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Bipolar Disorder. Astrid, Bradley, Colette, Jen, Kirstin, & Stephanie. What is Bipolar Disorder?. Bipolar Disorder. Manic-depression Brain disorder causing unusual shifts in mood, energy, & ability to function Differs from normal ups & downs everyone goes through Symptoms are severe

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Bipolar Disorder

Astrid, Bradley, Colette,

Jen, Kirstin, & Stephanie



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Bipolar Disorder

  • Manic-depression

  • Brain disorder causing unusual shifts in mood, energy, & ability to function

  • Differs from normal ups & downs everyone goes through

  • Symptoms are severe

    • Range from EXTREME MANIA to MAJOR DEPRESSIVE DISORDER

      • Damaged relationships

      • Poor job or school performance

      • Suicide Attempts


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Bipolar Disorder

Mania

“A manic episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive or irritable mood” (DSM-IV-TR, p357).

Depression

Depressed, sad, hopeless, discouraged , down in the dumps

Loss of interest or pleasure

Hypomania

Mania lasting 4 days

Unequivocal change in functioning uncharacteristic of the person when asymptomatic

Mood disturbance observable by others

Doesn’t impair social or occupational functioning

Doesn’t require hospitalization

Mixed Episode

Lasts at least 1 week with criteria for Mania & a Major Depressive Episode being met daily

Rapidly alternating moods with symptoms of a Manic & a Major Depressive Episode: Agitation, insomnia, appetite, dysregulation, psychotic features, suicidal thinking

Impairs social/occupational functioning

May require hospitalization



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Bipolar I Disorder

  • Manic or mixed symptoms, with or without depression

  • Further specified by the most current or recent behavior experienced:

    • Single Manic Episode

      • Presence of 1 manic episode and no past Major Depressive Episodes

    • Most Recent Episode Hypomanic

      • Currently or most recently in a Hypomanic Episode

      • History of at least 1 Manic or Mixed Episode

    • Most Recent Episode Manic

      • Currently or most recently in a Manic Episode

      • History of at least 1 Major Depressive, Manic or Mixed Episode


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Bipolar I Disorder

  • Most Recent Episode Mixed

    • Currently or most recently in a Mixed Episode

    • History of at least 1 Major Depressive, Manic or Mixed Episode

  • Most Recent Episode Depressed

    • Currently or most recently in a Major Depressive Episode

    • History or at least 1 Manic of Mixed Episode

  • Most Recent Episode Unspecified

    • Criteria, except for duration, are currently or most recently met for a Manic, Hypomanic, or a Major Depressive Episode

    • History of at least one Manic Episode

    • Mood symptoms cause clinically significant distress or impairment in social, occupational, or other impairment areas of functioning


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Bipolar II Disorder

  • At least one episode of depression

  • At least one hypomanic episode

    • Periods of depression tend to be much longer than the periods of hypomania

  • Criterion for Bipolar II:

    • Presence or history of at least 1 Major Depressive Disorder

    • Presence or history of at least 1 Hypomanic Episode

    • No Hx of a Manic Episode or Mixed Episode

    • Clinically significant distress or impairment in social, occupational, or other areas of functioning


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Cyclothymic Disorder

  • Chronic mood disturbance of 2+ years

    • Episodes of hypomania & depressed mood

  • Symptoms not severe enough to be classified as either Bipolar I or II disorder

  • Criterion for Cyclothymic Disorder:

    • 2 years presence of numerous periods of hypomanic symptoms and depressive symptoms that do not meet criterion for a Major Depressive Episode

    • During the 2 year period the person has not been without symptoms for more than 2 months at a time

    • No Major Depressive, Manic, or Mixed Episodes present

    • Clinically significant distress or impairment in social, occupational or other areas of functioning


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Less Common Forms of Bipolar

  • Rapid cycling bipolar disorder:

    • 4 or more mood swings within 12 months

    • Moods shifts can occur rapidly, sometimes within just hours

  • Mixed state bipolar disorder:

    • Symptoms of both

      mania and depression

      occur at the same time


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Onset, Prevalence, Signs & Symptoms


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Onset

  • Can appear in all stages of life, but most often occurs in late teens through early adulthood

    • Women: more likely in 20s and 30s

  • Earlier onset typically leads to more severe symptoms


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Prevalence

Lifetime prevalence: 1%

Children

  • Onset prior to age 10: 0.3% to 0.5% of bipolar patients

  • Number of US children & adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003 & continues to increase

  • Have doctors been more aggressively applying the diagnosis to children or is the incidence of the disorder actually increasing?




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Causes of Bipolar Disorder

  • Genetics

    • 75% risk: monozygotic twin

    • 60% risk: both parents

    • 20% risk: first-degree relatives

  • Organic

    • Abnormalities in brain function

  • Environmental Triggers

    • Significant events or changes leading up to illness

  • Personality

    • History of fluctuating mood, variable enthusiasms & periods of despondency can increase risk

  • Apparent link between head injury, epilepsy, & bipolar disorder




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Alterations in Brain Function: Neurotransmission (NT) Model

  • Catecholamine hypothesis:

    • Same hypothesis for schizophrenia & major depression

      • Difficult to genetically or biochemically distinguish

    • Depressive symptoms: NT activity deficits

    • Mania and psychosis: Excessive NT activity

  • NTs: Serotonin, GABA, norepinephrine, dopamine

  • Alternative hypothesis

    • NT dysregulation leads to loss of mood stabilization


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Bipolar Brain: Differences in Size

  • Frontal cortex shrinks

    • Decision-making, controlling impulsive behavior

  • Enlarged ventricles

    • Possible association with tissue loss

  • Enlarged amygdala

    • Part of limbic system: memory, emotions, motivation, fear

From left: view of a normal brain; patient with bipolar disorder has enlarged ventricles; bright white spots of hyperintensity associated with bipolar illness.


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Bipolar Brain: Differences in Function

Facial Recognition

Making Quick Decisions


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Bipolar Brain: Activity

  • PET scans: the individual shifts from depression to mania and back to depression over a 10 day period

  • Blue and green: low levels of brain activity

  • Red, orange, and yellow: high levels of brain activity


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