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Running head: PHYSIOLOGICAL PSYCHOLOGY 1 Bipolar Disorder Type-II Christopher Howard PSY 350 Instructor: Wayne Briner 8/10/2015 [no notes on this page] -1- PHYSIOLOGICAL PSYCHOLOGY 2 Bipolar Disorder Type-II Bipolar II disorder is one of the mood disorders in the bipolar spectra. Bipolar II disorder is characterized by at least one episode of hypomania and at least one episode of depression (Berk, M., Dodd, S., 2005). Unlike bipolar I disorder, patients with bipolar II disorder do not experience 1 episodes of mania, unless it is caused by the use of antidepressant drugs. According to DSM-5 classification, the hypomania must last for most of the day and for at least four days. In addition, three or more of the following have to be present: grandiosity, decreased need for sleep, being 1. experience episodes of mania, unless it is caused by the use of antidepressant drugs. this makes it sound simply like depression. [Wayne Briner] talkative, experiencing racing of ideas, distractibility, excessive involvement in pleasurable activity, not to have experienced a manic or mixed episode or psychomotor agitation (American 2 Journal of Psychiatry, 2013). 2. (American Journal of Psychiatry, 2013). APA uses author and date. [Wayne Briner] Etiology The causes of bipolar II disorder are not elaborate and several theories have been used to explain the etiology of this condition. Some of the causes that are thought to cause bipolar II disorder are attributed to biological factors, genetic factors, and the psychosocial factors. The biological factors implicated in bipolar II disorder are altered biochemistry and the two neurotransmitters in the central nervous system. The two neurotransmitters are norepinephrine and serotonin. Both serotonin and norepinephrine are excitatory neurotransmitters. Too low levels of norepinephrine cause depression, a major characteristic of bipolar II disorder. Postmortem studies have shown an increased NE turnover in the cortical and 3 thalamic areas of bipolar II disorder subjects. Serotonin is involved in brain activities such as wakefulness, regulation of sleep, moods, 3. subjects. You need to provide a citation for this information, it lets us know that you got it from a legitimate source. It is typical to have at least one citation for each paragraph. [Wayne Briner] 4 learning and memory (Barrett, K. E., Barman, S. M., & Boitano, S., 2010). In the brain, -2- 4. K. No initials in APA citation style. [Wayne Briner] PHYSIOLOGICAL PSYCHOLOGY 3 serotonin acts through its receptors. There are several receptors involved in the action of serotonin, known as the 5-hydroxytryptamine receptors and abbreviated 5-HT. Alterations in brain circuits using serotonin have been implicated in mood disorders and in depression. Positron emission tomography (PET) scans have shown reduced binding of serotonin to 5-HTIA receptors in the raphe and amygdala-hippocampus of patients with bipolar II disorder (Manji, H. K., 1 Quiroz, J. A., Payne, J. L., Singh, J., Lopes, B. P., Viegas, J. S., Zarate, C. A., 2003). Post mortem results of suicide completers suffering from bipolar II disorder have demonstrated low 1. 2003). a little on the old side [Wayne Briner] levels of serotonin and 5-hydroxyindoleacetic acid, a major metabolite of serotonin(Novick, D. M., Swartz, H. A., Frank, E., 2010). The cerebral spinal fluid of those with suicide impulse and those who have attempted suicide has also demonstrated low levels of the 5-hydroxyindoleacetic acid. Other biological factors that have been implicated in bipolar II disorder are hormonal imbalances and electrolytes imbalances. The receptor potential for serotonin receptors can be reduced by increased levels of serum cortisol. Hypothyroidism is also associated with depression and hypomania. Calcium is useful in brain electrochemistry and low serum calcium levels have 2 been implicated in bipolar II disorder. Psychosocial factors that cause a lot of stress have been implicated in causing bipolar disorder type-2. Such stressors include loss of a spouse and loss of a job or loss of a close relative such as losing a parent. For example, losing a parent before the age of 11 years is associated with an increased risk of developing bipolar II disorder later in life. The theory behind this is that long lasting stress can cause changes in the brain biology including neurotransmitter and brain signaling pathways. Stress is also associated with loss of synaptic contact between -3- 2. disorder. You need to provide a citation for this information, it lets us know that you got it from a legitimate source. Expand on these statements. [Wayne Briner] PHYSIOLOGICAL PSYCHOLOGY 4 neurons. Therefore, a person may have a repeated episode of bipolar II disorder even when the primary stressor has been removed. Other factors that are thought to cause bipolar II disorder include genetic factors. Monozygotic twins have a concordance rate of 70-90% for developing mood disorders, while siblings of different sex have concordance rates of only 8%. Familial factors are also implicated in development of bipolar II disorders. Family data indicate that a child whose parent has a bipolar II disorder has a risk of 20-25% of developing the same. Personality and lifestyle may also contribute to bipolar II disorder. People who feel insecure and have a rigid, strict and uncompromising lifestyle are likely to suffer from a bipolar disorder. Use of drugs and substance 1 abuse can also cause bipolar II disorder. Pathophysiology of Bipolar II Disorder Depletion of excitatory neurotransmitters in the brain causes an increase in the inhibitory 1. disorder. You need to provide a citation for this information, it lets us know that you got it from a legitimate source. [Wayne Briner] response of the brain to the inhibitory neurotransmitters such as gamma amino-butyric acid (GABA). This leads to inhibition of neuronal activities in brain areas that control mood, memory, learning and emotions such as the amygdala and the hippocampus. In bipolar II disorder, there is a reduced level of neurotransmitter serotonin at the synaptic connections for the neurons. There is reduced neuronal activity and this results in the mood depression that is typical of the bipolar II disorder. Norepinephrine is a stress hormone and affects areas of the brain in which attention and response to actions are controlled. When norepinephrine levels are reduced, there is persistent inhibition of neurons, causing slowed brain neuronal activity which results in the 2 hypomania that is seen in subjects of bipolar II disorder. 2. disorder. You need to provide a citation for this information, it lets us know that you got it from a legitimate source. Treatment of Bipolar II Disorder This is also part of the APA approach to papers. [Wayne Briner] -4- PHYSIOLOGICAL PSYCHOLOGY 5 During treatment, the safety of the patient should be considered. A complete evaluation is also very important. Stressful life events have to be addressed so as to avoid relapse. Treatment of bipolar II disorder is both pharmacological and non-pharmacological. Pharmacological treatment involves the use of antidepressant drugs and mood stabilizing drugs. The mood stabilizing drugs that can be used in treatment of bipolar II disorder include valproic acid, carbamazepine and lithium bicarbonate. Newer antipsychotic agents such as olanzapine can also be used. There are various categories of antidepressant drugs that are used in treatment of bipolar II disorder. These drugs are classified according to the neurotransmitters they affect and receptor selectivity. Selective serotonin reuptake inhibitors prevent the reuptake of serotonin from the neuronal synapses, allowing more time for its action. These drugs include fluoxetine. Selective serotonin norepinephrine reuptake inhibitors block the reuptake of both serotonin and norepinephrine. These drugs include venlafaxine and desvenlafaxine. Monoamine oxidase inhibitors reduce the breakdown of monoamine neurotransmitters. They include phenyzine and resegeline. Non pharmacological treatment for bipolar II disorder includes use of the electroconvulsive therapy (ECT). Family therapy and counseling are also useful in reducing stress and ensuring compliance to treatment. Diagnostic and research technologies employed in clinical diagnosis, care, and basic science research Clinical diagnosis of bipolar II disorder is through a detailed clinical history and mental examination, and diagnosis made using the DSM-5 guidelines. Diagnostic technologies help in the process of making a clinical diagnosis and in further evaluation of the patient. Positron emission tomography (PET) scans can be used to measure the receptor activity and the levels of serotonin in the brain. PET scans can also be used in the evaluation for the destruction of the [no notes on this page] -5- PHYSIOLOGICAL PSYCHOLOGY 6 neuronal synapses by checking for the degree of uptake of radionuclide labeled monoamines such as serotonin and norepinephrine. This can also be used in researching about the etiology of bipolar II disorder. Magnetic resonance imaging and electroencephalograms are used in imaging of the brain in checking for organic causes of mental illness. Electroencephalogram can be used in distinguishing bipolar II disorder from other forms of bipolar disorders by monitoring brain activity. Functional magnetic resonance imaging and spectrum photo emission tomography (SPECT) are used in researching for structural brain abnormalities as the basis for bipolar disorders, including bipolar II disorder (Heng, S., Song, A. W., & Sim, K., 2010). Thyroid function tests are used in establishing whether the condition is caused by hypothyroidism. Cortisol levels and dexamethasone suppression test can be used in detecting hormonal 1 imbalances that can cause or aggravate bipolar II disorder. 1. disorder. You need a formal conclusion [Wayne Briner] -6- PHYSIOLOGICAL PSYCHOLOGY 7 1 References American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders 1. References Your references need to be in APA format. [Wayne Briner] (5th ed.). Arlington, VA: American Psychiatric Publishing. 2 Berk, M., Dodd, S. (2005). Bipolar II disorder: a review. Bipolar Disorder. Barrett, K. E., Barman, S. M., & Boitano, S. (2010). Ganong's review of medical physiology. 2. Disorder. need publisher info [Wayne Briner] New Delhi: McGraw Hill, 2010 Heng, S., Song, A. W., & Sim, K. (2010). White matter abnormalities in bipolar disorder: 3 insights from diffusion tensor imaging studies. Journal of neural transmission, MacQueen, G. M.,Young, L. T. (2014). Bipolar II disorder: symptoms, course, and response to treatment. Psychiatric Services. Manji, H. K., Quiroz, J. A., Payne, J. L., Singh, J., Lopes, B. P., Viegas, J. S., Zarate, C. A. (2003). The underlying neurobiology of bipolar disorder. World Psychiatry, Novick, D. M., Swartz, H. A., Frank, E. (2010). Suicide attempts in bipolar I and bipolar II disorder: a review and meta‐analysis of the evidence. Bipolar disorders -7- 3. Journal of neural transmission, need journal info such as issue and page numbers [Wayne Briner]

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