BIPOLAR DISORDERS

(THE SHORT LECTURE)

Mood Disorders – Part 3
 Videos

Manic symptoms
http://www.youtube.com/watch?v=zA-fqvC02oM

Kay redfield jamison

http://www.youtube.com/watch?
v=mhPAXpW6KhI&list=PLScgI9IJlBNVhDGQZnY8
0wfVe2TaBgBGx
Some mood variation is normal…

M
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d
D
Unipolar vs. Bipolar Disorders

Depression

Unipolar

Depression Mania

Bipolar
 Bipolar Disorders: Definitions
Manic episode
(A) Distinct period of abnormally & persistently elevated, or
irritable mood lasting at least 1 wk (or any duration if
hospitalized) & increased activity or energy
(B) During mood disturbance, 3+ of following (4+ if mood =
irritable):
 ↑ self-esteem or grandiosity
 ↓ need for sleep
 More talkative than usual or pressure to keep talking
 Flight of ideas/thoughts feel like racing
 Distractibility
 ↑ in goal-directed activity or psychomotor agitation
 Excessive involvement in pleasurable activities that have high
potential for negative consequences (shopping sprees, sexual
indiscretions, etc)
(C) Marked impairment or hospitalization necessary to
prevent harm to self/others
 Bipolar Disorder: Definitions

Hypomanic episode: similar to manic but shorter

duration (4-6 days) and not severe enough to cause
marked impairment
 Hospitalized = automatically counts as manic

 Manic episode
 http://www.youtube.com/watch?v=zA-fqvC02oM
 Bipolar Mood Disorders

 Bipolar I Disorder
 Presence of at least one Manic Episode

 Often but not always MDE

 Significant interference with functioning

 Bipolar II Disorder
 At least 1 MDE and at least 1 Hypomanic Episode
 Never been a manic episode.

 Kay redfield jamison

 http://www.youtube.com/watch?
v=mhPAXpW6KhI&list=PLScgI9IJlBNVhDGQZnY80wfVe2TaBgB
Gx
 Symptom Pattern of Bipolar I

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 Symptom Pattern of Bipolar II

M
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 Domains of Effect in Mania
 Emotional
 Inflated self-esteem or grandiosity
o person may give advice on matters for which they only have superficial
knowledge (created the internet), or they have special relationship with a public
figure (e.g., Bill Gates), or grandiose delusions of being some important person

Physical
 Decreased need for sleep
 Behavioral
 More talkative and pressured speech
 Increased goal-directed behavior
 Excessive involvement in high-risk pleasurable activities
 Cognitive
 Racing thoughts or “flight of ideas”
 High distractibility
 Bipolar Mood Disorders cont’d
 Cyclothymic Disorder:
 For at least 2 yrs have had numerous periods with hypomanic
symptoms that don’t meet criteria for a hypomanic episode
AND numerous periods with depressive sx that don’t meet
criteria for a major depressive episode.
 Hypomanic and depressive periods have been present for at
least 50% of the time and person has not been w/o sx for more
than 2 months at a time
 Criteria for a major deppression, manic, or hypomanic episode
have never been met (though sometimes people go on to
develop BPI or II)
 Cycling

 Cycling = shift between mood states. Rapid cycling occurs if there

are 4 or more cycles in a year.

 Common for patients to have alternation (return to typical

baseline) between episodes. Can also have mixed episodes (both
MDD & manic symptoms).

 Patients average about one cycle every two years (median is 18

months).

 Depressive episodes are more common (usually 3:1) particularly as

disorder persists over time
 Bipolar Mood Disorders

Prevalence – Life: 0.4%-1.6%

No gender differences
Onset usually in late adolescence/early adulthood
 Subtypes and specifiers

Episode specifiers:
 Psychotic features

 Postpartum onset

Course specifiers (Pattern of

disorder over time):
 Rapid cycling

 Seasonal pattern
 Seasonal pattern of B P

 Bipolar I disorder (BD I) or bipolar II disorder (BD

II) with seasonal pattern (BD SP) is the DSM-IV-TR
diagnosis for persons with depressive episodes in the
fall or winter and mania (BD I) or hypomania (BD II)
in spring or summer
Bipolar Disorder: Etiology & Treatments
 Biological Findings

Genetics: strong evidence of heritability. If a first

degree relative has it, your risk of developing it is
15 times greater than the general population
 though risk is for BP & MDD if 1st degree relative = BP

Neurotransmitters: Excess norepinephrine and

low serotonin during manic phase

Brain Structure & Function: Imaging studies

suggest increased activity in limbic system
(amygdala); reduced gray matter & some
structural abnormalities
 Biological Treatments

Pharmacotherapy
 Lithium carbonate (lithium)
 Helps in 60% of cases
 High relapse if stop taking
 Side effects & dangerous if OD’d
 Anticonvulsants (for rapid cycling)
 E.g., Tegretol, Depakene
 ~50% show positive response; side effects common
Electroconvulsive therapy (ECT)
 Used for rapid-cycling
Psychological Findings – environment
matters!
 Negative life events increase time to recovery
from episodes of bipolar disorder (not due to
medication noncompliance)
 Life events involving goal attainment or
disruption of social rhythms increase manic
symptoms
 Social support exerts a stronger influence on
symptoms of depression than symptoms of mania
 Psychological Treatments
Medication is the most important method of treatment
for bipolar disorders, but psychotherapy is an effective
supplement
Family-Focused Therapy (FFT) -Appreciation of the ways
that patients' family system and relationships may support
patients' conditions, or alternatively, exacerbate them
– Identify conflicts within the family
– Reduce “expressed emotion” and improve communication
Interpersonal Social Rhythm Therapy- episodes of either
mania or depression often precipitated by: stressful life
events and disruptions in social rhythms
 Regulate sleep-wake cycles
 Resolve interpersonal problems effectively
 Bipolar Mood Disorders: Treatment

Largely medication:
 Lithium = most common tx
 Mechanism: may stabilize neurotransmitter systems, (5HT +
DA)
 More effective for mania than depression so often on
combined Lithium and antidepressants

 Issues: big differences in absorption rates of Lithium in

people so hard to find right dose. Difference between
effective and toxic dose is small – must be monitored carefully
 Also many side effects: weight gain, severe acne
 Bipolar Treatments

Anticonvulsants:
 e.g. Tegretol, Depakote.
Very effective on mania, but may not be as effective
as Lithium
 Bipolar Treatment

Clients often discontinue meds when not in an

episode and then experience relapse
Compliance w/ medications is adjunct psychotherapy
goal
Also, therapy to work on issues that may contribute to
depression (interpersonal, ways of thinking,
behaviors) and to improve self-monitoring of
symptoms so know when getting into an episode.
 To think about:

Text page 248. Think about the purported link between

creative accomplishments and bipolar disorder. What do
you think might contribute to this relationship? That is,
how do you think that these 2 things are associated?