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The prevalence of bipolar disorder is inconsistent across different countries.
The prevalence of bipolar disorder is inconsistent across different countries.
False
Patients from black and ethnic minority groups in the UK are less likely to present with a first episode of mania than the white population.
Patients from black and ethnic minority groups in the UK are less likely to present with a first episode of mania than the white population.
False
Social exclusion may influence the differences in bipolar disorder presentations among various ethnic groups.
Social exclusion may influence the differences in bipolar disorder presentations among various ethnic groups.
True
The DSM-5 and ICD-10 classify hypomania and mania based on the presence of psychotic features.
The DSM-5 and ICD-10 classify hypomania and mania based on the presence of psychotic features.
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Patients from minority groups have easier access to mental health services compared to the white population.
Patients from minority groups have easier access to mental health services compared to the white population.
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The lifetime risk for bipolar disorder is approximately 2-3%.
The lifetime risk for bipolar disorder is approximately 2-3%.
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The 6-month prevalence of bipolar disorder is significantly lower than the lifetime prevalence.
The 6-month prevalence of bipolar disorder is significantly lower than the lifetime prevalence.
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Bipolar disorder affects men more than women.
Bipolar disorder affects men more than women.
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The mean age of onset for bipolar disorder is around 30 years in community studies.
The mean age of onset for bipolar disorder is around 30 years in community studies.
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Bipolar disorder is often comorbid with anxiety disorders and cardiovascular disease.
Bipolar disorder is often comorbid with anxiety disorders and cardiovascular disease.
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Distinguishing bipolar disorder from recurrent unipolar depression is easy and straightforward.
Distinguishing bipolar disorder from recurrent unipolar depression is easy and straightforward.
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Bipolar II disorder can be diagnosed solely based on the presence of hypomania without requiring a major depressive episode.
Bipolar II disorder can be diagnosed solely based on the presence of hypomania without requiring a major depressive episode.
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In DSM-5, a manic episode is equivalent to a hypomanic episode in ICD-10.
In DSM-5, a manic episode is equivalent to a hypomanic episode in ICD-10.
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The presence of mild hypomanic episodes may influence treatment response in patients with recurrent major depression.
The presence of mild hypomanic episodes may influence treatment response in patients with recurrent major depression.
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The distinction between unipolar and bipolar depression is always clear and straightforward for clinicians.
The distinction between unipolar and bipolar depression is always clear and straightforward for clinicians.
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The term 'bipolar spectrum' refers specifically to bipolar I and II disorders only.
The term 'bipolar spectrum' refers specifically to bipolar I and II disorders only.
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According to DSM-5, a current mixed episode is categorized as a depressive episode.
According to DSM-5, a current mixed episode is categorized as a depressive episode.
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In the DSM-5 classification, mania with psychosis is classified as severe.
In the DSM-5 classification, mania with psychosis is classified as severe.
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Cyclothymia is included under bipolar I and II disorders in DSM-5.
Cyclothymia is included under bipolar I and II disorders in DSM-5.
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Manic disorders cannot be easily distinguished from schizophrenia due to overlapping symptoms.
Manic disorders cannot be easily distinguished from schizophrenia due to overlapping symptoms.
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Patients with bipolar II disorder typically regard spells of hypomania as an illness.
Patients with bipolar II disorder typically regard spells of hypomania as an illness.
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Extreme social disinhibition in older patients is a strong indicator of bipolar disorder.
Extreme social disinhibition in older patients is a strong indicator of bipolar disorder.
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The symptoms of mania typically change quickly in content but can outlast the phase of over-activity.
The symptoms of mania typically change quickly in content but can outlast the phase of over-activity.
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Schizoaffective disorder is used when there is a mixture of features from both manic disorders and schizophrenia.
Schizoaffective disorder is used when there is a mixture of features from both manic disorders and schizophrenia.
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A family history of borderline personality disorder can help distinguish it from rapid cycling bipolar disorder.
A family history of borderline personality disorder can help distinguish it from rapid cycling bipolar disorder.
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In younger adults, head injury or HIV may not lead to the manifestation of mania.
In younger adults, head injury or HIV may not lead to the manifestation of mania.
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Drug-induced states of excitement can last for a prolonged period even after treatment starts.
Drug-induced states of excitement can last for a prolonged period even after treatment starts.
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Mood disturbances in borderline personality disorder are often linked to interpersonal issues.
Mood disturbances in borderline personality disorder are often linked to interpersonal issues.
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Diagnosis of recurrent unipolar depression is straightforward compared to bipolar disorder.
Diagnosis of recurrent unipolar depression is straightforward compared to bipolar disorder.
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The concordance rate for mood disorders in monozygotic twins of a proband with bipolar disorder is about 40%.
The concordance rate for mood disorders in monozygotic twins of a proband with bipolar disorder is about 40%.
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Family studies indicate that first-degree relatives of bipolar probands have an increased risk of schizoaffective disorder.
Family studies indicate that first-degree relatives of bipolar probands have an increased risk of schizoaffective disorder.
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Bipolar disorder has a heritability estimate of approximately 85%.
Bipolar disorder has a heritability estimate of approximately 85%.
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Molecular linkage studies have consistently identified specific genes associated with mood disorders.
Molecular linkage studies have consistently identified specific genes associated with mood disorders.
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The familial segregation of bipolar disorder follows a simple Mendelian inheritance pattern.
The familial segregation of bipolar disorder follows a simple Mendelian inheritance pattern.
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Genome-wide association studies (GWAS) have identified several risk loci for bipolar disorder.
Genome-wide association studies (GWAS) have identified several risk loci for bipolar disorder.
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The genetic risk for bipolar disorder is primarily due to a few high-effect individual genes.
The genetic risk for bipolar disorder is primarily due to a few high-effect individual genes.
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There is currently a reliable diagnostic biomarker identified for bipolar disorder.
There is currently a reliable diagnostic biomarker identified for bipolar disorder.
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Epistasis refers to the genetic interactions that contribute to the risk of bipolar disorder.
Epistasis refers to the genetic interactions that contribute to the risk of bipolar disorder.
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Advancements in imaging have clearly distinguished bipolar disorder from recurrent unipolar depression.
Advancements in imaging have clearly distinguished bipolar disorder from recurrent unipolar depression.
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Childhood sexual abuse is specifically linked to the development of bipolar disorder.
Childhood sexual abuse is specifically linked to the development of bipolar disorder.
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Life events have no impact on the episodes of depression and mania in bipolar patients.
Life events have no impact on the episodes of depression and mania in bipolar patients.
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A high level of expressed emotion in a family can worsen the symptoms of bipolar disorder.
A high level of expressed emotion in a family can worsen the symptoms of bipolar disorder.
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Dopamine overactivity has been definitively proven as a cause of mania in bipolar patients.
Dopamine overactivity has been definitively proven as a cause of mania in bipolar patients.
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Anticonvulsants used in bipolar disorder management alter brain glutamate levels.
Anticonvulsants used in bipolar disorder management alter brain glutamate levels.
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The hypothalamic-pituitary-adrenal (HPA) axis is unaffected in patients with bipolar disorder.
The hypothalamic-pituitary-adrenal (HPA) axis is unaffected in patients with bipolar disorder.
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Increased levels of glutamate in bipolar patients have been a reliable diagnostic marker.
Increased levels of glutamate in bipolar patients have been a reliable diagnostic marker.
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Goal attainment can trigger manic episodes in bipolar patients.
Goal attainment can trigger manic episodes in bipolar patients.
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Cortisol levels are typically lower in individuals with bipolar disorder compared to healthy controls.
Cortisol levels are typically lower in individuals with bipolar disorder compared to healthy controls.
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The 'kindling' effect suggests that negative life events have a diminishing influence over time.
The 'kindling' effect suggests that negative life events have a diminishing influence over time.
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In patients with bipolar disorder not taking lithium, hippocampal volumes are higher than in recurrent depression.
In patients with bipolar disorder not taking lithium, hippocampal volumes are higher than in recurrent depression.
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Cerebral volume reduction over the course of bipolar illness may indicate a degenerative process in some patients.
Cerebral volume reduction over the course of bipolar illness may indicate a degenerative process in some patients.
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Functional imaging studies show a narrower range of neural dysregulation in bipolar disorder compared to unipolar depression.
Functional imaging studies show a narrower range of neural dysregulation in bipolar disorder compared to unipolar depression.
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Bipolar depressed patients show reduced neural responses in the amygdala when exposed to negative emotional cues.
Bipolar depressed patients show reduced neural responses in the amygdala when exposed to negative emotional cues.
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Cognitive deficits in bipolar disorder can be observed even in first-episode patients.
Cognitive deficits in bipolar disorder can be observed even in first-episode patients.
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The genetic predisposition to bipolar disorder may involve hundreds to thousands of relevant genes.
The genetic predisposition to bipolar disorder may involve hundreds to thousands of relevant genes.
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There is substantial evidence that cognitive deficits in bipolar disorder increase throughout the course of the illness.
There is substantial evidence that cognitive deficits in bipolar disorder increase throughout the course of the illness.
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Similarities in neuropathological changes exist between patients with bipolar disorder and patients with schizophrenia.
Similarities in neuropathological changes exist between patients with bipolar disorder and patients with schizophrenia.
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Euthymic bipolar patients display decreased activity in cortical regions when presented with positive emotional stimuli.
Euthymic bipolar patients display decreased activity in cortical regions when presented with positive emotional stimuli.
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Adverse early experiences, including abuse, have no impact on the predisposition to bipolar disorder.
Adverse early experiences, including abuse, have no impact on the predisposition to bipolar disorder.
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Study Notes
Epidemiology of Bipolar Disorder
- Lifetime risk for bipolar disorder: 0.3-1.5%
- 6-month prevalence similar to lifetime prevalence, indicating chronic nature of disorder
- Equal prevalence in men and women
- Mean age of onset: 18 years in community studies
- Highly comorbid with other disorders, including anxiety, substance misuse, and general medical conditions
Transcultural Factors
- Rates of bipolar disorder consistent across countries
- Increased prevalence in certain minority groups within countries, such as black and ethnic minority groups in the UK
- Patients from these minority groups more likely to present with first episode of mania and prominent psychotic features
Classification
- DSM-5 and ICD-10 distinguish hypomania from mania based on duration of symptoms, absence of psychotic features, and lesser degree of social and occupational impairment
Differential Diagnosis of Bipolar Disorder
Mania
- Distinguished from:
- Schizophrenia
- Organic brain disease (e.g. brain tumor, HIV infection)
- Amphetamine-induced excitement
Schizophrenia
- Distinguished from mania by:
- Auditory hallucinations and delusions
- More equal mixture of features of both syndromes (schizoaffective disorder)
Organic Brain Disorder and Drug Misuse
- Consider organic brain lesion, especially in middle-aged or older patients with expansive behavior and no past history of affective disorder
- Drug misuse can cause manic-like symptoms, distinguishable by history and urine drug screening
Bipolar Disorder and Recurrent Depression
- Distinguished by:
- Symptoms of mania or hypomania in past history
- Brief periods of hypomania may be difficult to identify or remember
Classification of Bipolar Disorder
- ICD-10 and DSM-5 classification systems:
- Manic episode
- Hypomanic episode
- Bipolar affective disorder (ICD-10) / Bipolar I and II disorders (DSM-5)
Aetiology
Overview
- Aetiological overlap between recurrent unipolar depression and bipolar disorder
- High heritability of bipolar disorder
- Molecular genetic techniques used to identify genetic loci relevant to pathophysiology
Genetic Causes
- Family and twin studies:
- Increased risk of both bipolar and unipolar mood disorders in first-degree relatives of bipolar probands
- High heritability (around 85%)
- Mode of inheritance:
- Polygenic inheritance with multiple genes of modest effect
- Rare structural chromosomal abnormalities and gene-gene interactions may contribute to genetic risk
- Molecular genetics:
- Genome-wide association studies (GWAS) have identified risk loci with some robustness to replication
- Identified genes cluster around biologically meaningful processes (e.g. voltage-gated calcium channels)
Brain Imaging
Structural Brain Imaging
- Changes in brain volume measured by MRI inconclusive due to confounding factors
- Hippocampal volumes lower in bipolar patients not taking lithium, reversed in patients taking lithium
- Reduction in cerebral volume over course of illness, suggesting possible degenerative process
Functional Imaging
- Bipolar depressed patients show elevated neural responses in amygdala and abnormal activity in prefrontal cortical regions
- Euthymic bipolar patients show elevated amygdala responses and decreased activity in cortical regions to positive emotional stimuli
- Abnormalities in neural responses to negative and positive emotional stimuli, including reward processing
Neuropsychological Changes
- Cognitive deficits present in bipolar disorder during both acute illness and periods of euthymia
- Modest but widespread deficits in executive function, verbal memory, attention, and processing speed
Conclusions
- Major genetic contribution to predisposition to develop bipolar disorder
- Environmental factors, including adverse early experiences, may also contribute to pathophysiology
- Brain imaging studies show functional abnormalities consistent with disordered emotional regulation and reward processes
- Modest but widespread neuropsychological deficits present in bipolar disorder
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Description
Test your knowledge on the epidemiology of bipolar disorder, including its lifetime risk, prevalence, and comorbidities. This quiz covers transcultural factors and more.
