Bipolar I & II: Symptoms, Diagnosis, and Differences

• These are study notes based on the provided text
• These are not an exhaustive list of what may be on the test

Mood Disorders & Suicide

• Bipolar I Symptoms include the alternation of major depressive episodes with full manic episodes
  • Can be diagnosed after one manic episode without a depressive episode
  • Depressive episode follows in the majority of cases
  • Tends to be chronic
• Bipolar II Symptoms are characterized by the alternation of major depressive episodes with hypomanic episodes
  • Hypomanic episodes are less severe, with no full manic episodes
  • Tends to be chronic
• Bipolar II does not have a history of full manic episodes
  • Bipolar I does
• Average age of onset for Bipolar II is 19-22 years old
  • Late adolescence/young adulthood
• Average age of onset for Bipolar I is 15-18 years
  • Adolescence
• Bipolar I experiences full manic episodes
• Bipolar II experiences hypomanic episodes
• 10% to 25% of cases progress to full Bipolar I disorder
• Lithium, a mood stabilizer, treats depression and manic symptoms
  • Toxic in large amounts and needs to be monitored
  • Effective for 50% of the population
  • The reason why it works is unclear
  • Family/CBT therapy can be helpful
• Persistent Depressive Disorder involves at least two years of depressive symptoms
  • Depressed mood most of the day on more than 50% of days
  • Symptoms can persist unchanged over long periods (≥ 20 years)
  • Cannot be symptom-free for more than two months at a time
  • Low-level depression interrupted by more severe depressive episodes or symptoms
• Mild depressive symptoms without any major depressive episodes are considered persistent depressive disorder
  • "Pure dysthymic syndrome"
  • Mild all the way through
• Mild depressive symptoms with additional major depressive episodes occurring intermittently are considered persistent depressive disorder
  • Previously called double depression
  • Mild punctuated by more severe, short-term depressive episodes
• A major depressive episode lasting 2+ years is considered persistent depressive disorder
  • "With persistent major depressive episode"
  • Persistent = without remitting
  • One long severe depressive episode
• Major Depressive Disorder may include one or more major depressive episodes separated by periods of remission
  • Single episode - highly unusual
  • Recurrent episodes are more common
  • Can stem From grief to depression
  • Major depression may occur as part of the grieving process
• Features of Major Depressive Disorder occur most of the day nearly every day for at least two weeks
  • How persistent and pervasive the disorder is
  • Children can look more like irritability than a depressed mood
• Anhedonia: Markedly diminished interest or pleasure in things that people used to enjoy (daily acitvities)
  • Varied symptoms: weight loss/weight gain, insomnia/hypersomnia
• Psychomotor agitation: Ansty, physiologically activation
• Psychomotor retardation: Moving slowly and not quick to respond
• Double Depression is a combination of major depressive episodes and persistent depression with fewer symptoms
  • Persistent depression (lower level/mild depressive symptoms for a long period) and major depressive episodes that interrupt it
  • Few symptoms present, then one or more major depressive episodes occur and revert back to a pattern of underlying depression
  • Associated with severe psychopathology and problematic future course
• Persistent depressive disorder differs from major depressive disorder: Fewer symptoms and is more chronic
  • More severe version of MPP
• Risk Factors for suicide:
  • Family History
  • Child maltreatment
  • Previous attempts
  • History of mental disorders, specifically clinical depression, bipolar disorder, schizophrenia, and borderline personality disorder
  • Alcohol and substance abuse
  • Hopelessness, aggressive, impulsive
  • Cultural and religious beliefs
  • Local epidemics of suicide, isolation, barriers to accessing mental health treatment, loss, physical illness, easy access to lethal methods, unwillingness to seek help
• Protective Factors for Suicide
  • Effective clinical care for mental, physical, and substance abuse disorders
  • Easy access to a variety of clinical interventions and support for help-seeking
  • Family and community support (connectedness)
  • Support for ongoing medical and mental health care relationships
  • Skills in problem-solving, conflict resolution, and nonviolent ways of handling disputes
  • Cultural and religious beliefs that discourage suicide and support instincts for self-preservation
• Suicide is one of the leading causes of death for young people
• Suicide rates are increasing, especially among women
• Most people who engage in suicidal behavior never seek mental health services
• Women are 3x more likely to attempt suicide
• Men are 3x more likely to complete suicide
• 78% of suicide deaths are men using guns
• 66% of male suicides use guns
• Suicidal actions become more common after the age of 14
• Teen suicide rates vary by ethnicity
  • Native Americans and Alaskan Natives have the highest
  • U.S. White Americans (12 per 100,000) almost twice as high as Black, Hispanic, and Asian
  • Divorced men risk suicide 2x more than married men
• No effect of marital status among women
• Steps to reduce a client's risk of suicide:
  • Screen all clients for suicidal risk during initial contact and remain alert to this issue throughout therapy
  • Arrange an environment that will not offer easy access to the instruments the client might use to commit suicide
  • Create an actively supportive environment
  • Recognize and work with the client's strengths and (though temporarily faint) desire to live
  • Communicate and justify realistic hope
  • Explore any fantasies the client may have regarding suicide (e.g., revenge fantasies)
  • Make sure communications are clear and evaluate the probable impact of any interventions
  • When considering hospitalization, explore the drawbacks as fully as the benefits, the probable long-term, and the immediate effects of this intervention
  • Be sensitive to negative reactions to the client's behavior (some may not want to be hospitalized)
  • Communicate caring

Terms To Know - Mood Disorders

• Mood Disorders are a group of disorders involving severe and enduring disturbances in emotionality
  • Ranging from elation to severe depression
• Persistent Depressive Disorder (dysthymia) is a persistently depressed mood with low self-esteem, withdrawal, pessimism, and despair
  • Present for at least 2 years with no absence of symptoms for more than 2 months
• Double Depression is a combination of major depressive episodes and persistent depression
  • Associated with severe psychopathology and a problematic future course
• Major Depressive Disorder involves one or more episodes separated by at least 2 months without depression
  • Recurrent
• Cognitive Therapy: a treatment approach that involves identifying and altering negative thinking styles related to psychological disorders, such as depression and anxiety, and replacing them with positive beliefs and attitudes
  • Promotes more adaptive behavior and coping styles
• Mania is a period of abnormally excessive elation or euphoria associated with some mood disorders
• Hypomanic Episode: a less severe and less disruptive version of a manic episode
  • One of the criteria for several mood disorders
• Mood Stabilizing Drug: medication used in the treatment of mood disorders, particularly bipolar disorder, that is effective in preventing and treating pathological shifts in mood
• Cyclothymic Disorder: a chronic version of bipolar disorder (at least 2 years) alternating mood elevation and depression levels that are not as severe as manic or major depressive episodes
  • Alternating (low-level cycling) between periods of mild depressive symptoms and mild hypomanic symptoms
• Depressive Cognitive Triad: thinking errors by depressed people negatively focused on themselves, their immediate world, and their future
• Bipolar II Disorder is the alternation of major depressive episodes with hypomanic episodes
• Bipolar I Disorder is the alternation of major depressive episodes with full manic episodes

Physical Disorders & Health Psychology

• Physiological response to stress:
  • Stress activates the sympathetic branch of the autonomic nervous system
  • Neuromodulators and neuropeptides act like neurotransmitters
  • Activates the HPA axis, producing cortisol
  • Stress dramatically and quickly alters immune function
• Social hierarchy influence stress response:
  • Social factors influence how we experience pain
  • Strong social support may reduce pain
  • High cortisol is associated with low social status
  • Low social status = fewer lymphocytes and immune suppression
  • Dominant males benefit from predictability and controllability
• Operant control of pain: Behavior seems under the control of social consequences
• Stanford Three Community Study: One of the known & most successful efforts to reduce risk factors for disease in the community.
  • Reduce risk factors for coronary heart disease (CHD)
  • Watsonville (Media + Intensive Instruction): The greatest improvement, as participants received personalized feedback and tailored health advice
  • Individualized intensive information helps reduce the risk of CHD over time
• Leading causes of death now: Heart disease, cancer, respiratory disease, unintentional injuries, stroke
• Leading causes of death 100 years ago: Diseases and illnesses (pneumonia, tuberculosis, diarrhea and enteritis, heart disease, liver diseases...)
  • Impure drinking water, contaminated food, sick people
  • Duration of illness was short
  • People felt no control over whether they got sick

Terms To Know - Physical Disorders & Health Psychology

• Behavioral Medicine: knowledge derived from behavioral science is applied to prevention, diagnosis, and treatment of medical problems
• General Adaptation Syndrome (GAS): sequence of reactions to sustained stress described by Hans Selye
  • Alarm, resistance, and exhaustion, which may lead to death
• Endogenous Opioids: exist in the body, endorphin + endogenous opioid systems are more powerful in males
• Fight or flight: the body's automatic reaction to a perceived threat or danger
  • Survival mechanism triggered by the sympathetic nervous system, preparing the body to either fight (confront the threat) or flee (escape from danger)
• Stroke/Cerebral Vascular Accident (CVA): the temporary blockage of blood vessels in the brain, resulting in temporary or permanent brain damage and loss of functioning
• Coronary Heart Disease (CHD): blockage of the arteries supplying blood to the heart muscle (myocardium)
  • Chest pain resulting from partial obstruction of the arteries = angina pectoris
  • Stress reduction prevents future heart attacks and prolongs life
• Psychoneuroimmunology: the study of psychological influences on the neurological responding implicated in our immune response
• Hypertension: high blood pressure, risk for stroke, and heart and kidney disease that is related to psychological factors
• Sympathetic nervous system: a part of the autonomic nervous system, primarily responsible for mobilizing the body during times of stress or danger by rapidly activating the organs and glands under its control
• Parasympathetic nervous system: a part of the autonomic nervous system
  • "Rest and digest" balance the sympathetic system

Eating & Sleep – Wake Disorders

• Three eating disorders (Anorexia, Bulimia, Binge Eating Disorder) cause great distress and share concerns about weight and body shape
  • Binge eating disorder and bulimia both have binge episodes
  • Anorexia sometimes leads to purging
• Anorexia involves severe caloric restriction to the point of semistarvation
• Bulimia involves both restriction and binging
• Binge eating disorder involves only binging
• Anorexia is the deadliest eating disorder, 50x higher risk for suicide
  • 20% die as a result, 5% dying within 10 years, 20-30% are suicides
• Causal factors of eating disorders include cultural influences and sociocultural origins (e.g., Westernized views that emphasize thinness), possible biological and genetic vulnerabilities (tend to run in families), psychological factors (low self-esteem), social anxiety (fears of rejection), and distorted body image (relatively normal-weight individuals that view themselves as fat and ugly)

Symptoms & Treatments of Eating Disorders

• Binge Eating Disorder (BED) symptoms:
  • Eating excess amounts of food in a discrete period of time
  • Brief episodes of eating perceived as uncontrollable
  • Pattern of binge-eating is not followed by purging
• Binge Eating Disorder (BED) treatment:
  • Short-term CBT to address behavior and attitudes on eating and body shape
  • IPT to improve interpersonal functioning
  • Drug treatments that reduce feelings of hunger
  • Self-help approaches
• Bulimia Nervosa symptoms:
  • Binging and purging
  • Misuse of laxatives and other drugs, vomiting, fasts for long periods of time after a binge
  • Salivary gland enlargement caused by repeated vomiting, chubby face appearance
  • Can erode dental enamel on the inner surface of teeth as well as tear the esophagus, upset the chemical balance of body fluids, risk of cardiac arrhythmia, seizures, kidney failure
• Bulimia Nervosa Treatments:
  • Drug treatment such as antidepressants
  • Short-term CBT to address behavior and attitudes on eating and body shape
  • IPT to improve interpersonal functioning
  • Tends to be chronic if left untreated
• Anorexia Nervosa symptoms:
  • Extreme weight loss, minimal amounts of food, excessive exercise
  • Intense fear of weight gain and losing control over eating
• Anorexia Nervosa treatments:
  • Behavioral and cognitive interventions
  • Hospitalization (70% below normal weight)
  • Outpatient treatment to restore weight, correct dysfunctional attitudes on eating & body shape
  • Family therapy
  • Tends to be chronic if left untreated, more resistant to treatment than bulimia
• Insomnia symptoms:
  • One of the most common sleep disorders + unrealistic expectations about sleep, microsleeps
  • Difficulty sleeping, initiating sleep, difficulty maintaining sleep, or nonrestorative sleep
• Insomnia treatment:
  • Medical (benzos) or psychological (anxiety reduction, improved sleep hygiene)
  • Combined approach is usually most effective

Terms To Know - Eating & Sleep Disorders

• Eating disorder involving recurrent episodes of uncontrolled excessive (binge) eating followed by compensatory actions to remove the food (vomiting, laxatives, and excessive exercise)
• Bulimia Nervosa: disorder involving brief periods when breathing ceases during sleep
• Sleep Apnea: assessment of sleep disorders
• Polysomnographic (PSG) Evaluation: a client sleeps in lab being monitored for heart, muscle, respiration, brain wave, and other functions
• Anorexia Nervosa (and subtypes): eating disorder characterized by recurrent food refusal, leading to dangerously low body weight
• Binge Eating Disorder: pattern of eating involving distress-inducing binges not followed by purging behaviors
• Hypersomnolence Disorder: sleep dysfunction involves an excessive amount of sleep and disrupts normal routines
• Insomnia Disorder: difficulty initiating sleep + difficulty maintaining sleep + nonrestorative sleep
• Rapid Eye Movement (REM) Sleep: periodic intervals of sleep during which the eyes move rapidly side to side, dreams occur, but body is inactive
• Narcolepsy: sleep disorder involving sudden and irresistible sleep attacks
• Bingeing: relatively brief episodes of uncontrolled, excessive consumption (usually of food or alcohol)
• Hypersomnia Parasomnias Dyssomnias: abnormally excessive sleep, sleepiness, and involuntary daytime sleeping
• Purging: induced vomiting, laxative abuse

Sexual Dysfunctions, Paraphilic Disorders, & Gender Dysphoria

• Stages of the sexual response cycle: Desire, arousal, plateau, orgasm, and resolution
  • Sexual urges occur in response to sexual cues or fantasies
  • Males experience penile tumescence, while females' blood pools in the pelvic area, leading to vaginal lubrication and breast tumescence
  • Brief period before orgasm
  • Males feel the inevitability of ejaculation, followed by ejaculation, while females experience contractions of the walls of the lower third of the vagina.
• Decrease in arousal occurs particularly in men after orgasm
  • Pain associated with sex can lead to additional dysfunction
• 60% of men over 60 experience erectile dysfunction
• Premature ejaculation and treatment: Orgasm occurs well before the man and his partner wish (approximately one minute after penetration + minimal sexual stimulation)
• Female orgasmic disorder symptoms: Marked delay, absence, or decreased intensity of orgasm in almost every sexual encounter
• Masochists like experiencing pain and humiliation, while sadists like to inflict pain and humiliation

Terms To Know - Sexual Disorders

• Sexual Dysfunction: disorder in which the client finds it difficult to function adequately while having sex
• Genito-Pelvic Pain/Penetration Disorder: difficulties with penetration during intercourse due to painful Contractions/spasm of the vagina
  • Appears only in females
• Sexual dysfunction in which a woman experiences pain or difficulty with penetration during intercourse (may include vaginismus)
  • 6% women
• Male Hypoactive Sexual Desire Disorder: little or no interest in any type of sexual activity.
  • Masturbation, sexual fantasies, and intercourse are rare
  • Accounts for half of all complaints at sexuality clinics
  • 6% of younger men and 41% of older men have problems with sexual desire
  • 1.8% of men have persistent lack of desire for at least 6 months
• Female Sexual Interest/Arousal Disorder: lack of or significantly reduced sexual interest/arousal
  • Reduced sexual interest, reduced sexual activity, fewer sexual thoughts, reduced arousal to sexual cues, reduced pleasure or sensations during almost all sexual encounters
  • Prevalence as disorder is defined in DSM 5 unknown
• For men, interest/arousal disorder increases as they get older
  • Decreases for women as they get older
• Orgasmic Reconditioning: a learning procedure to help clients strengthen appropriate patterns of sexual arousal by pairing appropriate stimuli with the pleasurable sensations of masturbation
• Gender Dysphoria: dissatisfaction with one's natal biological sex and the sense that one is really the opposite gender
• Gender Nonconformity: boys that behave in feminine ways and girls that behave in masculine ways
• Transvestic Disorder: paraphilia in which individuals, usually males, are sexually aroused or receive gratification by wearing clothing of the opposite sex
• Paraphilic disorder in which a person gains sexual gratification by rubbing against unwilling victims in crowds