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Part 2- L9.docx

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University of Otago
Gareth Treharne

Part 2- L9 Bipolar disorder Features of episodes of mania Features of depression - Euphoric or irritable mood - Depressed mood - Inflated self-esteem or grandiosity - Loss of interest - Decreased need for sleep - Weight change - Talkativeness, pressured speech - Insomnia/hypersomnia - Racing thoughts or flight of ideas - Agitation/ restlessness - Distractibility - Fatigue - Increased goal directed activity or - Worthlessness agitation - Impaired cognition - Excessive engagement in high-risk, - Thoughts of death pleasurable activities - Move and talk rapidly - conversation is often filled with jokes and attempts at cleverness - Flamboyance - Judgement is often poor Bipolar disorder I - Typically experience alternating episodes of depression and mania o Days o Weeks o Months o Years - Some may experience several episodes of either mania or depression, separated by periods of ‘normality’, in sequence. Bipolar disorder II - depressive episodes predominate - Swing between episodes of hypomania (an increase in activity over the normal, but not as excessive as mania) and severe depression - Will not have experienced an episode of mania Prevalence - 1-2% of adult population will have it at any one point - men and women does not differ o Women seem to have more depressive and fewer manic episodes o Men tend to cycle between these episodes more frequently o First episode usually occurs between 20-30 years Aetiology of bipolar disorder - Genetic factors o MZ twins 72% o DZ twins 14% o chromosomes 4, 6, 12, 13, 15, 18 and 22 - Biological mechanisms o serotonin and norepinephrine in depression  high levels of norepinephrine = mania  low levels of norepinephrine = depression  mania has been associated with low levels of serotonin – just as in depression  Low serotonin combined with low norepinephrine results in depression; combined with high norepinephrine, it results in mania o logical to assume that they also play a role in mania o Disturbances in activity of second messengers known as phosphoinositides, that instigate the firing of nerves including those involved in moderating mood, and altered sodium and potassium activity in the same neurons o damage to the neurons  neuronal abnormalities in the prefrontal cortex of young people with bipolar disorder - Psychoanalytic explanations o Psychoanalysts view mania as an extreme defence mechanism o Counter unpleasant emotional states or unacceptable impulses. - Cognitive models o schemata can act in a ‘bidirectional’ manner in people with bipolar disorder  A schema related to being loved, for example, may have two poles × ‘I am totally unlovable’ × ‘Everybody loves me.’ Treatment of bipolar disorder - Lithium therapy o typically not used o provoke rapid mood swings rather than stabilize mood - Cognitive behavioural approaches Mania course - Mania usually occurs before or after depression - Duration of wellness deceases with time - High rates of reoccurrence - Untreated patient have 4 episodes in 10 years - Following a single depressive episode 5-10% of cases transition to bipolar disorder o Subsequent episodes which occur look similar but have an increase of symptoms - Periods of wellness occur but decrease over time Kindling and sensitisation - Robert post made 4 observations o Reoccurrence of episodes is the norm o Frequency of reoccurrence with time o New symptoms ass to old ones o Later episodes are more severe and have a more acute onset - Kindling o If a bipolar person goes untreated for a period of years, could he or she begin to experience rapid cycling, or become treatment-resistant? ( o In epilepsy: (  If stressors initially set off episodes, in time could episodes appear without any such triggers?  Reason may be a process that has been termed "kindling."  The phenomenon of kindling in epilepsy was first discovered by researcher Graham Goddard.  Goddard was studying the learning process in rats; this included electrical stimulation of the rats' brains at a very low intensity, too low to cause any type of convulsing.  What he found was that after a couple of weeks of this treatment, the rats did experience convulsions when the stimulation was applied. Their brains had become sensitized to electricity, and even months later, one of these rats would convulse when stimulated o Process
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