Mood Disorders & Bipolar Disorders - PDF

Mood Disorders 7 Bipolar Disorders Defined 1)​ Compare and contrast the symptoms of mania, hypomania, mild and severe depression. Mania: Extremely elevated, euphoric, or irritable mood. Excessively high levels of energy, people with mania may not have a need for sleep. They m...

Mood Disorders 7 Bipolar Disorders Defined 1)​ Compare and contrast the symptoms of mania, hypomania, mild and severe depression. Mania: Extremely elevated, euphoric, or irritable mood. Excessively high levels of energy, people with mania may not have a need for sleep. They may even go days without sleep. Racing thoughts, grandiosity, distractibility. Impulsivity, risk taking, hyperactivity. Possibility of psychosis (delusions, hallucinations). Hypomania: This type of mania is less intense. Their mood may be elevated but less intense. They have an increased level of energy but they remain functional. They also have a decreased need for sleep but still sleep some. They have fast thoughts but they are organized. Increased productivity and sociability. Psychosis is uncommon. Mild Depression: These individuals have low mood, sadness and slight anhedonia. Their energy levels are slightly lower than normal. They struggle with falling or staying asleep. They have negative thoughts and showcase mild guilt. They have less interest in activities and psychosis is uncommon. Severe Depression: Characterized by persistent sadness, hopelessness, and despair. They exhibit fatigue and a lack of energy. They either have insomnia, where they cannot fall asleep, or hypersomnia which is characterized by an excessive amount of sleep. They have thoughts of suicidal ideation and worthlessness. They withdraw from social situations and are unable to function normally. Psychosis is possible in severe cases. 2)​ Compare and contrast Bipolar I and II. Bipolar I: Individuals have at least one full manic episode. Depression is often present but not required. It is more severe and may include psychosis. It can impair daily life functioning. Hospitalization is more common due to mania. Bipolar II: Individuals do not show full mania, only hypomania. Depression is required for diagnosis. It is less severe than Bipolar I but with recurrent depression. People may still function relatively well. It is less common but possible in severe depression. 3)​ Compare and contrast Schizoaffective Disorder with Bipolar disorder. Schizoaffective Disorder is a mental health condiiton that combines symptoms of schizophrenia with mood disorder symptoms such as depression or mania. Schizoaffective Disorder: Symptoms include mood disturbances and schizophrenia-like symptoms (depression, mania, and delusions, hallucinations). Psychosis can be present without mood symptoms.  Mood episodes can be depressive, manic, or mixed. Treatment requires antipsychotics plus mood stabilizers. Bipolar Disorder: Symptoms include mood episodes (mania, hypomania, depression) without primary psychosis. Psychosis occurs only during mood episodes, if at all. Treatment includes mood stabilizers and antidepressants. 4)​ List 5 behaviors associated with bipolar mania. Spending sprees and business ventures, hypersexuality and unwanted pregnancy, ill-considered marriages, conflict with the law, car accidents, fights and disputes, poor relationships 5)​ Describe the Altman Self Rating Scale. The ASRM is a 5-item self rating mania scale, designed to assess the presence and/or severity of manic symptoms. The ASRM may be used in an inpatient or outpatient setting to screen for the presence of and/or severity of manic symptoms for clinical or research purposes. Mood Disorder 8 The Neurobiology of Bipolar Disorders 1)​ List physiologic changes in brain region size associated with bipolar disorder. Enlarged Ventricles: Individuals with bipolar disorder may show ventricular enlargement in the brain which may indicate progressive brain volume loss. Decreased White Matter: The severity of bipolar disorder correlates with white matter reduction, disrupting myelinated tracts that connect different brain regions, particularly the prefrontal cortex and limbic system. Decreased white matter volume is also associated with suicidality. These hyperintensities suggest neuroinflammation, ischemia, or demyelination. Grey Matter Loss in the Right Frontal Cortex: Meta-analysis reveals right sided grey matter decreases, which may contribute to impaired emotional regulation and executive function deficits. 2)​ Define “hyperintensity signal”. What do hyperintensity signals reveal? A hyperintensity signal on an MRI scan refers to the bright areas seen in white matter. These are small regions of cell death that suggest that the myelin is damaged which may contribute to cognitive dysfunction. Also, since white matter consists of myelinated tracts, these lesions may disrupt neural connectivity, particularly between the prefrontal cortex and limbic system. 3)​ Describe the role of the amygdala and parahippocampal gyrus region as it relates to emotion.  The amygdala is crucial for recognizing fear and processing emotional responses. Damage or dysfunction can lead to impaired emotional recognition and dysregulated mood. The parahippocampal gyrus supports contextual memory and helps integrate emotions with past experiences. It works alongside the amygdala to assign emotional meaning to memories. 4)​ Evaluate research findings of amygdala activity in bipolar disorder. Hypothesize ways that age may influence this. At risk and bipolar adolescents show increased right amygdala and parahippocampal gyrus activation in response to fearful faces. Younger people may show greater right amygdala hyperactivity, explaining increased emotional volatility. Older individuals may develop left amygdala hyperactivity, leading to persistent emotional dysregulation, especially in mania and depression. 5)​ What do meta data on bipolar disorder and emotional recognition confirm? Describe how this relates to amygdala activity. Meta-analysis reveals that the adult left amygdala and parahippocampal gyrus is hyperactive in Bipolar patients along with right sided gray matter decreases in frontal cortex. This explains why people with bipolar disorder struggle with recognizing fearful and neutral facial expressions. Additionally, the right sided grey matter loss in the frontal cortex impairs top-down emotional control, allowing hyperactive limbic structures to dominate emotional responses. 6)​ Describe the role of the anterior cingulate cortex in bipolar disorder and evaluate fMRI findings of regional grey matter loss. The anterior cingulate cortex acts as a bridge between the limbic system (emotion) and prefrontal cortex (rational control). Dysfunction in this area can lead to reduced matter, leading to weaker emotional regulation. It can also alter activity levels; decreased during depression leads to emotional blunting and lack of motivation, and increased during mania leads to impulsivity and excess emotional reactivity. FMRI concludes that repeated mood episodes are linked to progressive ACC atrophy, suggesting that bipolar disorder has a neurodegenerative component. Mood Disorder 9 Sociocultural Aspects of Bipolar Disorders 1)​ Describe how common bipolar disorder is world-wide. In a combined sample of 61,392 adults from 11 countries, the total lifetime prevalence of BP-I was 0.6%, BP-II was 0.4%, and subthreshold BP was 1.4%, yielding a total prevalence estimate BPS of 2.4% worldwide. 2)​ Compare and contrast lifetime and 12-mo prevalence of bipolar disorder. The lifetime prevalence rates of BP-I, BP-II, and subthreshold BP from the pooled sample of eleven countries were 0.6%, 0.4%, and 1.4% respectively.  The 12-month prevalence of BP-I, BP-II, and subthreshold BP was 0.4%, 0.3%, and 0.8%, respectively. Lifetime rates of BP-I and subthreshold BP were greater in males than females whereas females had higher cases of BP-II. 3)​ Read a chart of cumulative age of onset to determine the average age of onset for bipolar disorder. Between the ages of 20-30 4)​ Describe “comorbidity” and use a table to determine the comorbidity of bipolar disorder with other mood disorders. Comorbidity is the simultaneous presence of two or more diseases or medical conditions in a patient. ¾ of those with BPS also met criteria for another lifetime disorder, more than half of whom had 3 or more disorders. Anxiety disorders, particularly panic attacks, were the most common comorbid conditions, followed by behavior disorders and substance use disorders. Significantly greater rates of comorbid disorders among those with BP-I and BP-II rather than subthreshold BP. 5)​ Use a table to evaluate the most clinical characteristics of BP1 and BP2 patients over 12 months. The vast majority of 12-month BPS cases reported severe or moderate manic/hypomanic or major depressive episodes in the past year. Combined manic/hypomanic and depressive episodes were more severe among BP-I and BP-II compared to threshold BP. 6)​ Interpret correlation of age, gender, and lifestyle with bipolar disorder risk Younger individuals are more at risk for initial onset, but age-related changes can worsen symptoms over time. Women tend to have a later onset and more depressive symptoms, while men have an earlier onset and more manic symptoms. Poor sleep, substance use, stress, and lack of exercise can exacerbate symptoms, while healthy habits and good social support can help stabilize the disorder. Mood Disorder 10: Pharmacology and Therapeutics of Antipsychotics 1)​ Describe the relationship between bipolar disorder and metabolic disorder. Bipolar and metabolic disorders are often comorbid, meaning they frequently occur together. Studies suggest that individuals with BP are at higher risk of developing metabolic issues such as obesity, diabetes, and cardiovascular problems. This may be caused by the use of certain medications (antipsychotics), lifestyle factors (poor diet, lack of exercise), and the biological underpinnings of bipolar disorder itself. Individuals with BPD have elevated uric acid levels. 2)​ Explain the comorbidity of bipolar disorder and gout as it relates to uric acid levels.  They share comorbidity linked to high uric acid levels. Gout, a form of arthritis, occurs when uric acid crystals build up in joints, causing pain and inflammation. Uric acid is typically elevated in individuals with bipolar disorder, possibly due to genetic, environmental, and dietary factors. Elevated uric acid levels are associated with purine metabolism, and studies suggest that certain purine-rich foods, sugar consumption, and the body’s inability to process uric acid effectively can contribute to both conditions. Lithium, historically used for gout treatment, may have an incidental benefit for managing elevated uric acid in individuals with bipolar disorder. 3)​ Why was lithium such an effective treatment for gout and mania? Lithium has the unique ability to influence uric acid metabolism. In gout, it reduced uric acid levels by increasing its excretion, thus alleviating symptoms of gout. For mania, lithium regulates mood by modulating neurotransmitters, particularly glutamate and GABA, to stabilize mood and prevent manic episodes. Its dual action on both uric acid and mood regulation made it an effective treatment for individuals experiencing both conditions, especially before the full understanding of lithium’s mood-stabilizing mechanisms was developed. 4)​ Hypothesize a causality relationship between gender, sugar consumption and bipolar mania based on research findings. Research indicates that sugar consumption, particularly fructose and high glycemic index foods, may contribute to elevated uric acid levels. Since males generally have higher levels of uric acid than females, they may be more prone to the effects of sugar intake on their metabolic health. In the context of bipolar disorder, elevated uric acid levels are associated with mood swings and the onset of manic episodes. Therefore, excessive sugar consumption in males may exacerbate bipolar mania by increasing uric acid, which could influence the biochemical pathways involved in mood regulation. 5)​ Explain how lithium’s ability to regulate glutamate may underlie its effectiveness. Glutamate is an excitatory neurotransmitter. In BPD, glutamate levels can fluctuate dramatically, leading to the extreme mood states characteristic of the disorder. Lithium stabilizes glutamate levels by reducing its excessive release and enhancing its uptake, preventing the overstimulation of neurons that can trigger manic episodes. This stabilization of glutamate in the synapse helps to prevent the rapid cycling between manic and depressive states, making lithium an effective mood stabilizer for bipolar disorder. 6)​ Describe the first and second line treatment for 3 phases of bipolar disorder. First-Line Treatments: ​ Manic Phase: The first-line treatment typically includes mood stabilizers like lithium or valproate. Antipsychotics such as olanzapine or risperidone may also be used to address severe manic symptoms.  ​ Depressive Phase: Antidepressants may be used, but with caution, as they can trigger mania in some individuals. Lamotrigine (a mood stabilizer) is often the preferred treatment for bipolar depression. ​ Maintenance Phase: Long-term treatment includes mood stabilizers (lithium, valproate) and sometimes antipsychotics to prevent recurrence of mood episodes. Second-Line Treatments: 7)​ Manic Phase: If first-line treatments are ineffective, anticonvulsants like carbamazepine or additional antipsychotic medications may be used. 8)​ Depressive Phase: If antidepressants are ineffective or contraindicated, second-line treatments include anticonvulsants, atypical antipsychotics, or the combination of lithium and antidepressants. 9)​ Maintenance Phase: Second-line treatments include a broader range of antipsychotics or anticonvulsants, sometimes in combination with a mood stabilizer. 10)​Explain the action of antipsychotics and their motor side effects. Antipsychotics work by altering the activity of neurotransmitters in the brain, particularly dopamine, which is involved in mood regulation and psychotic symptoms. They block dopamine receptors to reduce the symptoms of mania. They can have motor side effects, such as tremors, rigidity, bradykinesia (slowness of movement), and dyskinesia (involuntary repetitive movements), particularly with first generation antipsychotics.These side effects are due to the impact of dopamine blockade in areas of the brain responsible for motor control. 11)​Describe a mood chart and imagine hypothetical journal entries of a patient with bipolar disorder in response to a real life situation. A mood chart is a tool used by individuals with bipolar disorder and their therapists to track mood fluctuations, sleep patterns, and other symptoms over time. It typically involves recording daily moods on a scale, such as from 1 (depressed) to 10 (manic), along with relevant notes about activities, medication, and triggers. Mood Disorder 11 Genetic & Environmental Contributions in Bipolar Disorders 1)​ What is Methylation? When a small chemical group (methyl group, -CH3) attaches to a part of the DNA. This addition can turn off or silence a gene, preventing it from being used to make proteins. 2)​ Explain how methylation silences gene expression. Methyl groups are added to DNA, typically at CpG sites. Methylation in the promoter region blocks transcription factors. This prevents gene expression by hindering the transcription process. 3)​ Define “epigenetics”.  Epigenetics are changes in gene expression without altering the DNA sequence. This is caused by factors like environment, lifestyle, and experiences. Includes mechanisms like environment, lifestyle, and experiences. Includes mechanisms like DNA methylation. 4)​ Explain why monozygotic twin studies are useful for studying epigenetics in humans. Identical twins have the same genetic makeup. Differences in traits or disorders are due to environmental/epigenetic factors. Helps isolate the impact of epigenetic changes on gene expression. 5)​ Describe how promoter hypermethylation can lead to disorders like bipolar or schizophrenia. Excessive methylation in promoter regions silences gene expression. Silencing critical genes (5-HTT, and BDNF) affects brain function. This disrupts mood regulation, neural growth, and protection. 6)​ List 3 genes that undergo epigenetic modification 5-HTT (serotonin transporter gene): Epigenetic changes, including methylation have been implicated in bipolar disorder, influencing serotonin signaling. BDNF (brain-derived neurotrophic factor): Methylation of BDNF can reduce its expression, which may contribute to the mood dysregulation observed in bipolar disorder. COX-2 Plays a key role in inflammation and pain by producing prostaglandins, which are chemicals that promote inflammation, pain, and fever in response to injury or illness. Increased expression is often seen in inflammatory diseases. 7)​ Define BDNF and its role in bipolar disorder. Supports neural growth neuroplasticity. In BPD, BDNF levels are altered with reduced expression seen in the depressed phase. Methylation of BDNF supports neural growth and neuroplasticity. 8)​ Interpret findings that suggest lower levels of methylation lead to increased positive response to lithium treatment. Lower methylation leads to higher gene expression. Lithium treatment has been shown to increase BDNF levels and promote neuroplasticity, helping stabilize mood. Improved mood stabilization and neuroprotection with lithium.