05: Mania & Bipolar Disorder

Question 1

What is mania?

Answer 1

• Distinct period of abnormally and persistently elevated, expansive or irritable mood, AND
• Abnormally and persistently increased goal-directed activity or energy

Question 2

How does impairment affect a manic diagnosis?

Answer 2

• Severe impairment = mania
• Not severe impairment = hypomania
  
  • NB: Still an unequivocal change in functioning that is uncharacteristic

Question 3

What is the co-morbidity of manic episodes with depressive episodes?

Answer 3

> 90% of pts. who have a manic episode will eventually have a depressive episode.

Question 4

How is bipolar disorder diagnosed?

Answer 4

• If mania occurs: Bipolar I
• If hypomania occurs: Bipolar II
• Exclusion criteria
  
  • Other medical condition
  • Substance
    
    • Recreational drug (e.g., cocaine)
    • Rx drug (e.g., steroids)

Question 5

What does a diagnosis of (hypo)mania require?

Answer 5

• 3 additional symptoms if elevated/expansive mood
• 4 additional symptoms if irritable mood

Question 6

What duration is required for mania/hypomania?

Answer 6

• Mania: 1 week or hospitalization
• Hypomania: 4 consecutive days

Question 7

What are the additional symptoms for the diagnosis of mania/hypomania?

Answer 7

1. Distractability
2. Irresponsibility/poor judgement
3. Grandiosity
4. Flight of ideas/racing thoughts
5. Increased goal-directed Activity/psychomotor agitation
6. Decreased need for Sleep
7. Talktativeness/pressured speech

Mnemonic: DIG FAST

Question 8

What is grandiosity?

Answer 8

• Inflated sense of abilities
• Can be overvalued idea or delusonal
• Usually observed in MSE, rather than reported in Hx
• Example: Pt thinks they can drink infinite amount of poison and be fine; says he “felt fantastic” while delusional –> mania

Question 9

What constitutes decreased need for sleep?

Answer 9

• Pt tends not to complain about insomnia
• Feel rested despite less sleep than usual
• Can be for days
• Specific quesioning required (must ask exact amount of hours)

Question 10

What constitutes talkativeness/pressured speech?

Answer 10

• More talkative than usual may be reported in Hx
• Pressured speech (i.e., difficult to interrupt) observed in MSE

Question 11

What constitutes flight of ideas/racing thoughts?

Answer 11

• Racing thoughts: Unpleasant, subjective experience of thoughts going too fast; reported in Hx
• Flight of ideas: Excessive speech at a rapid rate that involves fragmented or unrelated ideas; observed in MSE

Question 12

What constitutes distractibility?

Answer 12

• Can be reported in Hx or observed in MSE

Question 13

What constitutes increased activity?

Answer 13

• May be reported in Hx if goal-directed
• Observed in MSE if purposeless, non-goal-directed (i.e., psychomotor agitation)

Question 14

What constitutes poor judgement?

Answer 14

• Excessive involvement in risky activities
• Often involve money and sex
• Increased impulsivity

Question 15

Describe mania with psychotic features.

Answer 15

• Mood congruent: grandiose or paranoid (believe everyone is interested in you)
• Mood incongruent: somatic, religious, reference
• If psychosis is present, mania (not hypomania) is diagnosed

Question 16

What is hypomania?

Answer 16

• Duration of at least 4 consecutive days
• Not severe enough to cause marked impairment or necessitate hospitalization
• No psychotic symptoms present
• Must compare to baseline; patient may seem simply friendly and outgoing, when in reality they are shy and introverted

Question 17

What is the epidemiology of (hypo)mania?

Answer 17

• Lifetime prevalence: 2%
• Male to female 1:1
• Onset in 20s