation.
6. These behaviours are negatively reappraisal and cause further internal changes (maintenance cycle).

Question 13

Treatment (6)

Answer 13

MEDICATION eg mood stabilisers

CBT
- Recent research showed CBT to be effective for =

• cognitive restructuring -depressive/manic mood states
• moderating risky behaviour and situations
• scheduling in calming activities/relaxation
• self-monitoring of mood, thoughts and feelings to detect warning signs – then have clear strategies to prevent progression into full-blown episodes
• enhance general coping strategies and facilitate goal setting
• building social networks

INTERPERSONAL SOCIAL RHYTHMS THERAPY (IPSRT)
= stablising circadian rhythms with tools like sleep/light exposure/social exposure/exercise and their timing

PSYCHOEDUCATIONAL THERAPY
- the importance of structure and a regular routine, i.e., getting enough sleep, avoiding excessive stimulation and reducing activity level
- the importance of medication adherence for relapse prevention

FAMILY FOCUSED THERAPY (particularly for depressive episodes)
– is based on the finding that bipolar
clients in a high “expressed emotion” (EE) environment fare worse than those in a low EE environment.
- Therefore, therapy targets families after the client has been stabilised following an episode.
- Components include: Psychoeducation, communication training, problem
solving skills, relapse prevention.

GROUP THERAPY
can enhance medication adherence and other Treatments compliance and may be useful during
recovery phase