lecture 2 mania and bipolar disorder severe mental health

  • Created by: Cruick96
  • Created on: 08-12-17 21:51
what percentage of the population are diagnosed w/ bipolar disorder?
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what are some general issues w/ diagnosing bipolar disorder?
identification = complex - episodic and variable nature of it. most frequently misdiagnosed as unipolar depression
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what did o'connell find about bipolar?
approx. 44% patients hospitalised for 1st ep relapse in 1 year
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how does hospitalisation differ for bipolar disorder?
more frequent hospitalisations than p's w/ SZ and longer stays when in hospital
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what did bauwens et al find about bipolar?
when asymptomatic, have good psychosocial functioning but is still poorer than controls
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what are the gender differences in bipolar?
type 1 there is no difference in sex. women 23x more likely to be admitted w/ episode of BPD in 1st postpartum month
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who is more vulnerable to bipolar?
more common in urban areas, higher social classes
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when is the onset of bipolar?
typically in early adolescence/early adulthood. mean age = 21 years
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how does mortality related to bpd?
increased risk - ramsey et al looked at 14,870 p's at 26 year follow up - increased mortality in mid-late life from all causes for ps w/ mania
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how does suicide relate to bpd?
estimates converge on about 7% of patients. some uk reports - 20% bipolar deaths due to suicide and 60% mention suicide ideation
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when does treatment occur for bpd?
average delay between onset of symptoms & treatment estimated to be around 6-8 years, sometimes a decade
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what are the costs associated w/ bipolar?
2002 estimated that NHS spent £199 million caring for people w/ bpd. Finberg et al estimated total costs of mood disorders in uk is about £19 billion = 25% were direct healthcare costs
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what disabilities are associated w/ bipolar?
one of top 20 leading causes of disability worldwide. estimated a young person receiving diagnosis inUS can expect to lose on average 9 years of life, 12 years of normal health & 14 years of employment
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what is the unemployment rate of bpd?
estimated to be around 46%
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what are the 4 types of bpd?
type 1, type 2, cyclothymic disorder & other specified & related disorders (bpd w/ psychosis)
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what is bpd type 1?
at least 1 ep of full blown mania/mixed ep (manic and depressive symptoms), usually has at least 1 depressive ep, usually psychotic experiences
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what is bpd type 2?
several protracted depressive eps and at least 1 hypomanic ep (doesn't quite meet criteria for mania). no manic eps
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what is cyclothymic disorder?
several periods of hypomanic and depressive symptoms. depressive symptoms don't meet criteria for depressive eps. subthreshold condition over all. rapid cycling between depression & hypomania
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what are the main dsm criteria for a manic ep?
elevated, expansive or irritable mood, lasting at least 1 week unless hospitalisation necessary, sig. distress/impairment of functioning
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what are the other dsm criteria for mania?
inflated self esteem/grandiosity, decreased need for sleep, more talkative, flight of ideas, distractability, increased goal directed activity, excessive involvement in pleasurable activities
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what is flight of ideas?
pressured/tangential speech, can still follow thought process, or racing thoughts
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what is increased goal directed activity?
increased house cleaning/sex seeking or psychomotoro agitation
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what are the dsm criteria for a hypomanic ep?
same symptoms as manic but duration criteria not met - 4 days. must be clearly different from usual euthymic mood, delusions and hallucinations may not be present, disruption to occupationa/social functioning not market, no hospitalisation, no psycho
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what are the dsm criteria for mixed ep?
criteria for manic and major depressive disorder met apart from duration. every day for at least a week. impairment to occupational functioning, social activities or relationships w/ others
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what is known about mixed mania?
dysphoric mood = normal component of mania, mixed states qualitatively different than simple mania, ps w/ this have euphoria & dysphoria simultaneously, ps in mixed states show ultra-rapid cycling between the 2, dys mood evident to different degrees
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what is rapid cycling?
4 bp eps in 1 year, eps marked by full/partial remission between 2 months/switch in polarity, continuous cycling (polarity w/ no remission), considered transient state not permanent, higher freq in people w/ earlier onset & women
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what is the lifetime prevalence of bpd spectrum?
in epidemiological date - 2.4%, 4-6% if including subthreshold symptoms
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what are bipolar spectrum disorders?
share many features w/ bipolar 1, affected persons don't meet full criteria though
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what is cyclothymic disorder?
pronounced mood instability - short periods of mild depression and hypomania
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how does cyclothymic disorder progress?
10% will develop type 1, 42% will develop type 2 within 4.5 year period. of these w/ type 2, about 10% will develop type 1 within 4.5 year period
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what did perugi estimate?
27-62% of all major depressions involve some degree of hypomania - often missed
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what did eckblad and chapman do?
developed 48 item hypomanic personality scale - self report measure of personality traits associated w/ hypomanic euphoria such as gregariousness and overactivity
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what did kwapli et al find?
13 year follow up of hypomanic personality scale high (n=36) and low (31) scorers. hypomania = 28% vs 3%, mania = N=2, vs n = 0
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what did leonard say about bpd?
argued unipolar mania = rare, and that bipolar disorder is therefore a variant of depression. led to widespread acceptance of bp concept
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what did cassidy et al do?
factor analysis of symptoms of over 200 manic & mixed manic ps and found 5 factors
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what were the 5 factors cassidy et al found?
dysphoric mood, increased hedonic functioning, psychomotor pressure, psychosis and irritability
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what is increased hedonic functioning?
euphoric mood, increased humour, increased interest in sex
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what is increased psychomotor pressure?
racing thoughts, rapid speech, increased activity
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what is lability?
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what did hunt et al find?
irritable only and elated only subgroups constituted only 10% and 15% of sample
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what did katin and goodwin find?
depression ratings are sometimes higher during manic than depressive eps
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what did strakowski find?
depression during mania more assoc. w/ suicide than during depressive eps
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what did goldberg et al find?
1380 p's w/ either type 1 or type 2. 54% had concurrent subsyndromal manic symptoms as a subsyndromal level, 14.8% met criteria for mixed ep
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what is the primacy of mania hypothesis?
intrinsic link between mania and depression, but excitatory process of mania is the primary process, w/ depression being a secondary result
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what is lithium?
has antimanic properties, but alleviates depressive symptoms. discontinuation of it often leads to manic ep. service users often report mania occurring before depressive ep
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what did Johnson, bentall et al do?
reanalysed data from MRC CBT for bipolar trial to ask q: do mania and depression negatively covary over time? 236 type 1 interviewed monthly to yield weekly assessments of mania and depression.
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what were the findings of johnson, bentall et al's study?
autocorrelation effect significant - past weeks mania predicted current mania (effect size v small tho - mania was poor predictor of depression and vice versa). no effect for week - no overall progression of symptoms.
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what did judd et al say about clinical implications?
subsyndromal manic symptoms during bpd MDE's highly prevalent (76.1%) and consistently linked to higher suicidality
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what did Goldberg et al say about clinical implications?
manic symptoms often accompany bipolar depressive eps but may be easily overlooked when appear less prominent than depressive features
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what was scott et al's evidence of depression like cog processes?
remitted ps score highly on dysfunctional attitudes scale, an index of vulnerability to self esteem problems
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what was jones et als evidence of depression like cog processes?
found neg self esteem distinguished both unipolar and bipolar ps from controls but was closely associated w/ depression
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what was lam et al's evidence of depression like cog processes?
found 6 items discriminated bpd from unipolar ps?
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what did kernis et al find about self esteem stability?
used self report diaries, pos & neg daily events had greater impact on self-feelings of indivs w/ unstable self esteem. intra-indiv self esteem ratings had greatest impact and varied relatively independently of average self esteem
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what did knowles et al find about self esteem and bpd?
average self esteem, very little difference. but in intra indiv - self esteem much more affected in bpd than controls and unipolar
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what was found in van der gruchts replication of knowles et als study?
looked at different groups - remitted ps added. average self esteem lowest in depressed ps, though intra indiv much higher in other groups compared to control
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what is the depression avoidance hypothesis?
vulnerability to mania is associated w/ depressogenic psychological processes. mania arises from attempts to avoid a neg emotional state
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what are the 4 suggested main response styles to depression?
rumination, problem solving, distraction and risk taking
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how do response styles to depression differ amongst controls, remitted, depressed and manic ps?
manic = greater use of active coping and risk taking than others. bp remitted = greater rumination.
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who is bad at problem solving?
unipolar depressed & bipolar indivs
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what did nolen-hoeksema find about ruminative tendency to cope w/ depressed mood?
impacts psychosocial wellbeing, linked to interpersonal problems, increases duration & severity of depression, predictive of depressive disorders & recurrent depression
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what did lam & wong find about the role of circadian desynchrony?
ps w/ bpd known to relapse after long distance travelling/jet lag
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what did healy argue about circardian desynchrony?
mood disorder incl mania are consequence of desynchrony of circadian rhythms. observed cog biases result from ps inferences about emotional & physiological changes that accompany desynchrony
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what did hudson et al find about role of circadian desynchrony?
nocturnal physiological measurements confirm mania is associated w/ loss of sleep
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what did barbini et al find about role of circadian desynchrony?
reported correlation between sleep duration and manic symptoms the next day
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what did markof-schwartz et al do?
measured social rhythm disrupting life events in remitted bipolar ps - about 2/3 of ps who became manic but none who became depressed experienced a SRD event within 8 week period preceding an ep
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what did harvey et al find?
euthymic BD ps showed similar levels of sleep disturbance to insomniacs
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what did colombo et al find about circadian desynchrony?
deprived 200 bipolar depressed ps of 3/5 nights sleep - only 5% showed manic symptoms and only 4 needed drug treatment for mania
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what did ng et al find about circadian desynchrony?
conducted meta analysis of sleep studies w/ interepisodic bdp ps - evidence of impaired sleep on all measures incl. actigraphy. effect as comparable to that in insomnia ps and effect most evident on questionnaire measures
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what did Perlman, Johnson & Mellman find about sleep predicting eps?
54 ps recruited when well, baseline symptoms assessed at 4 months (to allow recovery). sleep assessed at 6 months and symptoms assessed over 7-12 months. reduced sleep duration predicted depressive but not manic symptoms during follow up period
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what did gray argue about reward responsivity & mania?
argued there are 2 fundamental neuropsychological systems underlying motivation & emotion - behaviour inhibition system & behavioural activation system
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what is the behavioural inhibition system?
mediates response to punishment
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what is the behavioural activation system?
mediates response to reinforcement
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what did depue argue about reward responsivity & mania?
argued manic symptoms = manifestation of dysregulation of BAS, which is why ps are highly sociable, desire excitement & show high levels of motor activity
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what are carver & white's subscales of BIS/BAS scales?
behavioural inhibition (criticism or scolding hurts me quite a lot), reward responsiveness (when i'm doing well at something i like to keep at it), drive(go out of my way to get things i want), fun seeking (often act on spur of moment)
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what did myers, johnson & carver do?
tested 357 students who completed screening measure of manic & behavioural eps. regression revealed BAS fun seeking uniquely predicted self reported mania, BIS uniquely predicted self-reported depression
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what did mayer, johnson & winter find about BIS/BAS?
59 BD-I ps assessed monthly over 24 months - BIS cross sectionally associated w/ depression but didn't predict depression longitudinally. BAS scales not associated w/ current mania but predicted exacerbation of manic symptoms
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what did salavert et al find about BIS/BAS?
77 BD-I ps given sensitivity to punishment & sensitivity to reward scales & followed up over 18 months - those w/ manic eps had higher sensitivity to reward scales at baseline
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what did johnson et al do about goal attainment life events?
125 BPD-I ps interviewed monthly for av. 27 months. life events coded for threat (43.4% of ps), goal attainment (14.7%). symptoms assessed using hamilton/bech-rafaelson scales
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what was found in johnson et al's study regarding threat events?
depression predicted by baseline depression, severity of neg life event but not interaction between the 2. no prediction for mania
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what was found about goal attainment in johnson et al's study?
mania predicted by baseline mania, severity of goal attainment life event, but not interaction between the 2. results suggest different eps are related to specific life events but reactivity is not enhanced by existing symptoms. effect size small tho
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what did beck say about cognitions underlying mania?
mania mirrors depression, w/ pos dark triad: beliefs about self, world & future
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what did mansell et al find about cognitions underlying mania?
indivs prone to bipolar disorder attribute extreme personal meanings to change in internal states. appraisals can provoke spiral of change in internal state, appraisal, behav response & change in life experience that escalates in to mania
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what is the hypomanic interpretations questionnaire?
13 common relevant hypomania exps each followed by 3 poss explanations: pos self-dispositional appraisals, normalising internal explanations & normalising external explanations
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what is an example of a positive self-dispositional appraisal?
people can't keep up with me because i am full of good ideas and others are too slow
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what is an example of normalising internal explanations?
people can't keep up with me cos i am overstimulated at the moment
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what is an example of normalising external explanations?
people can't keep up with me cos there are too many demands on my time
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what was jones et al's 1st study on cogs underlying mania?
HIQ scores adequate reliability (internal, test retest) & HIQ-H subscale scores predicted hypomanic personality scores in student ps
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what was jones et als 2nd study on cogs underlying mania?
HIQ scores differentiated between self diagnosed bipolar ps (manic depressive fellowship) and controls. cut off 25. sensitivity (correctly detected) = 67%, specificity (controls correctly classified) = 68%
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what are the 4 factors johnson and jones came up with that correlated w/ HPS scores?
acting before thinking, pos interpretation of manic symptoms, over confidence following success, tendency to dampen pos emotions
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