Bipolar Disorders in DSM 5

Bipolar and Related Disorders

• Bipolar I Disorder: characterized by mania and depression
• Bipolar II Disorder: characterized by hypomania and depression
• Cyclothymic Disorder: characterized by hypomania and mild depression
• Other specified and unspecified bipolar and related disorders

Manic Episode

• Prevalence of bipolar disorder: 1% in the general population, with a 1:1 ratio of women to men
• Symptoms of mania:
  • Affective: elevated or irritable mood
  • Cognitive: inflated self-esteem, distractibility, and flight of ideas
  • Behavioral: unusual talkativeness, rapid speech, increased activity level, and excessive involvement in activities with a high potential for painful consequences
  • Physiological: less than usual amount of sleep needed
• Symptoms must be distressing and interfere with normal functioning, and not caused by other mental or somatic illnesses or substance abuse

Personality Disorders

• Histrionic Personality Disorder: characterized by excessive but shallow emotions and attention seeking
  • Wants to be the center of attention
  • Inappropriate sexually seductive or provocative behavior
  • Rapidly shifting and shallow expression of emotions
  • Uses physical appearance to draw attention to self
  • Speech is dramatic and exaggerated with emotion
  • Is easily influenced by others or circumstances
• Narcissistic Personality Disorder: characterized by an attitude that the world exists to meet their needs, lack of empathy
  • Sense of self-importance
  • Preoccupied with fantasies of unlimited success, power, beauty, or ideal love
  • Believes they are "special"
  • Requires excessive admiration
  • Has a sense of entitlement
  • Takes advantage of others to achieve their own ends
  • Lacks empathy
  • Often envious of others or believes that others are envious of them
  • Arrogant, haughty behavior or attitude
• Avoidant Personality Disorder: characterized by a pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative situations
  • Avoids occupational and social activities that involve interpersonal contact
  • Unwilling to get involved with people unless certain of being liked
  • Shows restraint within intimate relationships because of fear of being ridiculed
  • Inhibited in new interpersonal situations
  • Views self as socially inept, personally unappealing, or inferior
  • Reluctant to take personal risks or engage in new activities
• Dependent Personality Disorder: characterized by an excessive need to be taken care of, leading to submissive and clinging behavior and fears of separation
  • Difficulty making decisions without advice and reassurance
  • Needs others to assume responsibility for most major areas of life
  • Difficulty expressing disagreement with others
  • Difficulty initiating projects or doing things on their own
  • Goes to excessive lengths to obtain nurturance and support
  • Feels uncomfortable or helpless when alone
• Obsessive-Compulsive Personality Disorder: characterized by a preoccupation with orderliness and perfectionism
  • Preoccupied with details, rules, lists, order, organization, or schedules
  • Shows perfectionism that interferes with task completion
  • Excessively devoted to work to the exclusion of leisure activities and friendships
  • Reluctant to delegate tasks
  • Overly conscientious, scrupulous, and inflexible about matters of morality, ethics, or values
  • Unable to discard worn-out or worthless objects
  • Adopts a miserly spending style
  • Rigid and stubborn

Risk Factors and Treatment Options

• Risk factors for bipolar disorder:
  • History of childhood verbal, physical, or sexual abuse
  • Family history of schizophrenia
  • Family history of personality disorders
  • Childhood head injury
  • Unstable family life
• Treatment options for bipolar disorder:
  • Combination of psychotherapy and medication
  • Psychotherapy options:
    • Psychodynamic psychotherapy: helps recognize how they are responsible for the turmoil in their lives and learn healthier ways of reacting
    • Cognitive-behavioral therapy: involves actively retraining the way they think about problems, which improves emotions and behaviors
  • Medication options: antidepressants, anticonvulsants, antipsychotics, etc.

Sleeping Disorders

Basics

• Sleep is a particular state of consciousness:
  • Very active biological process
  • Consists of processes with widely differing functions and mechanisms
  • Has restorative effects on all aspects of functioning
  • Is essential to life
• 5 stages of sleeping:
  • Alpha stage: feelings of being relaxed and drowsy
  • Non-REM 1: transition from wakefulness to sleep, easy to wake
  • Non-REM 2: first stage of real sleep, muscle tension, heart rate, and body temperature decrease
  • Non-REM 3 & 4: stage 4 is the deepest sleep, heart rate, respiration, temperature, and blood flow decrease, growth hormone is released, physical growth and brain development, hard to wake
  • REM stage: brain activity similar to when awake, main dreaming stage, physiological responses increase, but movement is paralyzed
• Functions of sleep stages:
  • Non-REM: development, reconstruction, energy production, immune regulation, memory consolidation
  • REM: memory consolidation, psychological wellbeing, emotional learning, motivation, coping with stress, mood regulation

Two-Factor Model of Sleep Regulation

• Process S (homeostatic): controlled by the hypothalamus, pressure builds up during wakefulness
• Process C (circadian clock): controlled by the suprachiasmatic nucleus (SCN), internal clock system, operates even without environmental cues

Sleeping Disorders

• Dyssomnias: true sleep disorders
  • Insomnia: inability to fall or remain asleep, waking up early, and sleep that is non-restorative
  • Sleep apnoea: stopping breathing for 10 seconds or longer during sleep, may repeatedly wake up and be tired the next day
  • Narcolepsy: sleepiness during the day, "sleep attacks", brief periods of REM, and occasional cataplexy
  • Restless legs syndrome: discomfort in limbs causing restless movement, at rest and when in bed
  • Circadian rhythm disorders: jet lag, shift work, delayed/advanced sleep phase syndrome