What are the symptoms of a “high”?
What are the characteristics of a Major Depressive Episode in Bipolar?
A. At least 5 + symptoms during 2 week period (need #1 or # 2)
1. Depressed mood most of the day, nearly every day
2. Markedly diminished pleasure/interest in activities
- Significant weight loss or weight gain
- Insomnia or hypersomnia nearly every day
- Psychomotor Agitation
- Fatigue/Loss of energy nearly every day
- Feelings of worthlessness, excessive guilt nearly every day
- Diminished ability to concentrate nearly every day
- Recurrent thoughts of death, suicide, suicide attempts
B. Clinically significant distress or impairment
C. Not attributed to substance use or other medical condition
What are the diagnostic differences between Bipolar I and Bipolar II?
Bipolar I:
- Manic episode(s) must be present
- Major depressive and Hypomanic episode(s) can be present but not necessary for diagnosis
Bipolar II:
- Hypomanic episode(s) must be present
- Major depressive episode(s) must be present
What are some of the diagnostic issues associated with bipolar disorders?
- Underdiagnosed (~18 years late)
- Overdiagnosed (e.g. Borderline)
- Misdiagnosed (as Schizophrenia or Unipolar depression)
How can stressful life events affect Manic and Depressive episodes of BD?
Manic episodes likely preceded by:
- Disruption to routines & sleep-wake cycles
- Excessive focus on goal attainment
Depressive episodes likely preceded by:
- Low social support
- Low self-esteem
How much does genetic account for the prevalence of BP?
- Lifetime risk for family members of BP patients: 10% (vs.1% in the general population)
- Twin studies: BP heritability rate of about 85%
What is the lifetime prevalence of BP?
- Lifetime prevalence:
- Bipolar I: up to 1%
- Bipolar II: ~5%
What is the 12-month prevalence of BP?
- 12-month prevalence: 1.3%
Is there any sex differences in BP?
NO
How long is the delay in patient seeking treatment?
10-25 years
What is the outcome of untreated BP?
8-10 lifetime episodes of Mania and Depression
What is the relapse rate of bipolar patients who received treatment for their disorder?
- 40% within 1 year
- 73% within 5 years
What the main characteristics of Cyclothymic Disorder?
- Chronic + less severe than BP
- Numerous episodes of hypomania and depression symptoms that are not severe enough to meet criteria for manic or major depressive episodes
- Symptoms presents for at least 2 years, with no more than 2 months without symptoms
- Distress and impairments in functioning
What are the characteristics of a hypomanic episode?
- Uncharacteristic change of the individual
- Disturbance and change are observable by others
- No psychotic features
- Not severe enough to cause impairment (e.g. no hospitalisation)
- Not due to medical/substances condition
What are the characteristics of a major depressive episode in BP-I?
A. At least 5 + symptoms during 2-week period (need #1 or # 2)
1. Depressed mood most of the day, nearly every day
2. Markedly diminished pleasure/interest in activities
- Significant weight loss or weight gain
- Insomnia or hypersomnia nearly every day
- Psychomotor Agitation
- Fatigue/Loss of energy nearly every day
- Feelings of worthlessness, excessive guilt nearly every day
- Diminished ability to concentrate nearly every day
- Recurrent thoughts of death, suicide, suicide attempts
B. Clinically significant distress and impairment
C. Not due to other substances/medical condition
What is the course of BPs?
Predominantly depressive
- Bipolar I: 32% of time depressed, 9% manic
- Bipolar II: 50% depressed, 1% hypomanic
- 5-15% patients have 4+ episodes per year >> rapid cycling
Identify other disorders that have high comorbidity with BPs.
- 50% Anxiety disorders (GAD, panic, social phobia)
- 39% Substance misuse (“self-medication”)
What is the suicide rate of BP patients?
- 15x higher than general population
- 25% will attempt suicide
- 80% usually during depressive episode
- 10-20% will complete suicide
- Higher in BP-II (due to more frequent depressive episode?)
Explain the Diathesis-Stress Model of Bipolar Disorders?
Pharmacotherapy for BP
- Lithium:
- mood stabiliser
- main component of standard care
- not used regularly until ’60s
- for treating manic ep. and prevent future ep.
- 50% relapse within 5 months of ceasing
- Anticonvulsants
- Atypical Antipsychotics
- Sedative Hypnotics
- Antidepressants:
- doses lower and duration shorter than for unipolar depression
- combined with mood stabiliser to prevent inducing mania
Electro-Convulsive therapy (ECT)
- Used when medication is not viable (e.g. pregnant women)
- Effective for treating manic & depressive ep.
- Short-term side effects: confusion, disorientation, memory loss
- Pharmacotherapy required to maintain mood stability & prevent relapse
Psycho education
Group setting
Provide info about
- Symptoms of BP
- Diathesis-stress model
- Identifying early warning signs of relapse
- The importance of medication compliance
- Strategies to cope with stressors
- Need for routines & sleep-wake cycles
CBT for BP
- Aim: manage acute symptoms and prevent relapse
- Key technique: cognitive restructuring
- Patients encouraged to:
- Monitor symptoms
- Challenge hyper-positive symptoms
- Improve medication adherence
- Doster self-efficacy
How effective is CBT for BP?
- Reduce episodes and hospitalisations
- Improve medication adherence (esp. within 6 months post-treatment)
- Benefits of Mindfulness-based Cognitive Therapy
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Depression39
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Schizophrenia Spectrum & Other Psychotics32
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Bipolar29
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Anorexia Nervosa1
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Bulimia Nervosa0
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Binge Eating Disorder0
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ADHD1
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ODD & CD1
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Sexual Dysfunctions (SD)27
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Health Psych0
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Anxiety40
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Personality Disorder I23
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Personality Disorder II24
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Addiction - Substances0
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Addiction - Gambling Disorder24
