Unit 6:
By: Meka Kedir
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Bipolar Disorders
I. Clinical Descriptions and
Epidemiology of bipolar Disorders
II. Etiology of bipolar Disorders
III. Suicide
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Bipolar and Related Disorders
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Clinical Descriptions and Epidemiology of
Bipolar Disorders
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Bipolar Disorders
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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
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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
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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
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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
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Etiology of Bipolar Disorders
What factors contribute to onset
of mood disorders?
◦Neurobiological factors
- Genetics ,high level of
dopamine ,Serotonin and
norepinephrine
◦Psychosocial factors
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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
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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
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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
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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
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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
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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
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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
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Preventing Suicide
Talk about suicide openly and matter-of-factly
Treat the associated mental disorder
Treat suicidality directly
Suicide prevention centers
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Thank you!
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