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Bipolar disorder

Bipolar disorder. Woo Hee Lee. Bipolar disorder. Mood Disorder where person alternates between the hopelessness and lethargy of depression and the overexcited state of mania (Myers, Psychology) Manic-Depressive Disorder. Types. Bipolar I Disorder Bipolar II Disorder Cyclothymia

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Bipolar disorder

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  1. Bipolar disorder Woo Hee Lee

  2. Bipolar disorder • Mood Disorder where person alternates between the hopelessness and lethargy of depression and the overexcited state of mania (Myers, Psychology) • Manic-Depressive Disorder

  3. Types • Bipolar I Disorder • Bipolar II Disorder • Cyclothymia • Bipolar Disorder Not Otherwise Sepcified

  4. Major depressive episode • - An episode of a MOOD DISORDER • At least 2 weeks of depressed mood or anhedonia & at least four other symptoms • Poor/increased appetite & significant weight loss/gain • Insomnia/excessive sleep • Psychomotor agitation/retardation • Loss of energy with fatigue • Feeling of worthlessness/inappropriate guilt • Reduced concentration and ability to make choice • Repeated thoughts of death, suicidal ideation, attempted suicide

  5. Manic episode • At least 1 week of elevated, expansive, or irritable mood • At least three or more of the following • Increased activity/psychomotor agitation • Talkativeness or pressured speech • Flight of ideas or racing thoughts • Grandiosity and excessive self-esteem • Fall in need of sleep • Distractibility • Involvement in pleasurable activities with likeable unfortunate consequences

  6. Mixed episode • Mood Disorder • Lasting at least 1 week • Symptoms match for both a Major Depressive Episode and a Manic Episode

  7. Hypomanic episode • Elevated, expansive, or irritable mood • Lasting at least 4 days • At least three of the following • Self-esteem • Decrease in need of sleep • Increase in: speech, race of thoughts, distractibility, activity, psychomotor agitation, involvement in risky activities • Affect functioning and noticeable • Do not cause marked impairment

  8. Rapid cycling • Mood disturbance • Fluctuates over short period • Four or more mood episodes within a year • Episodes separated by symptom-free periods of at least 2 months or episode of opposite polarity

  9. Bipolar I disorder

  10. Features • Occurrence of Manic Episodes or Mixed Episodes • Often with Major Depressive Episodes • Substance-Induced Mood Disorder Episodes or of Mood Disorder Due to a General Medical Condition not counted • Not accounted by Schizoaffective Disorder and Psychotic Disorder • First Episode / Recurrence

  11. Features and Statistics • 10% to 15% of suicidal rate (completed) especially in depressive or mixed state • Child abuse, spouse abuse, other violent behavior • School truancy, school failure, occupational failure, divorce, episodic antisocial behavior • Usually associated with Alcohol and Substance Use Disorders • Anorexia Nervosa, Bulimia Nervosa, ADHD, Panic Disorder, Social Phobia • Increased rates of right-hemispheric lesions / bilateral subcortical / periventricular lesions

  12. statistics • Ethnicity, Age, and Gender • No reports based on race or ethnicity • Adolescents: 10% to 15% • Men = Women, but men with Manic and women with Major Depressive Episodes • Rapid Cycling more often in female • Women also associate with postpartum period • Prevalence • - Lifetime: 0.4% to 1.6%

  13. Course and pattern • Course • Average onset: 20 yrs (25% onset before 20) • Retrospective self-report 60% symptom onset before 20 • Recurrent – 90% • On average, 4 episodes in 10 years > Major Depressive • Family Pattern • First-degree biological relative with Bipolar I Disorder • Bipolar I Disorder 4% to 24% • Bipolar II Disorder 1% to 5% • Major Depressive Disorder 4% to 24%

  14. Bipolar ii disorder

  15. features • Occurrence of Major Depressive Episodes with at least one Hypomanic Episode • Hypomanic is not confused with euthymia • No Manic or Mixed Episode • Substance-Induced Mood Disorder or that due to General Medical Condition not included • Not accounted for Schizoaffective Disorder and Psychotic Disorder • In some cases, Hypomanic Episode do not cause impairment

  16. Features and statistics • 10% to 15% of Completed Suicide • School truancy, school failure, occupational failure, divorce • Mental disorders: Substance Abuse or Dependence, Anorexia Nervosa, Bulimia Nervosa, ADHD, Panic Disorder, Social Phobia, Borderline Personality Disorder • Medical Conditions: Hypothyroidism or mild thyroid hypofunction may associate with Rapid Cycling. Hyperthyroidism may keep or worsen hypomanic symptom.

  17. statistics • Women > Men • Men: Hypomanic Episodes • Women: Major Depressive Episodes, Rapid Cycling • Women more prone to depressive or intermixed mood symptoms • Women susceptible to develop episodes in immediate postpartum period • Lifetime Prevalence: 0.5%

  18. Course and pattern • Develop Hypomanic Episodes immediately before/after Major Depressive Episode: 60% to 70% • Lifetime episodes exceed that of Major Depressive Episode • Interval tends to decrease as person ages • Multiple Mood Episodes within a year: 5% to 15% • Continue mood lability & interpersonal or occupational difficulties between episodes: 15% • Psychotic symptoms not in Hypomanic Episodes and less in Major Depressive Episodes • Over 5 yrs, 5% to 15% of people develop Manic Episode • Biological Relatives elevates the rates of Bipolar II Disorder

  19. Cyclothymic disorder

  20. Features • Chronic, fluctuating mood disturbance of hypomanic symptoms & depressive symptoms • Hypomanic symptom not match for full criteria of Manic • Depressive symptom not match full criteria of MDE • Not Necessary to match Hypomanic Episode • Diagnosis only after initial 2 years of cyclothymic symptoms free of Major Depressive, Manic, and Mixed Episodes • Not account for Schizophrenia or Psychotic Disorders • Prolonged periods of cyclical, unpredictable mood changes

  21. Features and statistics • Substance-Related Disorders and Sleep Disorders may associate • Often begin early in life, reflect predisposition to other Mood Disorders • Men = Women • Life Prevalence: 0.4% to 1% • Mood Disorders Clinics: 3% to 5%

  22. Course and pattern • Begins in Adolescence or early adult life • If late in life, may suggest Mood Disorder due to General Medical Condition • Insidious onset & Chronic course • Development of Bipolar I or II Disorder: 15% to 50% • Family Pattern • First-degree relatives of persons with Cyclothymic Disorder have higher rates of MDD, Bipolar I or II Disorder • May be familial risk of Substance-Related Disorders • More Common in first-degree biological relatives of people with Bipolar I Disorder

  23. Bipolar disorder not otherwise specified

  24. Features • Do not meet criteria for Bipolar I or II Disorder or Cyclothymic Disorder • Examples • Very rapid alternation, not match minimal duration • Recurrent Hypomanic Episodes without depressive symptoms • Manic or Mixed Episode superimposed on Psychotic Disorder; Delusional Disorder; Residual Schizophrenia • Hypomanic Episodes with chronic depressive symptoms that are too infrequent • Diagnosed with Bipolar Disorder but unable to determine whether due to general medical condition or substance induced

  25. Jim Carrey • Jim Carrey – Actor, Comedian • Age 16, family troubles • Violent, depressed • Not talk to anyone • Throw himself against the walls • Let himself fall on the stairs • Depression even in the peak of success • Depression = Motivation behind comedies • Anti-depressant drug, Prozac www.nation.com.pk

  26. Sum-up Etiology • One of the most genetically influenced mental illnesses • Mechanisms yet unknown • Genetic and biological vulnerability & environmental factor work together • Reduction in activity of neurotransmitter • Abnormality in structure or function of receptors • Psychological agent • Stress agent • Hypothesis: bipolar disorder episodes and individual’s experiences cause stress, may influence brain and make organism to be more sensitive and react with episodes • Zubin & Spring, 1977 Stress-Model

  27. Multiple choice question 1 • What are the two features that should not be diagnosed as Bipolar II Disorder? • Manic Episode • Major Depressive Episode • Mixed Episode • Hypomanic Episode

  28. Multiple choice question 2 • Which mental illness is the least influenced by gene? • Acrophobia • Major Depressive Disorder • Bipolar I Disorder • Cyclothymic Disorder

  29. Multiple choice question 3 • What is the average onset of Bipolar I Disorder? • Childhood, usually associated with Child Abuse • Adolescence or Early Adulthood • Middle Age, after precipitation of stress over the years • No set time, it is very unpredictable

  30. Multiple choice question 4 • Which symptom can help the most for psychiatrist to diagnose patient with Bipolar Disorder? • The patients reports loss in weight and appetite • The Patients reports insomnia • The Patients reports severe inability to make choice • The Patients reports strong urge and will to participate in activities such as gamble, racing car and sexual activities

  31. Multiple choice question 5 • Who is least likely to develop Bipolar I or II Disorder? • Person diagnosed with Cyclothymic Disorder at age of 16 • Person with biological parents of Bipolar I Disorder • Person under lots of stress at his job and expectations for certain things • Person who eats excessive amount of fish and walnut.

  32. Free Response question • How is Bipolar Disorder different from Major Depressive Disorder?

  33. Bibliography (APA) • American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4thed.,Text Revision). Washington, DC, American Psychiatric Association. • Mash, E. J., & Barkley, R. A. (Eds.). (2003). Child Psychopathology (2nd ed.). New York / London, The Guilford Press • Miklowitz, D. J. (2002). The Bipolar Disorder Survival Guide: What You and Your Family Need to Know. New York / London, The Guilford Press. • Myers, D. J. (2010). Psychology (9th ed.). New York, Worth Publishers • Oddee. (2013, July 18). 10 Famous People Who Were Popular. Message posted to http://www.oddee.com. • VandenBos, G. R. (Eds.). (2007). A.P.A Dictionary of Psychology (1st ed.). Washington, American Psychological Association

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