ECON 546 Lecture Notes - Lecture 11: Ketamine, Grey Matter, Glucocorticoid
27 Jun 2018
School
Department
Course
Professor
Lecture 11: Bipolar Disorders Monday, February 12, 2018
Dr. Serge Beaulieu
The Basics
- Two phases of the disease: manic and depressive
oSome patients are mostly depressive, with only minor/infrequent manic
episodes
- In psychiatry, it is important for a diagnosis to be made only if there is a functional
impact
oOr else everyone would be diagnosed
- Epidemiology
oBipolar I: 1%
Periods of severe mood episodes from mania to depression
oBipolar I & II: 3%
Milder form of mood elevation, involving milder episodes of hypomania
that alternate with periods of severe depression
oBipolar spectrum: >4%
oNo gender preference
- Cause: genetic plus developmental, societal, cultural, environmental events
- Peak onset: 15-19 years, up to late 20s and 30s
- Cycles of acute or psychotic mania followed by acute or psychotic bipolar depression
- Mania: thoughts are very accelerated, difficult to link together
oDepressive mania: thoughts are very sad, can be suicidal
- Minimum duration of episode is 7 days for mania, hypomania for 4 days
- Rapid cycling: 4 episodes a year or more
Symptoms of Mania/Hypomania
- Decreased need for sleep
oTriggers manic phase
- Increased energy or motor agitation
- Racing thoughts
- Irritability
oMost common symptom
- Classic euphoria or elation
oMore common in late adolescence and early 20s
Distinguishing Symptoms
- Mania
oSevere, severe dysfunction
oMajor lapses of judgment
oPsychotic symptoms
oOften requires inpatient treatment
oNeed for acute mood stabilizer and/or neuroleptic treatment
find more resources at oneclass.com
find more resources at oneclass.com
- Hypomania
oMild, less severe
oLittle to mild dysfunction
oLittle to mild lapses of judgment
oCommonly responds to outpatient management
oSleep regulation and/or benzos can sometimes terminate episode
Myths and Misconceptions
- The word manic has a derogatory association and was associated to violence or
dangerous behaviours
- Name changed to bipolarity to reinforce the concept of polarity in the episodes
Early Evolution of the Disease
- First impairment associated with affective symptoms: 15.5 years old
- First fulfillment of diagnostic criteria: 18.7 years
- First treatment: 22.0 years
- First hospitalization: 25.8 years
- Studies show that the delay between the first emergence of symptoms and diagnosis of
the disorder is about 10 years
oA decade ago, most bipolar patients were 30-40 years old, with 15 years of
illness history not properly diagnosed
Bipolar Disorders Classification
- Substance-induced bipolar disorder: use of marijuana, PCP, etc. can trigger episodes
- DSM is an American classification, the real international classification is the ICD 11
SNPs
- There are SNPs associated with depressive disorders, and also with bipolar disorder
Sources of Phenotype Heterogeneity
- Genetic
- Biotype/biomarkers – driven classification
- Disease pattern/cycling/comorbidities and functional consequences
- “The biology of psychotic illnesses may fail to align neatly with the classic Kraeplinian
distinction between schizophrenia and manic-depressive illness”
Research Domain Criteria (RDoC)
- Research framework for new approaches to investigating mental disorders, integrates
many levels of information in order to explore basic dimensions of functioning that span
the full range of human behaviour
- Information should be collected from patients from all of these domains: negative
valence systems, positive valence systems, cognitive systems, systems for social
processes, arousal/regulatory systems
oNegative valence: fear, anxiety
oPositive valence: motivation, reward learning
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Two phases of the disease: manic and depressive: some patients are mostly depressive, with only minor/infrequent manic episodes. In psychiatry, it is important for a diagnosis to be made only if there is a functional impact: or else everyone would be diagnosed. Periods of severe mood episodes from mania to depression: bipolar i & ii: 3% Milder form of mood elevation, involving milder episodes of hypomania that alternate with periods of severe depression: bipolar spectrum: >4, no gender preference. Cause: genetic plus developmental, societal, cultural, environmental events. Peak onset: 15-19 years, up to late 20s and 30s. Cycles of acute or psychotic mania followed by acute or psychotic bipolar depression. Mania: thoughts are very accelerated, difficult to link together: depressive mania: thoughts are very sad, can be suicidal. Minimum duration of episode is 7 days for mania, hypomania for 4 days. Rapid cycling: 4 episodes a year or more. Decreased need for sleep: triggers manic phase.
