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Neuropsychopharmacology Reviews (2008) 33, 110–133

Pathophysiology of BD must encompass different systems on different physiological levels at which the disease manifests. BPD likely arises from the complex interaction of multiple susceptibility (and protective) genes and environmental factors.

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Neuropsychopharmacology Reviews (2008) 33, 110–133

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  1. Pathophysiology of BD must encompass different systems on different physiological levels at which the disease manifests BPD likely arises from the complex interaction of multiple susceptibility (and protective) genes and environmental factors The phenotypic expression of the disease includes not only mood disturbance, but also a constellation of cognitive, motor, autonomic, endocrine, and sleep/wake abnormalities. Neuropsychopharmacology Reviews (2008) 33, 110–133

  2. Etiology of Major Depression and Bipolar Disorder • Biological Factors • Genetic Factors • Psychosocial Factors • Cognitive Theory • Learned Helplessness

  3. Biological Factors • Biogenic Amines • Pre synaptic B2 receptors activation results in decrease amount of NE release • Low serotonin precipitates depression • Neuroendocrine regulation • Sleep abnormalities • Circadian rhythm • Kindling • Neuroimmune regulation

  4. Psychosocial Factors • Stressful life events more often precede episodes of mood disorder • Classical View of Depression: • Disturbances in the infant-mother relationship during the oral phase • Depression can be linked to real or imagined object loss • Introjection of the departed objects is a defense mechanism invoked to deal with the distress connected with the object’s loss • Because the lost object is regarded with a mixture of love and hate, feelings of anger are directed inward at the self

  5. Cognitive Theory • Cognitive triad of Depression • Views about the self – a negative self-precept • About the environment – a tendency to experience the world as hostile and demanding • About the future – the expectation of suffering and failure

  6. DSM-IV-TR Diagnostic Criteria for Bipolar II Disorder • Presence (or history) of one or more major depressive episodes. • Presence (or history) of at least one hypomanic episode. • There has never been a manic episode or a mixed episode. • The mood symptoms in Criteria A and B are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified. • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

  7. Specify current or most recent episode: • Hypomanic: if currently (or most recently) in a nypomanic episode. • Depressed: if currently (or most recently) in a major depressive episode. If the full criteria are currently met for a major depressive episode, specify its currently status and/or features: Mild, moderate, severe without psychotic features/severe with psychotic features. Chronic With catatonic features With melancholic features With atypical features With postpartum features If the full criteria are not currently met for a hypomanic or major depressive episode, specify the clinical status of the bipolar II disorder and/or features of the most recent major depressive episode (only if it is the most recent type of mood episode): In partial remission, in full remission. Chronic With catatonic features With melancholic features With atypical features With postpartum features Specify: Longitudinal course specifiers (with and without interepisode recovery) With seasonal pattern With rapid cycling

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