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Bipolar Disorder. Hallmark of Bipolar Disorder. Defined by manic symptoms Elevated, expansive or irritable mood (or any combination of these moods) plus (at least 3 or at least 4 if the mood is irritability)
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Hallmark of Bipolar Disorder • Defined by manic symptoms • Elevated, expansive or irritable mood (or any combination of these moods) plus (at least 3 or at least 4 if the mood is irritability) • Decreased need for sleep, racing thoughts, rapid speech, inflated self-esteem (grandiosity), impulsive reckless behavior, increased energy and activity, distractability
Mania versus Hypomania • Symptoms of mania must last at least one week or be interrupted by emergency treatment or hospitalization • Hypomania lasts for at least 4 days and results in a distinct change in functioning but not impairment. • Manic and depressive episodes can occur simultaneously in a mixed episode • A mixed episode must last at least one week and patients must fulfill criteria for a major depressive episode and a manic episode • At least 40% of bipolar patients have a mixed episode at some point in their illness
Bipolar Subtypes • Bipolar I: Presence of a single manic or mixed episode that is not substance induced (no depression required). • Unipolar mania rates are between 25%-33% in community samples but ~10% in clinical samples; • Most patients eventually have depressive episodes • Bipolar II • Major depressive episodes alternating with hypomanic episodes • 1 in 10 bipolar II patients eventually develops a full manic or mixed episode over a 10 year follow-up period (converting to a bipolar I).
Cyclothymia • Two or more years of alterations between hypomania and depressive symptoms but the alterations fall short of the meeting full criteria
Epidemiology • Approximately 4% of the population has bipolar I or II disorder • Cyclothymia affects 4.2 % of the general population • Major depressive illness is four times more prevalent than bipolar disorder • Approximately 1% of high school students met criteria for bipolar I or bipolar II
Age of Onset • Median age of onset for bipolar disoder is 25 years old • Based on the National Comorbidity Survey replication, 25% of patients had onset by age 17 • Earlier age of onset is associated with rapid cyclying
Sociodemographic Characteristics • Women and men have relatively equal rates of bipolar I disorder; • Women are more likely to have bipolar II disorder • Women are more likely to experience rapid cycling
Risk for Suicide • Suicide in bipolar disorder is at least 15 times higher than in the general population and four times higher than major depression • Approximately 50% of patients with bipolar disoder attempt suicide during their lifetime; • 15%-20% die by suicide
Diathesis/Personality/Stress: Bipolar Depression Stressor • Diathesis • Heritability ranges from 59% - 87% • Concordance for MZ twins is 57% • Females more at risk than males (for bipolar II) • Family history of bipolar disorders or unipolar disorders • Increase focus on neurotransmitter systems • Monoamine Dysreg • Overactive Norepinephrine • Excess in Dopamine • Negative life events • Low social support • High expressed emotion (criticism, hostility, emotional overinvolvment) • Sleep deprivation (for mania) • Personality • Hyperactive • Impulsive • Sensation Seeking (in response to threats) • Neuroticism • More sensitive to rewards (e.g. goal attainments)