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Unit 6 Bipolar and Related Disorders (1)

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10 views

Unit 6 Bipolar and Related Disorders (1)

Uploaded by

Esayas Nasha
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Unit 6:

By: Meka Kedir

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 1


Bipolar Disorders
I. Clinical Descriptions and
Epidemiology of bipolar Disorders
II. Etiology of bipolar Disorders
III. Suicide

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 2


Bipolar and Related Disorders

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Clinical Descriptions and Epidemiology of
Bipolar Disorders

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 4


Bipolar Disorders

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 5


DSM-5 Criteria for
Manic and Hypomanic Episodes
Distinctly elevated or irritable mood for most of the day nearly every day
Abnormally increased activity and energy
At least three of the following are noticeably changed from baseline (four
if mood is irritable):
◦ Increase in goal-directed activity or psychomotor agitation
◦ Unusual talkativeness; rapid speech
◦ Flight of ideas or subjective impression that thoughts are racing
◦ Decreased need for sleep

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Manic and Hypomanic Episodes…

◦Increased self-esteem; belief that one has special talents, powers,


or abilities (grandiosity delusion)

◦Distractibility; attention easily diverted

◦Excessive involvement in activities that are likely to have


undesirable consequences, such as reckless spending, sexual
behavior, or driving
11/29/2022 PSYCHIATRIC LECTURE BY MEKA 7
DSM-5 Criteria for
Manic and Hypomanic Episodes…
For a manic episode:

◦Symptoms last for 1 week or


require hospitalization or include
psychosis

◦Symptoms cause significant distress


or functional impairment

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Cont’d…
For a hypomanic episode:
◦Symptoms last at least 4 days
◦Clear changes in functioning
that are observable to others,
but impairment is not marked
◦No psychotic symptoms are
present

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Cont’d…
Bipolar I
◦At least one episode or mania
Bipolar II
◦At least one major depressive
episode with at least one
episode of hypomania

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 10


Cont’d…
Cyclothymic disorder (Cyclothymia)
◦ Milder, chronic form of bipolar disorder
◦ Lasts at least 2 years in adults, 1 year in
children/adolescents
◦ Numerous periods with hypomanic and depressive
symptoms
◦ Does not meet criteria for mania or major
depressive episode
◦ Symptoms do not clear for more than 2 months at a
time
◦ Symptoms cause significant distress or impairment

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 11


Epidemiology and Consequences
Prevalence rates of BD
◦0.6% worldwide for Bipolar I
◦0.4% – 2% for Bipolar II
◦4% for Cyclothymia
Average age of onset in 20s
No gender differences in rates of bipolar
disorders
◦ Women experience more depressive
episodes
Suicide rates high
11/29/2022 PSYCHIATRIC LECTURE BY MEKA 12
Etiology of Bipolar Disorders
What factors contribute to onset
of mood disorders?
◦Neurobiological factors
- Genetics ,high level of
dopamine ,Serotonin and
norepinephrine
◦Psychosocial factors

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 13


Etiology of Bipolar Disorders…

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Key Brain Structures Involved in Mood Disorders

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Social and Psychological Factors in Bipolar Disorder
Negative life events,
Negative cognitions,
expressed emotion, and
lack of social support
Predictors of mania;
◦Reward sensitivity
◦Sleep disruption

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 16


Treatment of Bipolar Disorders

Psychological treatment of bipolar


disorder
◦ Psychoeducational approaches
◦ Provide information about symptoms, course,
triggers, and treatments
Family-focused treatment (FFT)
◦ Educate family about disorder, enhance family
communication, improve problem solving

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 17


Biological Treatment of Bipolar Disorders
 Electroconvulsive therapy (ECT)
◦ Reserved for treatment non-responders
◦ Induce brain seizure and momentary
unconsciousness
◦ Unilateral ECT
- Side effects
◦ Memory loss
◦ ECT more effective than medications
◦ Unclear how ECT works

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 18


Medications for Treating Bipolar Disorders

Lithium
◦ Up to 80% receive at least some relief with
this mood stabilizer
◦ Potentially serious side effect
◦ Lithium toxicity

Newer mood stabilizers


◦ Anticonvulsants
◦ Depakote
◦ Antipsychotics
◦ Olanzapine /Zyprexa
◦ Both also have serious side effects

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 19


Suicidality

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Key terms
Suicide ideation: thoughts of killing oneself
Suicide attempt: behavior planned to kill
oneself
Suicide: death from deliberate self-injury
Non-suicidal self-injury: behaviors intended
to injure oneself without intent to kill oneself

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 21


Epidemiology
worldwide, 9% report suicidal ideation at least once in their lives,
2.5% have made at least one suicide attempt
Men are four times more likely than women to kill themselves;
women are more likely than men are to make suicide attempts that do not
result in death
 Men usually shoot or hang themselves;
women more likely to use pills
In Ethiopia the prevalence of suicidal ideation and attempted suicide were
ranged from 1 to 55% and 0.6% to 14% respectively.
Being divorced or widowed elevates suicide risk four- or fivefold

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 22


Risk Factors for Suicide
Psychological Disorders Social Factors
◦ Half of suicide attempts are ◦ Economic recessions
depressed at the time of the ◦ Media reports of suicide
act ◦ Social isolation and a lack of social
belonging
Neurobiological Models
Psychological Models
◦ Heritability of 48% for suicide ◦ Problem-solving deficit
attempts
◦ Hopelessness
◦ Low levels of serotonin ◦ Life satisfaction
◦ Overly reactive HPA system ◦ Impulsivity

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 23


Preventing Suicide

Talk about suicide openly and matter-of-factly


Treat the associated mental disorder
Treat suicidality directly
Suicide prevention centers

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 24


Thank you!

11/29/2022 PSYCHIATRIC LECTURE BY MEKA 25

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