Transcript Diathesis/Personality/Stress: Smoking

Bipolar Disorder
Hallmark of Bipolar Disorder
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Defined by manic symptoms
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Elevated, expansive or irritable mood (or any
combination of these moods) plus (at least 3 or at
least 4 if the mood is irritability)
Decreased need for sleep, racing thoughts,
rapid speech, inflated self-esteem
(grandiosity), impulsive reckless behavior,
increased energy and activity, distractability
Mania versus Hypomania
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Symptoms of mania must last at least one week or
be interrupted by emergency treatment or
hospitalization
Hypomania lasts for at least 4 days and results in a
distinct change in functioning but not impairment.
Manic and depressive episodes can occur
simultaneously in a mixed episode
–
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A mixed episode must last at least one week and patients
must fulfill criteria for a major depressive episode and a
manic episode
At least 40% of bipolar patients have a mixed
episode at some point in their illness
Bipolar Subtypes
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Bipolar I: Presence of a single manic or mixed
episode that is not substance induced (no
depression required).
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Unipolar mania rates are between 25%-33% in community
samples but ~10% in clinical samples;
Most patients eventually have depressive episodes
Bipolar II
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Major depressive episodes alternating with hypomanic
episodes
1 in 10 bipolar II patients eventually develops a full manic or
mixed episode over a 10 year follow-up period (converting
to a bipolar I).
Cyclothymia
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Two or more years of alterations between
hypomania and depressive symptoms but
the alterations fall short of the meeting full
criteria
Epidemiology
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Approximately 4% of the population has
bipolar I or II disorder
Cyclothymia affects 4.2 % of the general
population
Major depressive illness is four times more
prevalent than bipolar disorder
Approximately 1% of high school students
met criteria for bipolar I or bipolar II
Age of Onset
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Median age of onset for bipolar disoder is 25
years old
Based on the National Comorbidity Survey
replication, 25% of patients had onset by age
17
Earlier age of onset is associated with rapid
cyclying
Sociodemographic Characteristics
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Women and men have relatively equal rates
of bipolar I disorder;
Women are more likely to have bipolar II
disorder
Women are more likely to experience rapid
cycling
Risk for Suicide
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Suicide in bipolar disorder is at least 15 times
higher than in the general population and
four times higher than major depression
Approximately 50% of patients with bipolar
disoder attempt suicide during their lifetime;
15%-20% die by suicide
Diathesis/Personality/Stress:
Bipolar Depression
Stressor
Diathesis
Heritability ranges from 59%
- 87%
Personality
Concordance for MZ twins is
57%
Hyperactive
Low social
support
Females more at risk than
males (for bipolar II)
Impulsive
High
expressed
emotion
(criticism,
hostility,
emotional
overinvolvment)
Family history of bipolar
disorders or unipolar
disorders
Increase focus on
neurotransmitter systems
Monoamine Dysreg
Overactive Norepinephrine
Excess in Dopamine
Sensation Seeking
(in response to threats)
Neuroticism
More sensitive to
rewards (e.g. goal
attainments)
Negative life
events
Sleep
deprivation (for
mania)