BIPOLAR DISORDERWOO HEE LEE

BIPOLAR DISORDER- Mood Disorder where person alternates between the hope-

lessness 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 unfortu-

nate 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, activ-

ity, 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 STATIS-TICS- 10% to 15% of suicidal rate (completed) especially in de-

pressive or mixed state- Child abuse, spouse abuse, other violent behavior- School truancy, school failure, occupational failure, di-

vorce, episodic antisocial behavior- Usually associated with Alcohol and Substance Use Dis-

orders- Anorexia Nervosa, Bulimia Nervosa, ADHD, Panic Disor-

der, Social Phobia- Increased rates of right-hemispheric lesions / bilateral

subcortical / periventricular lesions

STATISTICSEthnicity, 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 periodPrevalence- Lifetime: 0.4% to 1.6%

COURSE AND PATTERNCourse- 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 DepressiveFamily 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 impair-

ment

FEATURES AND STATIS-TICS- 10% to 15% of Completed Suicide- School truancy, school failure, occupational failure, di-

vorce- Mental disorders: Substance Abuse or Dependence,

Anorexia Nervosa, Bulimia Nervosa, ADHD, Panic Disor-der, Social Phobia, Borderline Personality Disorder

- Medical Conditions: Hypothyroidism or mild thyroid hypo-function may associate with Rapid Cycling. Hyperthy-roidism 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 Ma-

jor 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 dif-

ficulties 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 symp-

toms free of Major Depressive, Manic, and Mixed Episodes- Not account for Schizophrenia or Psychotic Disorders- Prolonged periods of cyclical, unpredictable mood

changes

FEATURES AND STATIS-TICS- 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 Disor-der 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 DISOR-DER NOT OTH-ERWISE SPECI-FIED

FEATURES- Do not meet criteria for Bipolar I or II Disorder or Cy-

clothymic Disorder- Examples

- Very rapid alternation, not match minimal duration- Recurrent Hypomanic Episodes without depressive symp-

toms- Manic or Mixed Episode superimposed on Psychotic Disor-

der; 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 in-duced

JIM CARREYJim 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 ex-periences cause stress, may influence brain and make or-ganism to be more sensitive and react with episodes- Zubin & Spring, 1977 Stress-Model

MULTIPLE CHOICE QUES-TION 1What are the two features that should not be diagnosed as Bipolar II Disorder?A. Manic EpisodeB. Major Depressive EpisodeC. Mixed EpisodeD. Hypomanic Episode

MULTIPLE CHOICE QUES-TION 2Which mental illness is the least influenced by gene?A. AcrophobiaB. Major Depressive DisorderC. Bipolar I DisorderD. Cyclothymic Disorder

MULTIPLE CHOICE QUES-TION 3What is the average onset of Bipolar I Disorder?A. Childhood, usually associated with Child AbuseB. Adolescence or Early AdulthoodC. Middle Age, after precipitation of stress over the yearsD. No set time, it is very unpredictable

MULTIPLE CHOICE QUES-TION 4Which symptom can help the most for psychiatrist to diag-nose patient with Bipolar Disorder?A. The patients reports loss in weight and appetiteB. The Patients reports insomniaC. The Patients reports severe inability to make choiceD. The Patients reports strong urge and will to participate in

activities such as gamble, racing car and sexual activities

MULTIPLE CHOICE QUES-TION 5Who is least likely to develop Bipolar I or II Disorder?A. Person diagnosed with Cyclothymic Disorder at age of 16B. Person with biological parents of Bipolar I DisorderC. Person under lots of stress at his job and expectations

for certain thingsD. Person who eats excessive amount of fish and walnut.

FREE RESPONSE QUES-TIONHow is Bipolar Disorder different from Major Depressive Dis-order?

BIBLIOGRAPHY (APA)American Psychiatric Association. (2000). Diagnostic and Statistical

Manual of Mental Disorders (4th ed.,Text Revision). Wash-ington, DC, American Psychiatric Association.Mash, E. J., & Barkley, R. A. (Eds.). (2003). Child Psychopathology (2nd ed.). New York / London, The Guilford PressMiklowitz, 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 PublishersOddee. (2013, July 18). 10 Famous People Who Were Popular. Mes-sage posted to http://www.oddee.com.VandenBos, G. R. (Eds.). (2007). A.P.A Dictionary of Psychology (1st

ed.). Washington, American Psychological Association