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. (B)</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. (B)</p> Signup and view all the answers

What characterizes the seasonal subtype of mood disorders?

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

Which feature signifies peripartum onset in mood disorders?

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

What is a characteristic symptom of catatonia?

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

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

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

What is the hallmark of melancholic features in mood disorders?

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

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

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

What disorder are men with bipolar disorder frequently misdiagnosed as?

<p>Schizophrenia (C)</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 (B)</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 (C)</p> Signup and view all the answers

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

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

What significant impact does bipolar disorder have on relationships?

<p>Five times higher likelihood of disruption (C)</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 (C)</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 (D)</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 (A)</p> Signup and view all the answers

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

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

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

<p>Family interventions (A)</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. (D)</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) (C)</p> Signup and view all the answers

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

<p>Hospitalisation (A)</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. (B)</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. (D)</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 (C)</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. (B)</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. (D)</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. (D)</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. (B)</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. (C)</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. (C)</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. (B)</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 (C)</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 (A)</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 (A)</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 (C)</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 (A)</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. (A)</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 (A)</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 (C)</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 (A)</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 (D)</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 (D)</p> Signup and view all the answers

Which of the following best describes a major depressive episode?

<p>Prolonged sadness and loss of interest (A)</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. (A)</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 (D)</p> Signup and view all the answers

Flashcards

Hypomanic Episode

A period of abnormally elevated or expansive mood that is less severe than a manic episode.

DSM-5 Diagnostic Criteria

Specific guidelines in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, for diagnosing a condition.

Goal-directed activity increase

A heightened level of purposeful activities in social, work, or sexual contexts.

Psychomotor agitation

Excessive, purposeless, and non-goal-oriented physical activity.

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Impairment in functioning

Significant difficulties in social or occupational life due to a medical or psychological condition.

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Bipolar I Disorder

A bipolar disorder characterized by at least one manic episode. Major depression may occur, but is not necessary for diagnosis.

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Bipolar II Disorder

Characterized by at least one episode of major depression and at least one episode of hypomania but no manic episodes.

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Cyclothymic Disorder

A less extreme but more chronic form of bipolar disorder involving numerous periods of elevated and depressed mood, not severe enough to be a hypomanic, manic or major depressive episode.

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Manic Episode

A period of abnormally elevated mood or irritability characterized by increased energy, activity, and goal-directed behavior.

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Lithium

A mood stabilizer, historically used and still relevant in the treatment of bipolar disorder.

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DSM-5

Diagnostic and Statistical Manual of Mental Disorders, 5th edition. A standard classification of mental disorders.

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Major Depressive Episode

A period of at least two weeks marked by significant sadness and loss of interest in activities.

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Mania

An abnormally elevated mood or irritable mood characterized by increased energy and activity.

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Hypomania

A moodelevated period that is less extreme and doesn't cause daily function impairments.

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Bipolar Disorder

A spectrum of mood disorders that include highs (mania or hypomania) and lows (depression).

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Mood Episodes

Distinct periods of abnormally elevated, depressed, or irritable mood that comprise depressive and bipolar disorders

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Epidemiology of Bipolar Disorders

The study of the distribution and determinants of bipolar disorder in populations.

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Aetiology of Bipolar Disorders

Study of the causes and origins of bipolar disorders.

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Seasonal Pattern

Episodes of a disorder occur regularly at a specific time of year (e.g., winter depression).

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Rapid Cycling

Experiencing at least 4 episodes of a mood disorder within a year.

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Peripartum Onset

A mood disorder develops within 4 weeks of giving birth.

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Catatonia

Extreme lack of movement (immobility) or unusual, purposeless movements.

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Psychotic Features

Presence of delusions or hallucinations during a mood episode.

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Melancholic Features

Inability to experience pleasure, even in activities usually enjoyed (anhedonia).

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Prevalence Data

Statistical information about how common a disorder is in a population.

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Aetiology

The study of the causes of diseases or mental health disorders.

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Relapse in Bipolar Disorder

When symptoms of bipolar disorder return after a period of recovery, often due to factors like poor medication adherence or untreated triggers.

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Misdiagnosis of Bipolar Disorder

When an individual is incorrectly diagnosed with a different mental health disorder, such as schizophrenia or major depressive disorder.

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Overdiagnosis of Hypomania

Misinterpreting brief periods of elevated mood as hypomania, potentially leading to unnecessary medication.

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Anxiety in Bipolar Disorder

A common co-occurring condition with bipolar disorder, where individuals experience frequent anxiety symptoms.

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Substance Misuse in Bipolar Disorder

Higher rates of alcohol or drug abuse are observed in those with bipolar disorder, potentially as a way to self-medicate.

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Social Impact of Bipolar Disorder

Bipolar disorder often disrupts relationships and social connections due to unpredictable moods and behaviors.

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Economic Costs of Bipolar Disorder

Bipolar disorder can significantly impact employment and financial stability, leading to economic hardship.

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Suicide Risk in Bipolar Disorder

Individuals with bipolar disorder have a significantly higher risk of suicide compared to the general population.

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Goal-directed activity increase in BD

People with Bipolar Disorder (BD) often show a marked increase in goal-directed activities after initial success, even more so than people without BD.

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Confidence boost in BD

Successes and goal attainments in people with BD can lead to a surge in confidence, which in turn propels them to further goal engagement.

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Excessive goal engagement in BD

The heightened confidence and motivation after success can sometimes lead to excessive goal engagement in people with BD, potentially accelerating the development of manic symptoms.

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Hospitalization for Bipolar Disorder

Hospitalization might be necessary for individuals with Bipolar Disorder who are experiencing suicidal thoughts or psychotic symptoms.

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Mood stabilizing medication for BD

Medication is a crucial part of managing Bipolar Disorder and helps stabilize extreme mood swings.

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Psychoeducation for BD

A therapeutic approach that educates patients about Bipolar Disorder, helping them identify signs of relapse, understand medication adherence, and minimize risks.

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Cognitive Behavioral Therapy (CBT) for BD

CBT helps patients with Bipolar Disorder to challenge negative thoughts, develop coping mechanisms, and build self-efficacy.

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Interpersonal and Social Rhythm Therapy (IPSRT) for BD

IPSRT focuses on reducing disruptions to daily routines and sleep cycles, which can contribute to mood instability in Bipolar Disorder.

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Dopamine Agonists and Mania

Stimulants like dopamine agonists can trigger manic symptoms in people without bipolar disorder (BD). In people with BD, these stimulants tend to cause more intense manic reactions.

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Serotonin's Role in Mania

Serotonin acts as a balancing force on other neurotransmitters, including dopamine. Low serotonin levels might allow greater variability in dopamine activity, potentially contributing to manic episodes.

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Sleep Deprivation and Mania

Sleep deprivation can disrupt dopamine receptor sensitivity, make the brain more reactive to emotional stimuli, and affect prefrontal cortex activity. This can increase vulnerability to manic episodes.

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Life Events and Sleep

Stressful life events often disrupt sleep. Sleep disruption, in turn, can contribute to manic episodes. People with BD may experience more sleep-disrupting events before manic episodes.

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Circadian Rhythm Instability

People with BD show more variability in their daily activity patterns than those without BD, even when not experiencing an episode. This instability is linked to an increased risk of mood swings.

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Actigraphy

Actigraphy is a technique used to measure physical activity levels over time. It helps track sleep-wake cycles and other patterns of activity, revealing potential disruptions in circadian rhythms.

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Social Rhythms and Mania

Disturbances in social rhythms (e.g., changes in sleep patterns, routines, and social interactions) are linked to manic episodes. People with BD can experience an increased susceptibility to mood episodes when their social life is disrupted.

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Predicting Mood Episodes

Instability in social rhythms can predict future mood episodes, especially in individuals with subsyndromal manic or depressive symptoms.

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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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