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BIPOLAR
DISORDER
WOO HEE LEE
BIPOLAR DISORDER
-
Mood Disorder where person alternates between the
hopelessness and lethargy of depression and the
overexcited state of mania (Myers, Psychology)
-
Manic-Depressive Disorder
TYPES
-
Bipolar I Disorder
-
Bipolar II Disorder
-
Cyclothymia
-
Bipolar Disorder Not Otherwise Sepcified
MAJOR DEPRESSIVE
EPISODE
- An episode of a MOOD DISORDER
-
At least 2 weeks of depressed mood or anhedonia & at
least four other symptoms
-
Poor/increased appetite & significant weight loss/gain
Insomnia/excessive sleep
Psychomotor agitation/retardation
Loss of energy with fatigue
Feeling of worthlessness/inappropriate guilt
Reduced concentration and ability to make choice
Repeated thoughts of death, suicidal ideation, attempted
suicide
MANIC EPISODE
-
At least 1 week of elevated, expansive, or irritable mood
-
At least three or more of the following
-
Increased activity/psychomotor agitation
Talkativeness or pressured speech
Flight of ideas or racing thoughts
Grandiosity and excessive self-esteem
Fall in need of sleep
Distractibility
Involvement in pleasurable activities with likeable
unfortunate consequences
MIXED EPISODE
-
Mood Disorder
-
Lasting at least 1 week
-
Symptoms match for both a Major Depressive Episode
and a Manic Episode
HYPOMANIC EPISODE
-
Elevated, expansive, or irritable mood
-
Lasting at least 4 days
-
At least three of the following
-
-
Self-esteem
Decrease in need of sleep
Increase in: speech, race of thoughts, distractibility, activity,
psychomotor agitation, involvement in risky activities
Affect functioning and noticeable
-
Do not cause marked impairment
RAPID CYCLING
-
Mood disturbance
-
Fluctuates over short period
-
Four or more mood episodes within a year
-
Episodes separated by symptom-free periods of at least 2
months or episode of opposite polarity
BIPOLAR I
DISORDER
FEATURES
-
Occurrence of Manic Episodes or Mixed Episodes
-
Often with Major Depressive Episodes
-
Substance-Induced Mood Disorder Episodes or of Mood
Disorder Due to a General Medical Condition not counted
-
Not accounted by Schizoaffective Disorder and Psychotic
Disorder
-
First Episode / Recurrence
FEATURES AND
STATISTICS
-
10% to 15% of suicidal rate (completed) especially in
depressive or mixed state
-
Child abuse, spouse abuse, other violent behavior
-
School truancy, school failure, occupational failure,
divorce, episodic antisocial behavior
-
Usually associated with Alcohol and Substance Use
Disorders
-
Anorexia Nervosa, Bulimia Nervosa, ADHD, Panic
Disorder, Social Phobia
-
Increased rates of right-hemispheric lesions / bilateral
subcortical / periventricular lesions
STATISTICS
Ethnicity, Age, and Gender
-
No reports based on race or ethnicity
-
Adolescents: 10% to 15%
-
Men = Women, but men with Manic and women with Major
Depressive Episodes
-
Rapid Cycling more often in female
-
Women also associate with postpartum period
Prevalence
- Lifetime: 0.4% to 1.6%
COURSE AND
PATTERN
Course
-
Average onset: 20 yrs (25% onset before 20)
-
Retrospective self-report 60% symptom onset before 20
-
Recurrent – 90%
-
On average, 4 episodes in 10 years > Major Depressive
Family Pattern
-
First-degree biological relative with Bipolar I Disorder
-
Bipolar I Disorder 4% to 24%
Bipolar II Disorder 1% to 5%
Major Depressive Disorder 4% to 24%
BIPOLAR II
DISORDER
FEATURES
-
Occurrence of Major Depressive Episodes with at least
one Hypomanic Episode
-
Hypomanic is not confused with euthymia
-
No Manic or Mixed Episode
-
Substance-Induced Mood Disorder or that due to General
Medical Condition not included
-
Not accounted for Schizoaffective Disorder and Psychotic
Disorder
-
In some cases, Hypomanic Episode do not cause
impairment
FEATURES AND
STATISTICS
-
10% to 15% of Completed Suicide
-
School truancy, school failure, occupational failure,
divorce
-
Mental disorders: Substance Abuse or Dependence,
Anorexia Nervosa, Bulimia Nervosa, ADHD, Panic Disorder,
Social Phobia, Borderline Personality Disorder
-
Medical Conditions: Hypothyroidism or mild thyroid
hypofunction may associate with Rapid Cycling.
Hyperthyroidism may keep or worsen hypomanic
symptom.
STATISTICS
-
Women > Men
-
-
Men: Hypomanic Episodes
Women: Major Depressive Episodes, Rapid Cycling
Women more prone to depressive or intermixed mood
symptoms
- Women susceptible to develop episodes in immediate
postpartum period
Lifetime Prevalence: 0.5%
COURSE AND
PATTERN
-
Develop Hypomanic Episodes immediately before/after Major
Depressive Episode: 60% to 70%
-
Lifetime episodes exceed that of Major Depressive Episode
-
Interval tends to decrease as person ages
-
Multiple Mood Episodes within a year: 5% to 15%
-
Continue mood lability & interpersonal or occupational
difficulties between episodes: 15%
-
Psychotic symptoms not in Hypomanic Episodes and less in
Major Depressive Episodes
-
Over 5 yrs, 5% to 15% of people develop Manic Episode
-
Biological Relatives elevates the rates of Bipolar II Disorder
CYCLOTHYMIC
DISORDER
FEATURES
-
Chronic, fluctuating mood disturbance of hypomanic
symptoms & depressive symptoms
-
Hypomanic symptom not match for full criteria of Manic
-
Depressive symptom not match full criteria of MDE
-
Not Necessary to match Hypomanic Episode
-
Diagnosis only after initial 2 years of cyclothymic
symptoms free of Major Depressive, Manic, and Mixed
Episodes
-
Not account for Schizophrenia or Psychotic Disorders
-
Prolonged periods of cyclical, unpredictable mood
changes
FEATURES AND
STATISTICS
-
Substance-Related Disorders and Sleep Disorders may
associate
-
Often begin early in life, reflect predisposition to other
Mood Disorders
-
Men = Women
-
Life Prevalence: 0.4% to 1%
-
Mood Disorders Clinics: 3% to 5%
COURSE AND
PATTERN
-
Begins in Adolescence or early adult life
-
If late in life, may suggest Mood Disorder due to General
Medical Condition
-
Insidious onset & Chronic course
-
Development of Bipolar I or II Disorder: 15% to 50%
-
Family Pattern
-
-
First-degree relatives of persons with Cyclothymic Disorder
have higher rates of MDD, Bipolar I or II Disorder
May be familial risk of Substance-Related Disorders
More Common in first-degree biological relatives of people
with Bipolar I Disorder
BIPOLAR
DISORDER NOT
OTHERWISE
SPECIFIED
FEATURES
-
Do not meet criteria for Bipolar I or II Disorder or
Cyclothymic Disorder
-
Examples
-
-
Very rapid alternation, not match minimal duration
Recurrent Hypomanic Episodes without depressive
symptoms
Manic or Mixed Episode superimposed on Psychotic
Disorder; Delusional Disorder; Residual Schizophrenia
Hypomanic Episodes with chronic depressive symptoms
that are too infrequent
Diagnosed with Bipolar Disorder but unable to determine
whether due to general medical condition or substance
induced
JIM CARREY
Jim Carrey – Actor, Comedian
-
Age 16, family troubles
-
- Violent, depressed
- Not talk to anyone
- Throw himself against the walls
- Let himself fall on the stairs
Depression even in the peak of success
-
Depression = Motivation behind comedies
-
Anti-depressant drug, Prozac
www.nation.com.pk
SUM-UP ETIOLOGY
-
One of the most genetically influenced mental illnesses
-
Mechanisms yet unknown
-
Genetic and biological vulnerability & environmental
factor work together
-
- Reduction in activity of neurotransmitter
- Abnormality in structure or function of receptors
- Psychological agent
- Stress agent
Hypothesis: bipolar disorder episodes and individual’s
experiences cause stress, may influence brain and make
organism to be more sensitive and react with episodes
-
Zubin & Spring, 1977 Stress-Model
MULTIPLE CHOICE
QUESTION 1
What are the two features that should not be diagnosed as
Bipolar II Disorder?
A. Manic Episode
B. Major Depressive Episode
C. Mixed Episode
D. Hypomanic Episode
MULTIPLE CHOICE
QUESTION 2
Which mental illness is the least influenced by gene?
A. Acrophobia
B. Major Depressive Disorder
C. Bipolar I Disorder
D. Cyclothymic Disorder
MULTIPLE CHOICE
QUESTION 3
What is the average onset of Bipolar I Disorder?
A. Childhood, usually associated with Child Abuse
B. Adolescence or Early Adulthood
C. Middle Age, after precipitation of stress over the years
D. No set time, it is very unpredictable
MULTIPLE CHOICE
QUESTION 4
Which symptom can help the most for psychiatrist to
diagnose patient with Bipolar Disorder?
A. The patients reports loss in weight and appetite
B. The Patients reports insomnia
C. The Patients reports severe inability to make choice
D. The Patients reports strong urge and will to participate in
activities such as gamble, racing car and sexual activities
MULTIPLE CHOICE
QUESTION 5
Who is least likely to develop Bipolar I or II Disorder?
A. Person diagnosed with Cyclothymic Disorder at age of 16
B. Person with biological parents of Bipolar I Disorder
C. Person under lots of stress at his job and expectations
for certain things
D. Person who eats excessive amount of fish and walnut.
FREE RESPONSE
QUESTION
How is Bipolar Disorder different from Major Depressive
Disorder?
BIBLIOGRAPHY (APA)
American Psychiatric Association. (2000). Diagnostic and Statistical
Manual of Mental Disorders (4th ed.,Text Revision).
Washington, DC, American Psychiatric Association.
Mash, E. J., & Barkley, R. A. (Eds.). (2003). Child Psychopathology (2nd
ed.). New York / London, The Guilford Press
Miklowitz, D. J. (2002). The Bipolar Disorder Survival Guide: What You
and Your Family Need to Know. New York / London, The
Guilford Press.
Myers, D. J. (2010). Psychology (9th ed.). New York, Worth Publishers
Oddee. (2013, July 18). 10 Famous People Who Were Popular. Message
posted to http://www.oddee.com.
VandenBos, G. R. (Eds.). (2007). A.P.A Dictionary of Psychology (1st
ed.). Washington, American Psychological Association