Chapter 6 (Bipolar Disorder)
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Questions and Answers

What distinguishes a hypomanic episode from a manic episode in terms of functioning impairment?

  • A hypomanic episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual. (correct)
  • A hypomanic episode involves severe psychotic features.
  • A hypomanic episode necessitates hospitalization due to severe symptoms.
  • A hypomanic episode causes marked impairment in social or occupational functioning.

    • Which of the following behaviors is indicative of excessive involvement during a hypomanic episode?

  • Taking time off work to relax.
  • Carefully investing in stocks after extensive research.
  • Participating in unrestrained buying sprees. (correct)
  • Engaging in regular social activities with friends.

    • What might indicate that the change in mood is observable to others during a hypomanic episode?

  • The individual maintains normal social interactions.
  • The individual feels slightly more energetic than usual.
  • The individual exhibits noticeable goal-directed activities. (correct)
  • The individual quietly works on personal projects.

    • Which characteristic is NOT a defining feature of a hypomanic episode?

    <p>The episode leads to extreme impairment in daily functioning.</p> Signup and view all the answers

    What is a common misconception regarding the effects of substances during a hypomanic episode?

    <p>Substances can alter mood without leading to a hypomanic episode.</p> Signup and view all the answers

    What characterizes the seasonal subtype of mood disorders?

    <p>Episodes occur at a specific time of year</p> Signup and view all the answers

    How is rapid cycling defined in the context of bipolar disorder?

    <p>Having at least 4 episodes within the past year</p> Signup and view all the answers

    Which feature signifies peripartum onset in mood disorders?

    <p>Onset within 4 weeks of giving birth</p> Signup and view all the answers

    What is a characteristic symptom of catatonia?

    <p>Extreme physical immobility or excessive movement</p> Signup and view all the answers

    In the context of bipolar disorder, what do psychotic features often include?

    <p>Experiencing delusions or hallucinations</p> Signup and view all the answers

    What is the hallmark of melancholic features in mood disorders?

    <p>Inability to experience pleasure (anhedonia)</p> Signup and view all the answers

    What aspect is typically excluded from the definition of rapidly cycling bipolar disorder?

    <p>Having fewer than 4 episodes in a year</p> Signup and view all the answers

    Which type of treatment is likely to be considered for bipolar disorder?

    <p>Medication management and therapy</p> Signup and view all the answers

    What disorder are men with bipolar disorder frequently misdiagnosed as?

    <p>Schizophrenia</p> Signup and view all the answers

    Which of the following is a common reason for misdiagnosing bipolar disorder in women?

    <p>Inadequate exploration of hypomanic episodes</p> Signup and view all the answers

    What is a potential consequence of misdiagnosing brief periods of elevated mood in individuals?

    <p>Inappropriate use of mood-stabilizing medications</p> Signup and view all the answers

    What is the reported prevalence of substance misuse among individuals with bipolar disorder?

    <p>39 percent</p> Signup and view all the answers

    What significant impact does bipolar disorder have on relationships?

    <p>Five times higher likelihood of disruption</p> Signup and view all the answers

    What is the suicide rate for individuals with bipolar disorder compared to the general population?

    <p>Almost 15 times higher</p> Signup and view all the answers

    What percentage of individuals with bipolar disorder is likely to have at least one anxiety disorder?

    <p>Nearly one in two individuals</p> Signup and view all the answers

    What aspect of functioning is most significantly impaired in the majority of patients with bipolar disorder?

    <p>Psychosocial functioning</p> Signup and view all the answers

    What effect does achieving goals have on individuals with Bipolar Disorder?

    <p>It inspires increased goal engagement.</p> Signup and view all the answers

    Which of the following is a psychological approach for treating Bipolar Disorder?

    <p>Family interventions</p> Signup and view all the answers

    What can excessive goal engagement potentially lead to in individuals with Bipolar Disorder?

    <p>Development of manic symptoms.</p> Signup and view all the answers

    Which of the following is part of the treatment for Bipolar Disorder focusing on daily routines?

    <p>Interpersonal and social rhythm therapy (IPSRT)</p> Signup and view all the answers

    Which treatment is crucial for patients with Bipolar Disorder who are suicidal or psychotic?

    <p>Hospitalisation</p> Signup and view all the answers

    What was John Cade recognized for in the context of Bipolar Disorder treatment?

    <p>Discovering the effects of lithium.</p> Signup and view all the answers

    What is the goal of relapse prevention in the treatment of Bipolar Disorder?

    <p>To manage the instability of the condition.</p> Signup and view all the answers

    Which of these approaches focuses on enhancing self-efficacy in patients with Bipolar Disorder?

    <p>Cognitive behaviour therapy</p> Signup and view all the answers

    What is one consequence of sleep deprivation related to dopamine receptors?

    <p>It leads to reduced activation of the prefrontal cortex.</p> Signup and view all the answers

    Which of the following is true regarding the effects of dopaminergic agonists among different populations?

    <p>They can trigger manic symptoms in both people with and without BD.</p> Signup and view all the answers

    How do life events relate to sleep disturbances and mania in individuals with BD?

    <p>Life events often interfere with the ability to sleep, increasing the risk of mania.</p> Signup and view all the answers

    What is suggested about the variability in circadian patterns of activity in patients with BD?

    <p>It is greater than that observed in controls, even during stability.</p> Signup and view all the answers

    What effect does sleep deprivation have on emotional stimuli?

    <p>It heightens reactivity to negative and reward stimuli.</p> Signup and view all the answers

    Which statement is correct regarding self-ratings of instability in social rhythms?

    <p>They can signal the onset of mood episodes in individuals with high depressive and manic symptoms.</p> Signup and view all the answers

    In the context of BD, which statement is true about the relationship between amphetamines and manic symptoms?

    <p>Amphetamines may lead to more pronounced manic symptoms in individuals with BD.</p> Signup and view all the answers

    Which neurotransmitter system is believed to allow greater variability in dopamine function due to its deficits?

    <p>Serotonin system</p> Signup and view all the answers

    Which of the following disorders is characterized by the presence of one or more manic episodes?

    <p>Bipolar I Disorder</p> Signup and view all the answers

    What significant contribution to the treatment of bipolar disorder was made by John Cade?

    <p>Discovered lithium as an effective treatment</p> Signup and view all the answers

    Which bipolar disorder involves at least one major depressive episode and at least one hypomanic episode but no manic episodes?

    <p>Bipolar II Disorder</p> Signup and view all the answers

    Which term was coined by Karl Leonhard in 1957 to describe what was initially referred to as 'manic depressive insanity'?

    <p>Bipolar Disorder</p> Signup and view all the answers

    What is the key difference between cyclothymic disorder and the other bipolar disorders?

    <p>Cyclothymic disorder has less extreme but more chronic symptoms.</p> Signup and view all the answers

    Which mood state is associated with pathologically elevated, expansive, or irritable moods in bipolar disorders?

    <p>Manic episodes</p> Signup and view all the answers

    What are the three primary types of bipolar disorders recognized in DSM-5?

    <p>Bipolar I, Bipolar II, Cyclothymic Disorder</p> Signup and view all the answers

    Which type of bipolar disorder is characterized by numerous periods of elevated and depressed moods that are insufficient to qualify as hypomanic or manic episodes?

    <p>Cyclothymic Disorder</p> Signup and view all the answers

    What type of episode is NOT necessary for a diagnosis of Bipolar I Disorder?

    <p>Major depressive episode</p> Signup and view all the answers

    What type of disorder may be influenced by substances or medication, according to the DSM-5?

    <p>Substance/Medication Induced Bipolar Disorder</p> Signup and view all the answers

    Which of the following best describes a major depressive episode?

    <p>Prolonged sadness and loss of interest</p> Signup and view all the answers

    What is a primary role of mood episodes in diagnosing bipolar and related disorders?

    <p>They are used to distinguish types of mood disorders.</p> Signup and view all the answers

    Which is a feature of hypomanic episodes distinguishable from manic episodes?

    <p>Increased energy with less severe effects</p> Signup and view all the answers

    Study Notes

    • This material is reproduced with permission from the University of South Australia.
    • Further reproduction could be subject to copyright.

    Chapter 6: Bipolar Disorder

    • This chapter covers bipolar disorders: bipolar I, bipolar II, and cyclothymic disorder.
    • It describes possible causes and treatments.

    Learning Objectives

    • Differentiate between bipolar I, bipolar II, and cyclothymic disorders.
    • Understand the epidemiology of bipolar disorder.
    • Describe possible causes of bipolar disorder.
    • Describe medical and psychological treatments for bipolar disorder.

    The History of Bipolar Disorders

    • Mania and depression were initially viewed as separate disorders.
    • Later, during the 19th century mania and depression were considered a single entity.
    • In 1957, Karl Leonhard coined the term "bipolar disorder", and argued that 'manic depressive insanity' was too inclusive.
    • John Cade discovered lithium as an effective treatment for mania.
    • Bipolar I Disorder
    • Bipolar II Disorder
    • Cyclothymic Disorder
    • Substance/Medication-Induced Bipolar and Related Disorder
    • Bipolar and Related Disorder Due to Another Medical Condition
    • Other Specified Bipolar and Related Disorder
    • Unspecified Bipolar and Related Disorder

    The Bipolar Disorders

    • Bipolar disorders encompass bipolar I, bipolar II, and cyclothymic disorders.
    • These disorders share symptoms of pathologically elevated, expansive, or irritable mood.
    • These mood states are referred to as manic and hypomanic episodes.

    Bipolar I Disorder

    • Includes one or more manic episodes.
    • Major depression may or may not be present.

    Bipolar II Disorder

    • Includes at least one major depressive episode and one hypomanic episode.
    • No manic episodes are present.

    Cyclothymic Disorder

    • Characterized by numerous periods of elevated and depressed mood without meeting criteria for hypomania or major depression.

    DSM-5 Defined [Mood] Episodes

    • Primary depressive (and bipolar) disorders are based on episode presence or absence.
    • Episodes include Major Depressive, Manic, and Hypomanic.

    DSM-5 Diagnostic Criteria for a Manic Episode

    • A period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week.
    • Three or more significant symptoms, represent a notable change from usual behaviour.

    DSM-5 Diagnostic Criteria for a Hypomanic Episode

    • A distinct period of elevated or irritable mood and energy, lasting at least 4 consecutive days.
    • Three or more noticeable symptoms, a considerable change from usual behavior.

    Manic and Hypomanic Episodes

    • Depicting graphs representing the progression of a manic episode and hypomanic episode, illustrating the timeframe.

    Now, from Episodes to Disorders

    • Discussion of how episodes relate to depressive and bipolar disorders.

    DSM-5 Diagnostic Criteria for Bipolar I Disorder

    • Requires at least one manic episode.
    • The presence of other episodes (e.g., major depressive episode) is not better explained by another mental disorder.

    Bipolar Disorders: Bipolar I

    • Depicting graphs illustrating the cyclical nature of manic and depressive episodes in bipolar disorder I.

    DSM-5 Diagnostic Criteria for Bipolar II Disorder

    • Requires at least one episode of hypomania and one major depressive episode.
    • No manic episodes have occurred.

    Bipolar Disorders: Bipolar II

    • Depicting a graph illustrating the cyclical pattern of hypomanic and depressive episodes in bipolar II.

    Although

    • Depressive episodes typically occur more frequently (or longer duration) than hypomanic episodes in bipolar II disorder.
    • They are also more frequent compared to bipolar I disorder.

    DSM-5 Diagnostic Criteria for Cyclothymic Disorder

    • Individuals experience numerous periods of both hypomanic and depressive symptoms, lasting at least two years (or one year for children/adolescents).
    • These symptoms do not meet criteria for a major depressive, manic, or hypomanic episode.

    Subtypes of Bipolar Disorders

    • Anxious distress - Seasonal - Rapid cycling - Peripartum onset - Catatonia - Psychotic features - Melancholic features

    Rapid Cycling Subtype of Bipolar Disorder

    • Describes four or more mood episodes (manic, hypomanic, or depressive) within a year.
    • Graph depicting the fluctuating cycle over a year.

    The Bipolar Disorders

    • Including a general description, Epidemiology, Aetiology (causes), and Treatment.

    Prevalence Data - Australia

    • Presents prevalence data for various disorders, including bipolar affective disorder among Australian men and women.

    Prevalence Data – USA (lifetime)

    • Presents lifetime prevalence of bipolar disorders among men and women in the USA.

    The Epidemiology of Bipolar Disorders

    • Lifetime prevalence of bipolar disorders, often more common in women; a comparison between men and women.

    Problems with Underdiagnosis and Overdiagnosis of Bipolar Disorder

    • Issues associated with misdiagnosis as schizophrenia (males) or major depressive disorder (females).
    • This can result from insufficient exploration of the symptoms.
    • Individuals with borderline personality disorder also commonly present similar symptoms.

    Additional Problems Associated with Bipolar Disorder

    • High prevalence of anxiety disorders and substance misuse among bipolar patients.
    • Significant social and economic costs, including higher suicide rates compared to the general population.

    Impairment in Psychosocial Functioning

    • Patients with bipolar disorder often experience significant impairment in work, social, and family functioning.
    • Significant portion of individuals are unable to work full-time or have to work in sheltered settings.

    Bipolar Disorder and Creativity

    • Potential link between bipolar disorder and creativity.
    • Examples of historical figures in arts, literature, politics associated with the disorder.

    The Aetiology of Bipolar Disorder

    • Discusses the causes of bipolar disorder from a variety of perspectives.

    Aetiology: Genetic Factors

    • Discusses the genetic basis for bipolar disorders.

    Aetiology: Neurotransmitters

    • Discusses dopamine, serotonin, and glutamate theories concerning bipolar disorder.

    Stressful Life Events and Sleep Disruption

    • Discusses the impact of sleep deprivation and stressful life events on bipolar disorder.

    Aetiology: Goal Dysregulation

    • Focuses on the connection between goal dysregulation and the development of bipolar disorder.

    Treatment of Bipolar Disorder

    • Details about treatments including medication, hospitalisation, and psychological approaches.

    Medications for Bipolar Disorder

    • List of common medications (lithium, anticonvulsants, antipsychotics).
    • Potential side effects and cautions.

    Psychological Treatment of Bipolar Disorder

    • Discusses psychological treatments like psychoeducation, interpersonal and social rhythm therapy, family-focused therapy, and cognitive-behavioral therapy (CBT).
    • Explains CBT for bipolar disorder in more detail, with a graph illustrating its effectiveness.

    Any Questions?

    • Provides a general concluding question to invite interaction.

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