Assignment # 2

Asna Anwer
05-171211-202

Institute of Professional Psychology, Bahria University Karachi Campus

Course: Mental Health and Psychopathology - I

 Write a detailed note on the Etiology, Prevalence, and Prognostic Factors of “Bipolar
and Related Disorders” as outlined in DSM-5-TR. Mention ALL disorders separately
with each of the above-mentioned sections.
ETIOLOGY:
 Although the etiology of [early onset bipolar spectrum disorder] is not known,
substantial evidence in the adult literature and more recent research with children and
adolescents suggest a biological basis involving genetics, various neurochemicals, and
certain affected brain regions.
 It is distinctly possible that the differing clinical presentations of pediatric BD are not
unitary entities but diverse in etiology and pathophysiology.
GENETIC FACTORS:
Various research suggested that there is a high probability of hereditary transmission
for bipolar disorders. The following are some examples of genetic evidence for
bipolar disorders:
1. Family studies: Research on families has shown that bipolar disorders run in
families. The risk of developing bipolar I disorder among first-degree relatives
is almost seven times higher than in the general population. Interestingly, there
is a 50% risk that a child of a parent with bipolar disorder will also develop a
serious psychiatric disorder. Among one long-term investigation, it was
discovered that among children of bipolar parents, subthreshold manic or
hypomanic episodes were a diagnostic risk factor for the emergence of
recurrent manic, mixed, or hypomanic episodes. In fact, in families with
bipolar probands, unipolar illness is often the most prevalent type of mood
disorder. However, the families of unipolar probands only had a somewhat
higher incidence of bipolar disorder. This familial overlap raises the
possibility that these two types of mood disorders share some genetic basis.
2. Twin studies: MZ twins had a concordance rate of.67 for bipolar disorder
while DZ twins had a concordance rate of.20. These results have led to the
hypothesis that bipolar disorder has a heritability of.59. However, the
discovery of MZ concordance rates less than 100% emphasizes the
significance of environmental factors.
3. Adoption Studies: Bipolar disorder was more common in the biological
parents of bipolar adoptees than in a control group, but not in the adoptive
parents. These findings demonstrated genetic, not adoptive, ties mediated the
familial aggregation of bipolar disorder.
4. Genetic Epidemiology: When compared to relatives of patients whose first
affective symptoms appeared before age 12, first-degree relatives of patients
 whose symptoms appeared at age 13 have a higher lifetime prevalence of
bipolar disorder.
5. Molecular genetic: Adults with bipolar disorder seem to be more susceptible
to the cumulative small effects of changes in a variety of distinct genes, none
of which are strong enough to cause the condition independently. One of the
genes linked to this condition by the researchers is involved in a biochemical
pathway where lithium is thought to function therapeutically. Diacylglycerol
kinase eta, an enzyme that the gene generates, operates nearer the origin of the
lithium-sensitive pathway than the protein that lithium is hypothesized to
target.

NEUROANATOMICAL DIFFERENCES
 White matter hyper intensities: White matter hyper intensities are small
aberrant regions that can be seen by magnetic resonance imaging, particularly
in the frontal lobe. The degeneration of axons or myelin may be the root cause
of these abnormalities.
 Smaller amygdala: The amygdala is implicated in the disease early on,
according to a considerable amount of research. The amygdala's role as the
brain's primary regulator of emotion and social behavior (assigning emotional
valence to stimuli and memories, aiding encoding), is compatible with its
involvement in BD. The amygdala is crucial in the development of emotions
and emotional memory. Your senses are integrated into an almond-shaped
structure, which connects them to your emotions. Additionally, it influences
fundamental actions like eating, arousing sexual desire, and the "fight-or-
flight" response to stress.
 Decreased hippocampal volume: A brain region with a horseshoe shape called
the hippocampus is involved in memory, learning, and emotion. It creates
fresh memories and groups them with associated emotions and recollections.
 Reduced gray matter volume in the dorsolateral prefrontal cortex (DLPFC)
 Strong evidence points to striatal involvement early in the course of the
illness. These parts of the brain have been linked to the regulation of socially
acceptable emotional behavior. A deficit in the fermentation coming from the
frontal lobes or impairments downstream in the circuitry involving the
pallidum and thalamus may be compensated for by an increase in striatal
volume.

PREVALENCE:
 There are no statistics on the prevalence of preadolescent bipolar
disorder.
 14 to 18-year-olds: 1% lifetime prevalence
 Subsyndromal signs: 5.7%
 10 to 12 years is the average age of onset.
 Initially, depression usually occurs
 Most studies show a 3-6% prevalence rate for adults worldwide, which
is significantly higher.
 PROGNOSIS:
Early-onset bipolar spectrum disorder's prognosis could include a protracted
and highly relapsing course, major impairments in home, school, and peer
functioning, legal issues, frequent hospitalizations, and increased rates of
substance misuse and suicide.

In essence, young people with [early onset bipolar spectrum illness] have a
chronic brain disorder that is biopsychosocial in nature and that, as of right
now; neither a treatment nor a growth out of it is possible.
Pediatric bipolar disorder typically has worse prognosis and is more
incapacitating.
Juvenile BPD has a significantly earlier onset age, is much more chronic. It is
characterized by severe impairment, a considerable lot of emotional lability,
and impulsivity. They appear to have a more serious and protracted sickness.
Suicidality (ideas/attempts) has been found to occur more frequently in people
whose condition first manifested before the age of 18.
BPD with adult onset is typically episodic, with episodes being shorter and
more distinct.

Results for people with a wide-ranging phenotypic (subsyndromal) likewise

show a significant impairment. For these people, it has negative repercussions
for their capacity to adjust to the pressures placed on them as children.

Results by subtype (adult research)

 BIPOLAR DISORDER I:
More severe, more cyclical and mixed episodes, more substance addiction, and a
tendency to regain premorbid levels of functioning in between episodes. The more
traditional form of BD, known as BP I, is characterized by distinct and easily
distinguishable periods of mania and depression. It is believed that BP I= is more
serious: experience significantly more cycling or mixed episodes (significant 51 vs
30%); have significantly more severe affective episodes (as shown by more
hospitalization. Lower Global Assessment Scale scores, and a higher prevalence of
psychotic features); use drugs or alcohol slightly more frequently (significant 50 vs
40%); and tend to return to their premorbid level of psychosocial functioning in
between episodes.
 BIPOLAR DISORDER II:
More severe major depressive episodes, more frequent bouts with shorter gaps
between them, more chronic, less intense and frequently unrecognized manic periods,
and a propensity for anxiety. The depressive episode of the BP spectrum, BP II is
thought to be more chronic and is associated with more major depressive episodes (74
vs. 50%; significant difference); shorter inter-episode intervals; and higher levels of
anxiety (38 vs. 23%), particularly social phobias (Judd et al., 2003).
 CYCLOTHYMIA:
It can be harmful; frequently goes undiagnosed; many people acquire a more severe
form of bipolar disorder.
 Cyclothymia is characterized by recurrent episodes of hypomania and depression as
well as chronic mood swings. As opposed to bipolar II or I, hypomanic and depressive
episodes are less frequent, less intense, and last for shorter periods. However, these
mood fluctuations might make it difficult to communicate with people or function at
work. Many, but not all, sufferers of cyclothymia go on to develop a more serious
case of bipolar disorder.
 BIPOLAR DISORDER NOT OTHERWISE SPECIFIED (NOS):
Do not forget that BP-NOS is our umbrella term for children. Given the wide range
of people who have this diagnosis, it is currently challenging to make broad
statements about outcomes for the largest group of BP disorders.