Summary
Bipolar Complete Summary - 3.4 Affective Disorders
- Course
- Institution
Complete and extensive summary for week 4 of the course 3.4 Affective Disorders, year 2023/2024. Grade received = 8.3!
[Show more]
Seller
Follow
lindej03
Content preview
3.4 Affective DisordersWeek 4
Bipolar Disorder
,Bipolar Disorder → Lifetime Perspective
Carvalho et al (2020)
Bipolar Disorder
Introduction
● Mood fluctuations are common in normal daily life as a result of life events
● Severe and persistent, result in distress & behavioral impairment → underlying disorder
● Bipolar I
○ Presence of overt manic episodes
○ Overconfidence, grandiosity, talkativeness, extreme disinhibition, irritability,
decreased need for sleep, highly elevated mood
○ Psychotics symptoms and delusions occur in 75% of episodes
○ Episode needs to be at least 1 week long for diagnosis
● Bipolar II
○ Presence of episodes of depression alternating with hypomania (instead of
mania)
○ Episode should be at least 2 weeks long for diagnosis
● Cyclothymic disorders
○ Recurrent depressive & hypomanic states lasting for 2 years
● Atypical bipolar-like phenomena → other specified bipolar related disorder category
● Bipolar can also be affected by depressive symptoms
● Onset is typical at age 20
○ Earlier onset associated with poorer prognosis, longer treatment delays, severe
depressive episodes, higher prevalence of concurrent anxiety & substance abuse
○ First episode of bipolar is usually depressive, depressive episodes usually last
longer than manic or hypomanic
■ Because of this often misdiagnosed as depression
● Evidence of overdiagnosis → when there is reliance on self-reported screening
instruments (high rates of false positives)
● In up to ⅓ of patients, bipolar is not diagnosed until 10 years after the onset
Epidemiology and burden of illness
● 17th leading source of disability
● Prevalence
○ Lifetime prevalence → 2.4%
○ 12 month prevalence → 1.5%
○ Varying levels per country → cultural differences
○ Bipolar I no gender difference
○ Bipolar II more often in females
○ Prevalent in primary care practice
, ● Risk factors have been identified, but not often high quality evidence
○ IBS, childhood adversity
● Typically arises during formative years in children & adolescents → often affects
achievements
○ Cognitive & psychosocial dysfunction
● 6-7% commit suicide (rates are 20-30 times higher than in the population)
● High rates of coexisting psychiatric conditions (anxiety, substance abuse, personality
disorders, ADHD
○ Increase burden & worsen prognosis
● Chronic medical conditions are more prevalent
○ Metabolic syndrome, migraine, obesity, diabetes type 2
○ Twice the risk of death
Genetic & neurobiologic features
● Heritability 70-90%
● Many genes with small effect sizes contribute
○ 30 significant loci
○ Sets involved in regulation of insulin secretion & endocannabinoid signaling
○ Common variants only account for 25% of the disorder
○ Thought to interact with environmental factors
● Kindling hypothesis
○ Explains stress sensitization leading to recurring affective episodes
○ The first episode occurs after exposure to a stressor
○ Subsequent episodes can occur without exposure to a stressful event
○ Mechanisms strengthened if illness is not treated or if person is exposed to
psychoactive substances or has lifestyle risks
○ Epigenetic mechanisms could also contribute
● Neuroprogression → changes in brain structure & cellular function
○ Observed in studies of recurrent affective disorder
○ Reduced cortical thickness in brain regions like PFC (stress regulation)
○ Epigenetic mechanisms, deregulation of mitochondrial function, pathways
subserving neuroplasticity, inflammation, increase in oxidative & nitrosative stress
have been proposed as factors that proposed neuroprogression in bipolar
○ Changes in HPA axis play a role
○ May account for worsening cognitive & functional impairments
○ May contribute to higher prevalence of coexisting conditions
○ Evidence for further progression of disorder being associated with worsened
response to mood-stabilizing medication
○ A subgroup of people experience no cognitive and psychosocial differences
(heterogeneous disorder)
Management
● General principles
○ Most patients seek primary care help
, ○ Other disorders that mimic affective episodes should be ruled out (substance
abuse & psychotic disorders)
○ Factors influencing treatment
■ Patients preference
■ Coexisting conditions
■ Safety of patients during episodes should be ensured
■ Discuss pharmacological & non pharmacologic treatments
■ Monitor adherence
● Treatment of acute episodes
○ Acute mania
■ Pharmacologic treatment is first step
■ If resistant or severe → combined with nonpharmacologic
■ Mood stabilizers (eg lithium)
■ Antipsychotics (eg aripiprazole, risperidone)
■ No meaningful differences found in the efficacy of the medications
■ If there is no response to medication after 1-2 weeks, different medication
is considered
● Combination of antipsychotic with mood stabilizer is more effective
for severe mania
■ Antipsychotics can have metabolic adverse effects
■ Electroconvulsive therapy has been reported to be effective for refractory
mania & aggressive/psychotic symptoms
○ Acute depression
■ Patients with bipolar are depressed more of the time than they are
manic/hypomanic
■ Greater presence of unwanted side effects of drugs during depressive
episodes than manic episodes
● Low initial dose and gradual upward dose recommended
● Only limited number are approved for episodes (4)
■ Other treatments are usually used alongside drugs (antipsychotic with
mood stabilizers)
■ Efficacy of ketamine & anti inflammatory drugs suggested in RCTs
■ Controversy
● Treatments with antidepressants may carry risk of switches to
(hypo)mania during treatment (affective switches)
● Acceleration of cycling between episodes
■ Nevertheless SSRIs have been demonstrated to be effective in short term
(small effect sizes, no significant differences in response or remission)
● Effects are limited
■ Risk of switches is higher among bipolar I than bipolar II → less use of
antidepressants but if necessary, combined with mood stabilizers
■ ECT is effective for treatment resistant depression
The benefits of buying summaries with Stuvia:
Guaranteed quality through customer reviews
Stuvia customers have reviewed more than 700,000 summaries. This how you know that you are buying the best documents.
Quick and easy check-out
You can quickly pay through credit card or Stuvia-credit for the summaries. There is no membership needed.
Focus on what matters
Your fellow students write the study notes themselves, which is why the documents are always reliable and up-to-date. This ensures you quickly get to the core!
Frequently asked questions
What do I get when I buy this document?
You get a PDF, available immediately after your purchase. The purchased document is accessible anytime, anywhere and indefinitely through your profile.
Satisfaction guarantee: how does it work?
Our satisfaction guarantee ensures that you always find a study document that suits you well. You fill out a form, and our customer service team takes care of the rest.
Who am I buying these notes from?
Stuvia is a marketplace, so you are not buying this document from us, but from seller lindej03. Stuvia facilitates payment to the seller.
Will I be stuck with a subscription?
No, you only buy these notes for $9.76. You're not tied to anything after your purchase.
Can Stuvia be trusted?
4.6 stars on Google & Trustpilot (+1000 reviews)
75632 documents were sold in the last 30 days
Founded in 2010, the go-to place to buy study notes for 14 years now