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Questions and Answers
What is a significant characteristic of bipolar II disorder?
What is a significant characteristic of bipolar II disorder?
Which factor is most commonly associated with the onset of manic episodes in bipolar disorder?
Which factor is most commonly associated with the onset of manic episodes in bipolar disorder?
Which neurotransmitter is NOT mentioned as being linked to manic symptoms in bipolar disorder?
Which neurotransmitter is NOT mentioned as being linked to manic symptoms in bipolar disorder?
What is the estimated prevalence of a manic episode across the general population?
What is the estimated prevalence of a manic episode across the general population?
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What phenomenon suggests that repeated, subthreshold stimulation may lead to manic episodes in bipolar disorder?
What phenomenon suggests that repeated, subthreshold stimulation may lead to manic episodes in bipolar disorder?
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Which of the following accurately describes dysthymia?
Which of the following accurately describes dysthymia?
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What defines a mixed episode in bipolar disorder?
What defines a mixed episode in bipolar disorder?
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Which statement is true regarding the prevalence of bipolar disorder?
Which statement is true regarding the prevalence of bipolar disorder?
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Which of the following distinguishes bipolar I disorder from major depressive disorder?
Which of the following distinguishes bipolar I disorder from major depressive disorder?
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What is true about the symptoms and functioning in mood disorders compared to schizophrenia?
What is true about the symptoms and functioning in mood disorders compared to schizophrenia?
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Study Notes
Mood Disorders
- Mood or affective disorders are characterized by a primary disturbance in internal emotional state causing distress and problems in social/occupational functioning.
- Patients experience emotions as somewhat worse than expected (dysthymia), very much worse than expected (depression), somewhat better than expected (hypomania), or very much better than expected (mania).
- Types of mood disorders include:
- Major depressive disorder: Recurrent episodes of depression lasting at least 2 weeks.
- Bipolar disorder: Episodes of both mania and depression (bipolar I) or hypomania and depression (bipolar II), lasting at least a week or 4 days, respectively.
- Dysthymic disorder: Dysthymia lasting 2 years (1 year in children).
- Cyclothymic disorder: Hypomania and dysthymia over 2 years (1 year in children).
Epidemiology
- Lifetime prevalence of major depressive disorder ranges from 5-12% in men and 10-20% in women.
- Bipolar disorder has a 1% lifetime prevalence, with no significant difference between men and women.
Bipolar Disorder
- Characterized by episodes of mania and depression (bipolar I) or hypomania and depression (bipolar II).
- Episodes alternate periodically or cyclically.
- Mood and functioning typically return to normal between episodes.
Bipolar Disorder (I and II)
- Bipolar I is distinguished by the presence of mania.
- Mixed episodes include symptoms of both mania and depression, intermixed or rapidly alternating.
- Bipolar II involves hypomanic (less severe than manic) episodes alongside depressive episodes.
Epidemiology (Bipolar Disorder)
- Lifetime risk of manic episodes approximately 0.8-1%.
- Equal prevalence in men and women.
- Mean age of onset is 17-25 years.
- Can occur from childhood to age 50+
- Often comorbid with anxiety and substance misuse.
Genetics
- Estimated 90% of bipolar disorder patients have a first-degree relative with a mood disorder.
- Concordance rates vary between 33-90% for monozygotic twins and 5-25% for other siblings.
Psychosocial Factors
- Life events like bereavement, personal separation, or work problems can trigger the first manic episode.
- Sleep deprivation is a potential precipitating factor.
Monoamine Theory
- Increased levels of noradrenaline, serotonin and dopamine linked to manic symptoms.
- Excitatory neurotransmitter glutamate also implicated.
Clinical Symptoms (Depressive Episode)
- Sadness and helplessness persisting for weeks, reduced interest/pleasure, fatigue, sleep disturbances, feelings of worthlessness, and suicidal thoughts.
Clinical Symptoms (Manic Episode)
- Restless activity, excitement, excessive laughter, inflated self-worth, rapid speech, and impulsive behavior.
Clinical Features of Manic Episode
- Increased sociability/familiarity, excessive cosmetics, disregard of social norms, elevated mood, excessive talkativeness, rapid speech.
- Also include thoughts, issues with concentration, distractibility, racing thoughts, inflated self-esteem, grandiosity.
- Increased activity/restlessness, decreased need for sleep, excessive spending, irresponsible behavior, and increased appetite.
Criteria for Manic Episode (DSM-5)
- Abnormally elevated mood and persistently increased activity or energy for at least a week.
- Presence of three or more specific symptoms, significantly different from typical behavior.
- Impairment in social or occupational functioning or need for hospitalization.
Mood Disorders Caused by Medical Conditions
- Central nervous system (CNS) disorders like strokes, brain tumors, dementia, and epilepsy associated with mania.
- Endocrine disorders like thyrotoxicosis and Cushing's syndrome.
Substance-Induced Mood Disorder
- Certain medications (e.g., antidepressants, corticosteroids, dopamine agonists) can cause mood disorders.
- Drugs like amphetamines, cannabis, cocaine, and alcohol also play a significant role.
Other Psychiatric Disorders
- Schizophrenia, schizoaffective disorder; and agitated depression can be confused with mood disorders.
Assessment & Questionnaires
- Tools like the Young Mania Rating Scale (YMRS) measure the severity of manic episodes in children/adults.
- Other investigations might include hormonal assays, electrolytes, urine drug screens, or brain imaging scans.
Course and Prognosis
- Length of manic episodes varies but typically lasts 3-6 months.
- Episodes often recur with shorter intervals as patients age.
- Lithium therapy can lead to 60-70% remission rates.
Management (Short-term)
- Hospitalization used for serious symptoms, self-harm risk, or substantial side effects.
- Electroconvulsive therapy (ECT) as a treatment option when medication alone is insufficient.
Management (Long-term)
- Mood stabilizing agents like lithium, valproate, and carbamazepine along with antipsychotic agents, such as olanzapine, risperidone, quetiapine, and ziprasidone used as prophylaxis.
- Psychotherapy and psychoeducation important for long-term management, supporting patients in recognizing and limiting triggers.
First-Line Treatment
- Lithium is a first-line treatment in bipolar disorder.
- Antipsychotic drugs commonly co-administered initially to manage behavior and psychotic issues.
Important Considerations
- Monitoring serum lithium levels crucial due to potential side effects.
- Treatment duration for bipolar should be extended to prevent relapse (at least 2 years).
- Patients should be educated about precipitating factors like sleep deprivation, seasonal variations, or stress.
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Description
Explore the various types of mood or affective disorders, including major depressive disorder and bipolar disorder, along with their characteristics and prevalence rates. This quiz will help you understand the emotional states involved and their impact on social and occupational functioning.
