Bipolar Disorder

1. Bipolar Disorder Astrid, Bradley, Colette, Jen, Kirstin, & Stephanie

2. What is Bipolar Disorder?

3. 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

4. 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

5. Types of Bipolar

6. 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

7. 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

8. 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

9. 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

10. 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

11. Onset, Prevalence, Signs & Symptoms

12. 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

13. 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?

14. Signs & Symptoms

15. Causes

16. 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

17. Triggers

18. Genetics

19. 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

20. 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.

21. Bipolar Brain: Differences in Function Facial Recognition Making Quick Decisions

22. 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