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Bipolar disorder (Epidemiology (Suicide (Risk factors (Family history,…

- - - - lead to psychosis and lose touch with reality e.g. hallucinations
      - difficult to treat as need to balance medication
  - - - 8 studies included
      - 740 patients
      - Re-occ
        
        41% 1 year
        
        25.7% 6months
        
        60% 4 years
      - Youth @ first episode associated with risk of reoccurrence 1 year later
  - - - Family history
      - Substance abuse
      - Social isolation: 'us vs them' attitude adopted by many with BPD
- - - - 60/70% remission
    - - 33 RCTS, 7000 patients, all treatments better than a placebo
      - Issues of side-effects and non-adherance
        
        Non-adherence
        
        60% fully or partially do not adhere to prescribed drugs after a manic or mixed episode - depressive less so? 20% of Lithium takers are adherent (80% not - high)
        
        Risk of relapse or suicide, particularly in younger, more severe or hospitalized patients. Comorbid patients (PDs or SUDs) more likely not to adhere
    - - Antidepressants
        
        Can induce mania
        
        Are effective at dealing with depression
        
        Best when combined with Lithium
  - - - Explains strategies for symptom identification, relapse prevention, ensuring adherence and reducing risky behaviour
  - - - I
        
        Most important?
        
        Very effective especially for treating mania
        
        Less effective for depression symptoms
        
        Allows work on individuals specific needs e.g. 'alarm signals' - red flags/ triggers
    - - Reduces stigma
      - High drop out - 30%
      - Learn from one another e.g. self-care
      - Less relapse
      - Not adapted to the individual
  - - - Improve knowledge of bipolar (educate), reduce Expressed Emotion, Enhance Communication, Problem Solving training (cog)
        
        RCTs show less hospitalization and better adherence are effects of this treatment type
- - - - Hence treatment should also be different than for unipolar depression
  - - - Less severe version but still characterised by noticeable mood swings
      - Symptoms present for 2 years
- - - - Positive feedback
        
        Acceleration of mania
- - - - 'major episode' consists of
        
        lasting at least a full week if not longer
        
        hospitalization required
      - Could be a mixed episode (depression symptoms also present)
      - Preceded by
        
        Irritability/ Distractability
        
        Euphoria
        
        Grandiose ideas
        
        Impulsive behaviour
  - - - Meaning
        
        The same symptoms but milder/ less impairing/ for a shorter period/ not requiring hospitalization
    - - Consisting of
        
        Two or more weeks
        
        Intense sadness, loss of interest, fatigue
        
        Insomnia
        
        Weight change
        
        Suicide attempts
- - - - Hospitalization for 6 months - labelled as Schizophrenia
    - - Diagnosed (4+ years after onset) as PD and put on Lithium
- - - - some estimates as high as 85%
      - Different for mania and depression
      - 57% concordance for MZ twins
    - - Schz
        
        8% risk PD MZ twins
        
        13% risk Schz if parents mania
        
        COMT: control of metabolism of dopamine in prefrontal cortex (PFC) associated
- - - - Sleep deprivation: a vicious cycle
        
        interfere with dopamine receptors
      - Manic symptoms
    - - Mood disorders associated with decreased sensitivity of serotonin receptors
      - Inhibiting Tryptophan (pre-cursor for S) in trials
        
        Showed that families with PD members show increased and decreased cognitive deficits
    - - Associated with 3x risk of manic symptoms
      - Higher impulsivity etc