Bipolar Disorders- Psych 300 Nov. 5 PDF

**[Bipolar disorder- mood disorders:]** *What is Bipolar disorder?* Bipolar disorder is a recurrent episode of abnormally elevated mood(manic) then low mood (depressive). \*\*It is unknown how long this disorder lasts. (Lifelong disorder) [Manic episode:] - Self-esteem/grandiosity inflated -...

**[Bipolar disorder- mood disorders:]** *What is Bipolar disorder?* Bipolar disorder is a recurrent episode of abnormally elevated mood(manic) then low mood (depressive). \*\*It is unknown how long this disorder lasts. (Lifelong disorder) [Manic episode:] - Self-esteem/grandiosity inflated - At least on week - Decreased need for sleep - More talkative Diagnostic: Must have 3 symptoms for at least 1 week - Inflated self-esteem - Decreased new for sleep (3-4hrs/night) - More talkative - Racing thoughts - Distractibility (unable to sit) - Increased activity - Excessive involvement in pleasurable activities that have consequences/ are danger (ex: gambling, driving fast, walking on a rope) **Types of bipolar disorder:** 1. **Bipolar 1 (classic)** Clear manic episode \*\*ONLY manic episode 2. **Bipolar 2 (harder to detect)** Hypomanic episode- not recognized Last short period of time (weeks-months) Ex: change in behaviour (being nicer than usual/meaner than usual) 3. **Cyclothymic disorder** Mood swings (less severe cycling of mood) Last 2 years Impairment of life must be present Ex: promising actions that cannot fulfil \*\*similar to depression -- severity continuum (depression=mania) **[Rapid cycling specifier: (another type of bipolar disorder)]** What? Mixed episodes of mania and depressive. - At least 4 episodes/year - Greater in women - Higher rate of suicide - Less responsive to treatment [Psychotic features:] 1. Hallucinations -- auditory (ex: voices saying you are special) 2. Delusions -- grandeur powers, special mission (could be religious) -manic episode **[Clinical picture: bipolar disorders]** - Often initially onset with severe depression (higher chance for bipolar disorder) - Onset greater for teens and adolescence (avg. age = 18) - Mania mixed with depressed mood - Comorbid medical conditions - Comorbid psychological conditions [Epidemiology:] **General:** - Low rate (1.3%) prevalence (lower than depression) - Equally common in women and men **Biological contributors:** 1. **Genetic:** **Psychosocial contributors:** Unknown however some possibilities triggering. - Sleep disturbance - Exposure to traumatic event (onset) **Treatments:** 1. **Biological** A. Lithium carbonate medication. High affectivity. (50% respond well, 30% partial response) Low short-term recurrence. Allow concentration. Problem: Patients do not like the effects. (feel life is flat) Go off medication Long-term damage internal organs. B. Valproate A type of anticonvulsant Less effective in preventing suicide (impulsive actions common) 2. **Psychological** A. Family based therapy- teach facilities how to cope with patient \*\*not sufficient- must take medications **[Suicide chapter.8: ]** Behaviour stemming from depression. \*\*Significant global problem [Rates:] 1. [General ] 1 suicide/43 seconds 3000/day That is still underestimate 4^th^ leading cause of death Canada has high suicide rate high In BC suicide greater than vehicle accidents, drug... 2. [Gender ] - Women higher to *commit* suicide - Men more likely to *complete* suicide (shoot, hang) - Younger 18-24 women commit (use pills and have time to decide you don't want to kill yourself) \*\*in china rate for women higher in completing suicide 3. [Age:] - Children commit suicide (low) age 6-7 - Puberty a risky time 30% commit - Suicide rate in adolescence increasing (why? Changes in society, less supportive families, divorce, home types) - Adolescence feels a lot of pressure (grades, income....) - Use of alcohol use increased, and substance abuse greater - 4. [University students ] - 10-25% have suicidal ideation - Significant problem - How? Drugs, jumping off buildings... 5. [Older adults ] - Higher risk for suicide (older men) - In positive situation: Develop a crystallized sense- new identity (living a satisfied life) \*\*Increase in drinking \*\*Gun control laws decline rate of suicide significantly 6. [Cultural influences] Suicide is an honourable act in Japan (more accepted) Indigenous population have higher rate of suicide (Canada 3x greater) Specially ones living on reserves (not enough opportunities with job, education and substance abuse) Rate higher in indigenous people in residential schools \*\*people with greater social identity less likely to commit suicide therefore protected (more in touch with culture, engage in spiritual practices) [Risk factors:] *What causes suicidal behaviour?* *Physical pain substitutes for psychological pain.* - Severely stressful event - Loss of a loved ones - Financial problems - Intoxication, alcohol, and drug use cause impulsive actions of suicide - Active psychotic symptoms (people with psychoses such as command to kill oneself, grandiose view) - Psychiatric release recent -- clear improvement in recent disorders shown yet its due to planning suicide - Chronic illness, pain, injury (excess pain and believe cannot continue) - Exposure to suicide cause suicide (seems more acceptable) - Previous suicide attempts (engage in rehearsal initially maybe for attention but may accidentally kill oneself) - Social isolation (feel a burden, not connected to others) - Unemployment (feeling life is meaningless) [Warning signs of suicide:] a. Acute suicidal thinking/preoccupation b. Suicide plan (various levels of planning) - How specific (I know how many pills I need...) - Active (are they thinking about it now?) - Previous attempts (do they have experience/rehearsal) - Means (how prepared they are, equipments and tools for suicide) - How lethal (is there a second chance gun shooting or pills, what form of death planning) c. Hopelessness severe- do you have hope for the future? (Big predictor) d. Change in behaviour (giving valuable objects a way, a will, expensive objects) e. Preparation [Treatments:] 1. Routine assessments Assess whether at risk for suicide (good psychological/medical care) \*\*Discussing suicide does not cause/worsen suicide 2. Assess: - Ideation -severity - Active vs. Passive - Plan (is it specific? Lethal?) 3. Cognitive Behavioral - Find life problems: what's the problem influencing suicide? (changing schools, change a situation) - Emotion regulation (collect skills for self-soothing and teach de-centring, relaxation) - Developing social competence: social skills - Coping skills: when getting thoughts what can you do? Exercise....