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Block 3 Unit 2 Bipolar Disorder

1. What do you mean by bipolar disorder? How does it differ from other mood disorders?

• Bipolar disorder, also known as manic-depressive disorder, is a psychiatric condition characterised by episodes of abnormally elevated energy levels, cognition, and mood (mania or hypomania), with or without depressive episodes.
• It differs from other mood disorders, such as unipolar depression, in that it involves both manic or hypomanic episodes and depressive episodes, while unipolar depression only involves depressive episodes.

2. Discuss the symptoms of bipolar disorders in detail.

• Bipolar disorder is characterised by distinct episodes of mania, hypomania, depression, or mixed states.
• Depressive Episodes: Features include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness; disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems in concentration, loneliness, self-loathing, apathy or indifference; loss of interest in sexual activity; shyness or social anxiety, irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal ideation. Severe cases may include psychotic features.
• Manic Episodes: These involve abnormally elevated mood, flight of ideas, and increased psychomotor activity.
• Hypomanic Episodes: These are periods of manic behaviour that are not extreme enough to greatly impair function. They are less severe than manic episodes.
• Mixed Episodes: These blend depressive and manic/hypomanic features, where criteria for both mania and depression are met simultaneously.

3. What is a manic episode? Differentiate between manic and hypomanic episodes.

• A manic episode is a state of abnormally elevated mood, flight of ideas, and increased psychomotor activity. Manic episodes are severe enough to cause significant impairment in social or occupational functioning, and can sometimes include psychosis.
• A hypomanic episode is a period of manic behaviour that is less extreme than a full manic episode. It does not typically cause severe social or occupational impairment and is without psychosis. Hypomanic episodes are a less intense version of mania.

4. Discuss the types of bipolar disorder. Differentiate between bipolar I disorder and bipolar II disorder.

• The DSM-IV-TR lists three specific subtypes and one non-specified category of bipolar disorder:
  • Bipolar I Disorder: Characterised by manic or mixed episodes that last at least seven days, or manic symptoms that require immediate hospital care. Depressive episodes typically also occur, lasting at least two weeks.
  • Bipolar II Disorder: Defined by a pattern of depressive episodes alternating with hypomanic episodes, but without full-blown manic or mixed episodes.
  • Cyclothymia: A milder form of bipolar disorder, with hypomanic episodes shifting back and forth with mild depression for at least two years.
  • Bipolar Disorder NOS (Not Otherwise Specified): Diagnosed when a person has symptoms that do not meet the criteria for either bipolar I or II.
• Key differences:
  • Bipolar I involves full manic episodes, while Bipolar II involves hypomanic episodes.
  • Bipolar I can include mixed episodes and periods of psychosis, while Bipolar II does not include full manic or mixed episodes.

5. Explain the causes of bipolar disorder.

• The causes of bipolar disorder are likely to vary between individuals.
• Biological Factors:
  • Studies suggest a strong genetic component. Family studies show a higher risk of mood disorders among relatives. Twin studies indicate higher concordance rates for identical twins than fraternal twins. The overall heritability has been put at 0.71.
• Psychological Factors:
  • Psychological factors and individual psychosocial variables may interact with genetic dispositions.
  • Early experiences of adversity and conflict may increase the risk of developing bipolar disorder.
• Environmental Factors: Recent life events and interpersonal relationships can contribute to the likelihood of onset and recurrence of bipolar mood episodes.

6. Describe the treatment and prognosis of bipolar disorder.

• Treatment:
  • Long-term treatment is required to maintain control of symptoms.
  • Effective plans include medication and psychotherapy to prevent relapse and reduce severity.
  • Medications may include mood stabilisers, atypical antipsychotics, and antidepressants.
  • Psychoeducation, often delivered in group settings, helps people recognise signs of relapse.
  • Psychotherapy may include cognitive-behavioural therapy.
• Prognosis:
  • A good prognosis is associated with effective treatment and an accurate diagnosis.
  • Many individuals can live full and satisfying lives with proper management.
  • Factors within an individual's control like adherence to medication, knowledge of the disease, good relationships with doctors and therapists and good physical health contribute to improved prognosis.
  • Studies have shown that while many achieve recovery, a significant percentage may experience new episodes or switch phases.

7. Differentiate between bipolar disorder and other forms of depressive disorder.

Bipolar Disorder vs. Other Depressive Disorders

The key difference between bipolar disorder and other forms of depressive disorder lies in the presence of manic or hypomanic episodes in bipolar disorder. Depressive disorders, such as major depressive disorder and dysthymia, are characterised by persistent low mood and related symptoms without the presence of mania or hypomania.

Here's a more detailed breakdown:

• Bipolar Disorder:
  • Characterised by mood swings that include both depressive episodes and manic or hypomanic episodes.
  • Manic episodes are marked by abnormally elevated mood, flight of ideas, increased energy and psychomotor activity.
    • Manic episodes can be severe, causing significant impairment in social or occupational functioning, and may include psychotic symptoms such as hallucinations or delusions.
  • Hypomanic episodes are a milder form of mania that does not cause severe social or occupational impairment, and lack psychotic features.
  • Individuals may experience mixed episodes, where symptoms of both mania and depression are present simultaneously.
  • There are different types of bipolar disorder, including Bipolar I, which involves full manic episodes, and Bipolar II, which involves hypomanic episodes without full mania.
  • Cyclothymia is a milder form of bipolar disorder characterised by hypomanic and mild depressive episodes.
• Other Depressive Disorders:
  • Include conditions like major depressive disorder (MDD), dysthymia, and adjustment disorder with depressed mood.
    • The symptoms of major depressive disorder include severe and long lasting feelings of sadness or related symptoms that get in the way of a person’s functioning.
    • Dysthymia is characterised by long-term, chronic symptoms that do not disable, but keep one from functioning well or from feeling good.
    • Adjustment disorder with depressed mood occurs in response to a major life stressor or crisis, and does not exceed six months in duration.
  • These disorders are defined primarily by the presence of depressive symptoms, such as:
    • Persistent feelings of sadness, anxiety, guilt, anger, isolation or hopelessness.
    • Disturbances in sleep and appetite.
    • Fatigue and loss of interest in usual activities.
    • Problems with concentration.
    • Self-loathing, apathy, or indifference.
  • These disorders do not include the manic or hypomanic episodes that are characteristic of bipolar disorder.
  • In unipolar depression the mood remains at one emotional state or “pole”.

Key Differences Summarised:

In essence, bipolar disorder is distinguished by its fluctuating mood states that encompass both poles of emotion (mania/hypomania and depression), while other depressive disorders are characterised by primarily depressive symptoms without the manic/hypomanic component. It's important to note that individuals with bipolar disorder often experience depressive episodes, which can make it difficult to distinguish from other depressive disorders if a manic or hypomanic episode has not yet occurred.