Abnormal Mood: Elated Mood

Question 1

how does DSM classify bipolar?

Answer 1

course and pattern

• bipolar 1 and bipolar 2
• cyclothymic disorder

Question 2

how does ICD classify bipolar?

Answer 2

episode severity

• hypomania
• mania with psychotic features
• mania without psychotic features

Question 3

what is bipolar 1?

Answer 3

has to have met criteria for mania although previous episodes may have been hypomanic/depressive
classic form of manic depression in the last century

Question 4

what is bipolar 2?

Answer 4

current or past hypomanic episode and current or past depressive episode
has never met criteria for manic episode
most common

Question 5

what are specifiers?

Answer 5

subcategories of diagnosis recognised by DSM that reflect the presence of particular symptoms
specifiers can be added onto bipolar diagnosis
to allow further clarify the specifics of the individuals disease character but it can become difficult to define boundaries of illness

Question 6

examples of specifiers?

Answer 6

"with anxious distress"
"with mixed features"
with cataconia
with rapid cycling
with melancholic features
etc
etc

Question 7

how does ICS classify bipolar?

Answer 7

disorder characterised by 2 or more episodes in which the patient’s mood and activity levels are significantly disturbed
this disturbance consisting on some occasions of hypomania or mania and on others depression
repeated episodes of hypomania or mania only classified as bipolar

Question 8

how can bipolar be distinguished from depression?

Answer 8

a single episode of mania or hypomania is still bipolar even if you haven’t had the opposite episode yet
the first episode of hypomania or mania in a background of long term depression means that its bipolar and not depression

Question 9

what is hypomania?

Answer 9

means a level of disturbance below mania

Question 10

how is a hypomanic episode defined?

Answer 10

mood is elevated or irritable to a degree that is definitely abnormal for the individual and sustained for at least 4 days
at least 3 of the following present, leading to impaired daily functioning
- increased activity/physical restlessness
- increased talkativeness
- difficulty in concentration or distractibility
- decreased need for sleep
- increased sexual energy
- mild spending sprees or other reckless/irresponsible behaviour

Question 11

criteria for manic episode?

Answer 11

mood must be predominantly elevated, expansive or irritable and definitely abnormal for individual and sustained for 1 week
at least 3 of the following (4 if mood is only irritable) leading to impaired daily living
- increased activity
- increased talkative
- flight of ideas/thoughts racing
- loss of normal social inhibitions (inappropriate behaviour)
- decreased need for sleep
- inflated self esteem or grandiosity
- distractibility or constant change in activity/plans
- foolhardy/reckless behaviour
- marked sexual energy or sexual indiscretions

Question 12

if someone ends up in hospital, is it generally mania or hypomania?

Answer 12

mania

Question 13

functional impairment in hypomania vs mania?

Answer 13

hypomania = abnormal for individual 
mania = severe interference with functioning

Question 14

how is insight affected in manic/hypomanic episode?

Answer 14

usually impaired

Question 15

lifetime prevalence of bipolar?

Answer 15

1-4%

1-2.5% 1 year prevalence

Question 16

incidence of bipolar?

Answer 16

fraction of 1%

Question 17

describe the onset of bipolar

Answer 17

usually in late teens or early 20s (10 years earlier than unipolar depression)
earlier onset in family history and episodes triggered by lower stress levels
onset after 60 is rare and usually due to organic cause, worse prognosis

Question 18

comorbidities with bipolar?

Answer 18

anxiety disorders (including OCD)
alcohol/drug misuse
personality disorders (esp borderline)
eating disorders
schizophrenia
schizoaffective disorder

Question 19

is there any genetic element to bipolar?

Answer 19

can have genetic susceptibility
multiple genes each with small effect
generally due to complex interactions with gene-gene and gene-environment

Question 20

what are subsyndromal symptoms?

Answer 20

symptoms outside of mood which can affect individual despite a seeminly normal mood

• attention
• concentration etc

Question 21

clinical course in BP 1 and 2?

Answer 21

Both spend around 50% of the time asymptomatic
BP1 = around 1/3 time depressed, rest in manic/mixed
BP2 = around 50% of time depressed, other 2-3% manic/mixed

Question 22

how is depression different in Bipolar?

Answer 22

doesn’t respond well to depression treatment