DSM-5 criteria for bipolar
A: distinct period of abnormally and persistently elevated/irritable/expansive mood and energy/activity lasting at least 1 week (where its noticeable by others)
B: 3 or more of following:
- flight of ideas/thoughts racing, more talkative/pressure speech, decreased need for sleep, distractibility, increased goal directed activity/psychomotor agitation (cant sit still), excessive involvement in risky behaviours (ie spending spree, unsafe sex practices)
bipolar disorders general
- bipolar 1: at least one manic episode, no need for depression episodes, often has worse prognosis
- bipolar 2: at least one hypomanic episode (at least 4 days) and at least one major depressive episode
- Cyclothymic disorder: numerous periods of subthresthold hypomania and numerous periods of subthreshold depression
t or f: bipolar 1 is often comorbid with MDD
false, it cannot be comorbid with MDD
lifetime prevalence of bipolar
- bipolar 1: 0.6%
- Bipolar 2: 0.4% (less common than unipolar disorders)
Sex ratio and age of onset for bipolar
- sex ratio= 1:1 (slight more men for 1 and more women for 2)
- age of onset; late teens/early 20s
ethnic disparities in bipolar diagnosis and treatment
- black ppl are more at risk of being misdiagnosed with schizophrenia
- if properly diagnosed, they are also less likely than white patients to receive treatment
heritability estimate for bipolar
- 0.85
- children w/ parents with bipolar disorder are a 4 fold greater risk of developing a mood disorder but most wont develop manic/hypomanic symptoms
GWAS (bipolar)
- genome wide association studies
- analyze entire genome (requires huge sample)
- looks for genetic markers that statistically distinguish traits from others
from a genetic standpoint, BP has more in common with ____ than with ____
schizophrenia, unipolar major depression
pharmacotherapy for bipolar
- lithium, anti convulsants (divalproex), anti psychotics (olazapine, quetiapine, risperidone, aripiproazole)
what level of adults and adolescents are fully/partially non-adherent (no follow up) to medication after the first year
- adults=40-60%
- adolescents=65%
lithium’s therapeutic window (mmol/L)
- <.4=little theraputic effect
- .4-1.0=manis prophylaxis
-.8-1.2= acute mania treatment
-1.2-1.5= possible renal impairment - 1.5-3.0 = renal impairment, weakness, drowsiness, thirst, diarrhea
- 3.0-5.0= confusion, convulsions, coma, death
adjunctive psychotherapy for bipolar examples
- Family focused therapy (FFT)
- Interpersonal and social rhythm therapy (ISRT)
- cognitive behavioural therapy
Expressed emption (EE)
- family members’ attitudes toward person w bipolar
- examples: critical, hostile or over involved
- high EE is associated with higher relapse
FFT (bipolar)
- family focused therapy, has 3 stages
- stage 1: psychoeducation of for patient and family about bipolar disorder
- stage 2: communication enhancement training (ie communication skills, active listening, making pos requests for change, express pos and neg feelings)
- stage 3: problem solving skills training (identify specific family conflicts, brainstorm and generate solutions together, evaluate dis/advantages together, develop implementation plan)
Circadian rhythm disruption theory
- 24 hour sleep-wake cycle is regulated by suprachismatic nucleus, based on input from retina
- stims melatonin release from pineal gland
- example in high relapse rates during ramadan (mainly manic episodes)
sleep deprivation trigger mania in ___% of patients
77%
circadian rhythm disruption events
- social zeitgebers: enviro and interpersonal influences that keep time
- social zeitstorers: social influences that disrupt ability to maintain daily rhythms
ISRT
- interpersonal and social rhythm therapy, 3 stages
- Stage 1: monitor behaviours and relationships associated with changes in mood (choose interpersonal prob area)
- Stage 2: track social rhythm regularity, adjust to regular social rhythms, work on interpersonal problem area
- Stage 3: developing skills to manage shifts in routines, build patient confidence
what worksheet does ISRT use
- Social rhythm metric (SRM)
- shows goal activity, goal/target time to complete, when it was actually completed, and who was involved
ISRT vs clinical management
- SRM scores increased sooner and remained high with ISRT vs clinical management
- regulation of daily routines mediated effect of ISRT on relapse
t or f: both goal attainment events and general positive events predicted increase in manic symptoms
false, only goal attainment
anticipation of reward vs punishment and goal attainment in bipolar
- greater activity in ventral striatum (nucleus accumbens) and orbitofrontal cortex
- people w bipolar disorder showed enhanced sensitivity to rewarding stimuli
- goal attainment and success inspire burts of confidence, fueling increased goal attainment in BP
- excessive goal attainment can accelerate dev of manic symptoms
- following goal attainment, teach self regulation as self management tool can help prevent mania
recovery focused CBT
- Stage 1: introduce recovery approach to clients (assessing mood/function, discovering how they understand their diagnosis, making recovery informed therapy goals)
- Stage 2: chart relationships between mood and recovery goal (apply CBT techniques to facilitate pos coping
- Stage 3: consider wider function issues in recovery (develop and complete recovery plan, share lessons learned with their key supports)
