2. Mania/Hypomania Flashcards
1
Q
Define: Mania (3)
A
- is a period of severe and sustained elevated mood that leads to disturbed behavior and function.
- It may be associated with psychotic symptoms.
- When the elevation in mood is less severe or more brief, the term used is “hypomania,” which can progress to mania.
2
Q
Describe the epidemiology of mania (3)
A
- The worldwide lifetime prevalence of bipolar I and II and subthreshold disorders is 0.6%, 0.4%, and 1.4%, respectively (1.0%, 1.1%, and 2.4% for the United States).
- The median age of onset is about 25 yr.
- Six percent of patients diagnosed with bipolar disorders die through suicide within 20 yr of Dx.
3
Q
Describe the impact of interacting genetic and environmental factors on bipolar disorders (2)
A
- affect phenotypic expression of alleles implicated in bipolar disorders.
- For instance, childhood physical and sexual abuse is associated with earlier onset and illness severity, and stressors can precipitate and perpetuate symptoms.
4
Q
There is an average ____ increased risk to develop bipolar disorder among adult relatives of patients with bipolar I and II disorders.
A
10x
5
Q
Describe HX of mania (16)
A
- Important notes before beginning the interview:
- The patient who is manic or psychotic may not be reliable. Mania and hypomania affect insight, and it is not uncommon for patients with bipolar disorder to be unaware that they are ill. Collateral information gathered from family, caregivers, ambulance, or available police reports is needed to corroborate information.
- Make sure that you are safe during the interview. Patients with mania may be impulsive, irritable, or have labile moods.
- The patient may not tolerate a full interview. In this case, cover questions looking for diagnostic proof , and those regarding safety (suicide, homicide, who is looking after their children at home).
- Patient identifiers: name, age, occupation
- Social and contextual information: relationship status, living arrangement, work or source of income, children, caregivers of children besides the patient
- Ask about the DSM-5 criteria for bipolar disorders
- Screen for symptoms of depression, anxiety, or psychosis. The following screening questions may be asked:
- “Has there ever been a time when you were feeling depressed or very low that you weren’t your usual self?”
- “Do you consider yourself as a ‘worrier?’” “Any superstitions or rituals like counting, washing, checking?” “Or thoughts that come into your head that are hard to get rid of?” “ Have you ever had panic attacks?”
- “Do you ever worry that people might be plotting to harm you?” “Do you have any special abilities that other people don’t usually possess?” “Are you hearing voices or messages?” “What about visions?”
- Recent and current stressors: personal losses that have occurred or anticipated (e.g., death in family, loss of work, property), role transitions, financial difficulties, interpersonal conflict, isolation
- Social supports available
- Suicide
- Substance use
- Forensic history
- Psychiatric history
- Family psychiatric history. Screening for family history of bipolar disorders is critical
- Medical history
- Medications
- Allergies
- Personal history: childhood relationships, performance in school at different stages, highest level of education, occupations held, relationships in adolescence and adulthood, history of abuse at any stage in life
6
Q
Name categories of DDX of mania/hypomania (3)
A
- Psychiatric
- Substance/medication-induced
- General medical conditions
7
Q
Name PSYCHIATRIC of DDX of mania/hypomania (6)
A
-
Bipolar disorders
- Bipolar I or II disorder
- Cyclothymic disorder
- Major depressive disorder
- Anxiety disorders
- Psychotic disorders
- Schizophrenia
- Schizoaffective
- Delusional disorder
- ADHD
- Borderline personality disorders
8
Q
Name SUBSTANCE/MEDICATION-INDUCED DDX of mania/hypomania (6)
A
- Substances of abuse
- Stimulants
- Alcohol
- Hallucinogens
- Medications
- Antidepressants
- Dopamine agonists
- Steroids
9
Q
Name GENERAL MEDICAL CONDITIONS DDX of mania/hypomania (10)
A
- Infectious
- HIV
- Tertiary syphilis
- Neurological
- Stroke*
- Traumatic brain injuries*
- Tumor
- Seizures
- Multiply sclerosis*
- Systemic
- Hyperthyroidism, thyrotoxicosis
- Cushing’s disease*
- Systemic Lupus Erythematosus
10
Q
Describe General Observations and Physical exam: Mania/Hypomania (7)
A
- Mental status exam
- Vital signs
- Pupils
- Signs of self-harm behavior
- Stigmata of drug or alcohol use
- Signs of hyperthyroidism
- Weight loss
11
Q
Describe mental status exam: Mania/Hypomania (11)
A
- presentation is varied
- maybe dressed in brighter colored clothing
- agitated, aggressive, violent, or in catatonic stupor
- poor attention, distractible
- mood is often expansive, feels connected to people in his surroundings
- affect may be euphoric, labile or irritable
- flight of ideas
- pressured speech
- delusions may be grandiose, religious, paranoid, or persecutory
- there may be auditory hallucinations often connected to the delusions
- often no insight and poor judgment.
12
Q
Describe investigations: Mania/Hypomania (15)
A
- Blood work =
- CBC
- electrolytes
- BUN
- creatinine
- fasting blood glucose
- liver profile
- thyroid profile
- TSH
- B12/folate
- Urinalysis, urine drug screen
- Additional screening:
- neurologic consultation
- CXR
- ECG
- CT scan as indicated
13
Q
Describe diagnosis: Manic Episode (4)
A
Abnormally and persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy for at least 1 wk (or any duration if hospitaliza- tion is necessary). Increases in goal-directed activity or energy are new features in DSM-5.
- At least three of the following symptoms or four if the mood is only irritable (pneumonic is GSTPPAID)
- Grandiosity
- Sleep decreased
- Talkativeness
- Pleasurable activities with painful consequences
- Pressured speech
- Activity level increased
- Ideas (flight of)
- Distractible
- The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
- The symptoms are not due to substances or medical conditions.
- If the manic episode occurs after drugs, or medication treatment (e.g., antidepressants or ECT), but persists at the full syndromal level even after treatment is stopped, then there is evidence for bipolar I.
14
Q
Describe diagnosis: Hypomanic Episode (3)
A
- Criterion 1 of manic episode is met, but duration is at least 4 d.
- Criteria 2 and 4 of manic episode are met.
- Episodes associated with an uncharacteristic decline in functioning that is observable by others
15
Q
Describe: Bipolar 1 disorder (2)
A
- disorder in at least one manic episode has occurred commonly accompanied by Major depressive episode but not required for Dx.
- Condition should not be better explained by schizophrenia, schizophreniform, schizoaffective, delusional disorder, or other psychotic disorders.
