Abnormal Mood: Elated Mood

Question 1

what is bipolar I?

Answer 1

mania + depression

Question 2

what is bipolar II?

Answer 2

hypomania + depression

this is the most common form

Question 3

what is bipolar II 1/2?

Answer 3

depressions superimposed on cyclothymic temperament

Question 4

what is bipolar III?

Answer 4

aka “pseudo-unipolar”

hypomanic episodes only occur following use of antidepressants for depression

Question 5

what is bipolar IV?

Answer 5

depressions arising from a hyperthymic temperament

Question 6

how do you distinguish between between depression and bipolar?

Answer 6

a single episode of hypomania or mania = bipolar (even if not been depressed yet)

Question 7

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?

Answer 7

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

Question 8

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?

Answer 8

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

Question 9

what would you see in terms of appearance and behaviour in those with mania?

Answer 9

bright clothes
distractibility
loss of normal social inhibitions / overfamiliarity

Question 10

what would you see in terms of speech in those with mania?

Answer 10

increased talkativeness (hard to interrupt) 
punning and clang associations

Question 11

what would you see in terms of thought in those with mania?

Answer 11

increased flow (lots of thoughts)
flight of ideas and loosening of associations
grandiosity

Question 12

can mania occur both with and without psychotic symptoms (delusions - grandiose, self-referential, erotic or persecutory content)?

Answer 12

yes

when don’t have psychotic symptoms, they may still have perceptual disorders (subjective hyperacusis, seeing very vivid colours)

Question 13

what is the typical age of onset of bipolar?

Answer 13

late teens or early 20s

approx 10 years earlier than unipolar depression

Question 14

what usually results in earlier onset and episodes being precipitated by lower levels of stress?

Answer 14

family history

Question 15

bipolar is usually diagnosed at first presentation - true or false?

Answer 15

false - usually delay

Question 16

onset after age of 60 is rare and is often associated with what?

Answer 16

treatment resistance, progressive decline in functioning and underlying organic cause

Question 17

what is the lifetime prevalence of bipolar disorder (of any kind)?

Answer 17

1-4%

Question 18

what other conditions is bipolar associated with?

Answer 18

anxiety disorders (panic, GAD and OCD)
alcohol and drug misuse 
personality disorders (BPD)
eating disorders 
schizoaffective disorder 
schizophrenia

Question 19

what is the relation between schizophrenia and bipolar?

Answer 19

shared environmental effects were small but substantial

the co-morbidity between disorders was mainly due to additive genetic effects common to both

Question 20

what genes cause susceptibility to schizophrenia and bipolar?

Answer 20

NRG1
G72
G30

Question 21

what genes cause susceptibility to schizophrenia?

Answer 21

DISC2

Question 22

what genes cause susceptibility to bipolar disorder?

Answer 22

ANK3

Question 23

are high levels of morbidity common in bipolar?

Answer 23

yes

dont forget physical health morbidity

Question 24

what are subsyndromal symptoms?

Answer 24

symptoms not severe enough to be classed as an episode but these can be disabling - up to 70% of mood disturbance is subsyndromal

Question 25

what type of bipolar has the highest % of time symptomatic - I or II?

Answer 25

II - 53.9%

I - 47.3%

Question 26

in both types of bipolar, what is most common mood disturbance?

Answer 26

depression

Question 27

what are predictors of poor outcome of bipolar in adolescence?

Answer 27

early onset 
low socioeconomic status 
subsyndromal mood symptoms
long duration of illness
rapid mood fluctuation 
mixed presentations 
psychosis 
comorbid disorders
family psychopathology