Mania
pleasant valence, high activation
Manic episode DSM-5-TR
- distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity/energy, lasting at least 1W and present most of the day, nearly everyday (or any duration for hospitalisation)
- during this period, 3+ of these symptoms persist and noticeable change from usual behaviour: inflated SE/grandiosity; decreased sleep need; more talkative/pressure to keep talking; flight of ideas; distractibility; increased goal-directed activity; excessive risky activities
- mood disturbance sufficiently severe to cause marked function impairment/hospitalisation needed, or there are psychotic features
- not attributable to substance/medical condition
Hypomanic episode DSM-5-TR
- distinct period of abnormally and persistently elevated, expansive, irritable mood and acivity/energy lasting 4+ consecutive days, most of day, nearly everyday
- during period, 3+ of following symptoms (4 if only irritable mood) to significant degree: inflated SE/grandiosity; decreased sleep need; more talkative/pressure to keep talking; flight of ideas; distractibility; increased goal-directed activity; excessive risky activities
- change in functioning uncharacteristic of when nonsymptomatic
- observable change by others
- not severe enough to markedly impair function or require hospitalisation
if psychotic episodes= manic - not attributed to substance/medical condition
manic vs hypomanic episode
duration: manic=1W, hypomanic=4days min
functional consequences: manic= impairment
Manic=hospitalisation
Manic= psychotic features
B1 disorder DSM-5-TR
- occurrence of a manic episode
- at least one manic episode is not better explained by a schizophrenia/psychotic disorder
B2 disorder DSM-5-TR
- at least one hypo and at least one MD episode
- never experienced mania
- at least one hypomanic episode and at least one MD epsiode are not better explained by schizophrenia/psychotic disorder
- symptoms of depression or the unpredictability caused by frequent alternation between depression and hypomania episodes cause function impairment or distress
Cyclothymic disorder DSM-5-TR
- at least 2 years (1 in children + adolescents), numerous periods with hypomanic symptoms not meeting criteria for hypomania and number MD symptoms not meeting criteria for MD epsiode
- During this period, symptoms present at least half the time, and not without symptoms for more than 2MO at a time
- criteria never been met
- symtpoms not better explained by S/P disorder
- not attributed to substance/medical condition
- significant distress and impair functioning
Hallucinations
sensory experiences that do not correspond to external stimuli
Delusions
beliefs that are not supported by evidence and resistant to change and culturally unusual
Johnson’s goal dysregulation theory
identifies dysregulated goal pursuit as a core pathology
goal attainment predicts mania but not depression
linked to dopamine dysfunction
interpersonal and social rhythm therapy
stabilising daily routines and avoiding circadian disruption
addressing recurrent vulnerability produced by nonadherence to medication, life stressors and disruption of social rhythms
Psych treatment for BD: principles of change
improve symtpom awareness
reduce engagement in overly ambitious goal pursuit and practice self calming after goal attainment life events
address interpersonal stress and social isolation
promote regular sleep-wake cycles and activity cycles
develop plans to foster support if mood episodes emerge
increase motivation for medication adherence
