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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

Bipolar Disorder

Astrid, Bradley, Colette,

Jen, Kirstin, & Stephanie

bipolar disorder3
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
bipolar disorder4
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

bipolar i disorder
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
bipolar i disorder7
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
bipolar ii disorder
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
cyclothymic disorder
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
less common forms of bipolar
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

onset
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
prevalence
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?
causes of bipolar disorder
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
alterations in brain function neurotransmission nt model
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
bipolar brain differences in size
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.

bipolar brain differences in function
Bipolar Brain: Differences in Function

Facial Recognition

Making Quick Decisions

bipolar brain activity
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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