Abnormal mood: elated mood

Question 1

Classification of bipolar disorder in the ICD10? (3)

-definition?

Answer 1

Hypomania
Mania with psychotic features
mania without psychotic features

• disorder characterised by 2 or more episodes in which the patients mood and activity levels are significantly disturbed, consisting on some occasions of hypomania or manis and , on other, depression. Repeated episodes of hypomania or mania only are classifies as bipolar.
  i. e. single episode of hypomania/mania is bipolar disorder even if you haven’t been depressed yet

Question 2

Hypomanic episode

• definition?
• what signs must be present? (6)

Answer 2

-mood elevated or irritable to a degree that is definitely abnormal for the individual concerned and sustained for at least 4 consecutive days

• at least 3 of:
  1. inc activity or restlessness
  2. increased talkativeness
  3. difficulty in concentration or distractibility
  4. decreased need for sleep
  5. increased sexual energy
  6. mild spending sprees or reckless behaviour

Question 3

Manic episode

• definition?
• what signs must be present?
• what psychotic symptoms occur in mania with psychosis?

Answer 3

-mood elevated or irritable to a degree that is definitely abnormal for the individual concerned, prominent and sustained for at least 1 week (unless admitted)

• 3 of following signs with severe interference with daily living and function:
  1. Increased activity or physical restlessness;
  2. Increased talkativeness (‘pressure of speech’)
  3. Flight of ideas or the subjective experience of thoughts racing
  4. Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances
  5. Decreased need for sleep
  6. Inflated self-esteem or grandiosity
  7. Distractibility or constant changes in activity or plans
  8. Behaviour which is foolhardy or reckless and whose risks the subject does not recognize e.g. spending sprees, foolish enterprises, reckless driving
  9. Marked sexual energy or sexual indiscretions.

-delusions or hallucinations
(other than those that are completely impossible or culturally inappropriate and hallucinations that are not in the third person or giving a running commentary

Question 4

Bipolar disorder

• onset
• common comorbidities?
• course of bipolar disorder?(2)
• predictors of poor outcome? (9)

Answer 4

-late teens or early 20s
family hx of BPAD results in earlier onset

-anxiety disorders
alcohol and drug misuse
personality disorder
easting disorders
schizoaffective disorder
schizophrenia 

-acutely: 
hypomania & depression
Maintenance: either, 
predominantly hypomanic
predominantly depressive
mixed affective states
Rapid cycling

- Early-onset
Low socioeconomic status
Subsyndromal mood symptoms
Long duration of illness
Rapid mood fluctuation
Mixedpresentations
Psychosis
Comorbid disorders
Familypsychopathology

Question 5

Remember risk of suicide

Answer 5

is highest within those with bipolar disorder