Abnormal Mood - Elevated Flashcards
What system defines mood disorders?
ICD -10
F30
Manic episode
F31
Bipolar affective disorder
F32
Depressive episode
F33
Recurrent depressive episode
What are the 2 main classification systems for bipolar disorder?
- ICD-10
* DSM-5
Outline how DSM classifies bipolar disorder.
- Bipolar I and Bipolar II
- Cyclothymic disorder
DESCRIBES COURSE AND PATTERN
Outline how ICD classifies bipolar disorder.
- Hypomania
- Mania + psychosis
- Mania - psychosis
DESCRIBES EPISODE SEVERITY
BIPOLAR I
Mania + depression
For a diagnosis of BIPOLAR I to be made, what must be present?
Must have met the criteria for mania, although previous episodes may have been hypomaniac +C/or depressive
What does BIPOLAR I represent?
The ‘classic’ form of manic-depressive psychosis in the last century
BIPOLAR II
Hypomania + depression
What must you understand about BIPOLAR I?
It is not just mania – most people will have had episodes of major depression
Bipolar II is a midler form of the disease
FALSE
What does bipolar II have than I often doesn’t?
Chronic depressive episodes
Bipolar III
Pseduo-unipolar
When only do hypomanic episodes occur in Bipolar III?
Following use of antidepressants for depression
How does DSM recognise different combinations of symptoms?
By allowing ‘specifiers’ – subcategories of diagnosis that reflect the presence of particular sx.
According to ICD-10, what is BPAD?
Bipolar Affective Disorder
A disorder characterized 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 are classified as bipolar.
A single episode of hypomania or mania is bipolar disorder, even if you haven’t been depressed yet
TRUE
The first episode of (hypo)mania on a background of recurrent depression means that it’s bipolar disorder and not depression anymore
TRUE
Outline the criteria for a ‘hypomanic episode’ in the ICD-10 criteria.
A. The mood is elevated or irritable to a degree that is definitely abnormal for the individual concerned, and sustained for at least 4 consecutive days.
B. A least 3 of the following signs must be present, leading to some interference with personal functioning in daily living:
- increased activity or physical restlessness
- increased talkativeness
- difficulty in concentration or distractibility
- decreased need for sleep
- increased sexual energy
- mild spending sprees, or other types of reckless or irresponsible behaviour
How long does an episode of hypomania have to last to be diagnosed?
At least 4 days
Outline the criteria for a ‘manic episode’ in the ICD-10 criteria.
A. Mood must be predominantly elevated, expansive or irritable, and definitely abnormal for the individual concerned. The mood change must be prominent and sustained for at least 1 week (unless it is severe enough to require hospital admission).
B. At least three of the following signs must be present (four if the mood is merely irritable), leading to severe interference with personal functioning in daily living:
- Increased activity or physical restlessness
- Increased talkativeness (‘pressure of speech’)
- Flight of ideas or the subjective experience of thoughts racing
- Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances
- Decreased need for sleep
- Inflated self-esteem or grandiosity
- Distractibility or constant changes in activity or plans
- Behaviour which is foolhardy or reckless and whose risks the subject does not recognize e.g. spending sprees, foolish enterprises, reckless driving
- Marked sexual energy or sexual indiscretions.
How long does a manic episode have to last to be describes as mania by ICD-10 criteria?
At least 1 week (unless hospital admission is needed)
Why is the distinction between mania and hypomania difficult?
It relies on subjective interpretations of symptom severity.
When is the typical onset of bipolar?
Late teens/early 20’s
Compare the age of onset of BPAD to unipolar depression
Occurs 10 years earlier
What is the effect of a family history of BPAD on onset?
This often results in earlier onset, and episodes which are precipitated by lower levels of stress.
What is there often a delay between?
First presentation and diagnosis.
Onset after what age is rare?
60
What is the onset after the age of 60 associated with?
Treatment-resistance, progressive decline in functioning, and an underlying organic cause
What ACUTE mental states are associated with BPAD?
(Hypo)mania.
Depression.
What MAINTENANCE mental states are associated with BPAD?
Predominantly (hypo)manic.
Predominantly depressive.
Mixed affective states.
Rapid cycling.
In both types, what is the most common mood disturbance? What % of people have this at follow-up?
Depression
- 30-50% of follow-up
What are the predictors of poor outcome in adolescent?
- Early-onset
- Low socioeconomic status
- Subsyndromal mood symptoms
- Long duration of illness
- Rapid mood fluctuation
- Mixed presentations
- Psychosis
- Comorbid disorders
- Family psychopathology
Risk of suicide in bipolar is
HIGH
The most robust differentiation is between bipolar I (mania + depression) and bipolar II (hypomania + depression)
TRUE
