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Lecture 9 - Bipolar

Mental Health and Disorder (University of Lincoln)

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Lecture 9 – Bipolar
Bipolar is a type of mood disorder
Deining bipolar disorder:
- Disinct episode of depression and mania e.g mania and hypomania
- There are rare reports of individuals who experience mania in isolaion
- Manic episodes can last from a few days to several months
Hypomania(associated with Bipolar II) – Noiceably diferent behaviour from his own stable
mood e.g. being excepionally cheerful and sleeping for three hours instead of their usual 7,
spending more money than usual. However, this is not seen as problemaic as there are a lot
of cheerful people who need less sleep, so this is not considered as abnormal.
Mania (associated with Bipolar I) – On the other hand, manic episodes are out-of-control
happy, even during serious events like funerals and running around at midnight shouing
about how much they love everyone. This behaviour is abnormal for anyone.
- One or more of the following condiions has to exist in mania but not in hypomania
>> Psychoic symptoms, signiicant impairment in daily life, the manic person is oten
in receipt of treatment due to the severity of symptoms
Bipolar I
- Presence or history of at least ONE manic (Extreme) episode, oten with depression,
hypomania or mixed mood in their history
- The manic episode may have been preceded by and may be followed by hypomanic
or major depressive episodes
Criteria for a manic episode:
Unusual and coninual elevated, unreserved or irritable mood and unusual and coninual
increase in energy levels lasing at least a week (hypomania is 4 days).
Must have prescence of at least 3 of the following:
- Inlated sense of self-esteem or grandiosity
- Less need for sleep
- Increased talkaiveness
- Racing thoughts
- Easily distracible
- Increase in goal-directed acivity or unintenional and purposeless moions
- Unnecessary paricipaions in aciviies with high potenial for painful consequences
Bipolar II
- Involves ONE or more depressive episodes with at least ONE hypomanic
- No manic episodes
DSM-5 Changes for manic and hypomanic episodes

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- Criteria A for manic and hypomanic episodes now include an emphasis on changes in
acivity and energy
- Has a “bipolar and related disorder diagnosis” if individuals do not meet the full
criteria for bipolar II disorder
- Introducion of cyclothymic disorder which is a mild form of bipolar, with
subthreshold major depressive symptoms and hypomania over a period of 2 years
Is there an under-diagnosis of bipolar?
- Many individuals with major depressive disorder may have hidden bipolarity
- Non-response to anidepressant drugs in clinical trials has been correlated with
undetected bipolar
- Adolescents may be over diagnosed due to commonly exhibiing a hyperthymic
temperament
Prevalence
- 0.4-1.6% lifeime prevalence rate
- Equal female:male raio
- Develops late teens/early 20’s
- High SES
- Increased in high income countries
Is there increasing rates?
- Youth diagnosis has increased in past few years
- Most fall into bipolar disorder not otherwise speciied
- Dangers of over-diagnosing youth
Prognosis
- Lifeime disorder
- Episodic, rapid cycling afects more women than men
- Suicide risk is high, a third of those diagnosed atempt suicide
Mood disorders and creaivity – is there a link?
- Creaivity is associated with psychological disturbances and even “madness”
- Link between mood disorders and arisic achievement and creaivity
- Nancy Andreasen (1970) explored the link between creaivity and mental disorders
by looking at psychiatric histories of 30 authors and expected a correlaion with
schizophrenia. She found that 80% had experiences mood disorders, and in a 15 year
follow up, 2 of these authors and commited suicide
- Other large scale studies show evidence of this, as well as higher prevalence rates in
arisic and scieniic professions
What comes irst? Madness or genius?
- Creaive individuals have been shown to have greater family history of psychological
disturbances

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- Arisic communiies value emoional expressions and so would welcome those with
psychological disturbances.
Aeiology of bipolar disorder:
Triggers for depressive episodes – negaive life events, seasonality
Triggers for manic episodes – posiive or negaive life event, medicaion, seasonality or sleep
disrupion, goal atainment (associated with dysregulaion in the behavioural acivaion
system which regulates sensiivity for rewards)
Biogeneic factors –
Genes -10-25% of irst degree relaives of bipolar disorder suferers have reported symptoms
of a mood disorder, 7% irst degree relaives have bipolar disorder. There is a greater geneic
component than depression shown by twin studies: MZ twins 69.6%, and DZ twins 29.3%.
Neuropathology – there are brain regions involved in bipolar disorder, such as increased
acivaion of the amygdala and reduced acivity of the prefrontal cortex (shows an overlap in
MDD and schizophrenia)
Neurochemistry – increased levels of norepinephrine during mania and low levels in
depression, BUT the most efecive treatment is lithium carbonate as it stabilises sodium and
potassium ions in neuronal membranes, stabilises the synapic processes and afects gene
expressions
Psychological therapies
- Monitor moods and prodromes
- Improve coping/management of symptoms with cogniive behavioural strategies
- Family focused therapy and marital intervenion
- Life goals
- Sleep management
- Insight development
- Psychological therapies have been shown to be efecive in helping individuals deal
with their mood episode beter e.g to understand
- that mania is a protecive response to the psychological state of depression (such as
self-esteem) and is a defence mechanism against depression in classical
psychoanalysis

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Implicaions for intervenion –


1) Psycho-educaion:
Circadian rhythm – the role of rouine and minimising disrupions
Recogniion and anicipaion of stressors
Recogniion of prodromes
Biopsychosocial treatment
Misatribuion of sensaions to power weakness/powerfulness
Impact on support/ family and sigma
2) Cogniive Behavioural Therapy –
Collaboraive discovery of links between social environment and afect, behaviour,
cogniion
Coping: behavioural inhibiion during manic prodrome and acivaion during
depressive prodrome, interpersonal and environmental stressors
Dealing with NATs and UATs
Misatribuion of sensaions to weakness/powerfulness

Summary of BPD:
- Bipolar disorder is disinguished from depression by the presence of manic episodes
• Prevalence is less than major depression though bipolar II does have lower threshold
for diagnosis
• There is a strong geneic component but the underlying causaion is unknown

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• Disinguishing between the deining symptoms for a psychiatric diagnosis can be


diicult and there is strong overlap with both schizophrenia and major depression

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