Abnormal Mood: Elated Mood Flashcards
what is bipolar I?
mania + depression
what is bipolar II?
hypomania + depression
this is the most common form
what is bipolar II 1/2?
depressions superimposed on cyclothymic temperament
what is bipolar III?
aka “pseudo-unipolar”
hypomanic episodes only occur following use of antidepressants for depression
what is bipolar IV?
depressions arising from a hyperthymic temperament
how do you distinguish between between depression and bipolar?
a single episode of hypomania or mania = bipolar (even if not been depressed yet)
the ICD-10 criteria for a hypomanic episode states that patient must have a mood elevated or irritable to degree that is abnormal for individual and sustained for at least 4 consecutive days as well as 3 of what 6 symptoms?
1) increased 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 other reckless behaviour
the ICD-10 criteria for a manic episode states mood must be predominantly elevated or irritable and definitely abnormal and must be sustained for at least 1 week (unless severe enough for hospital admission) as well as 3 of what 9 symptoms?
1) increased activity or restlessness
2) increased talkativeness
3) flight of ideas or thoughts racing
4) loss of abnormal social inhibitions
5) decreased need for sleep
6) inflated self-esteem or grandiosity
7) distractibility or constant change in plans
8) foolhardy or reckless behaviour whose risks the pt does not recognise
9) marked sexual energy or sexual indiscretions
what would you see in terms of appearance and behaviour in those with mania?
bright clothes
distractibility
loss of normal social inhibitions / overfamiliarity
what would you see in terms of speech in those with mania?
increased talkativeness (hard to interrupt) punning and clang associations
what would you see in terms of thought in those with mania?
increased flow (lots of thoughts)
flight of ideas and loosening of associations
grandiosity
can mania occur both with and without psychotic symptoms (delusions - grandiose, self-referential, erotic or persecutory content)?
yes
when don’t have psychotic symptoms, they may still have perceptual disorders (subjective hyperacusis, seeing very vivid colours)
what is the typical age of onset of bipolar?
late teens or early 20s
approx 10 years earlier than unipolar depression
what usually results in earlier onset and episodes being precipitated by lower levels of stress?
family history
bipolar is usually diagnosed at first presentation - true or false?
false - usually delay
onset after age of 60 is rare and is often associated with what?
treatment resistance, progressive decline in functioning and underlying organic cause
what is the lifetime prevalence of bipolar disorder (of any kind)?
1-4%
what other conditions is bipolar associated with?
anxiety disorders (panic, GAD and OCD) alcohol and drug misuse personality disorders (BPD) eating disorders schizoaffective disorder schizophrenia
what is the relation between schizophrenia and bipolar?
shared environmental effects were small but substantial
the co-morbidity between disorders was mainly due to additive genetic effects common to both
what genes cause susceptibility to schizophrenia and bipolar?
NRG1
G72
G30
what genes cause susceptibility to schizophrenia?
DISC2
what genes cause susceptibility to bipolar disorder?
ANK3
are high levels of morbidity common in bipolar?
yes
dont forget physical health morbidity
what are subsyndromal symptoms?
symptoms not severe enough to be classed as an episode but these can be disabling - up to 70% of mood disturbance is subsyndromal
what type of bipolar has the highest % of time symptomatic - I or II?
II - 53.9%
I - 47.3%
in both types of bipolar, what is most common mood disturbance?
depression
what are predictors of poor outcome of bipolar in adolescence?
early onset low socioeconomic status subsyndromal mood symptoms long duration of illness rapid mood fluctuation mixed presentations psychosis comorbid disorders family psychopathology
