Abnormal Mood - Mania Flashcards
How does the DSM-V describe bipolar disorder?
Describes course and pattern Includes specifiers (e.g with anxious distress) Categories = bipolar I, bipolar II, cyclothymic disorder
How does the ICD-10 describe bipolar disorder?
Describes episode severity
Categories = hypomania, mania with psychotic features, mania without psychotic features
What is needed to diagnose bipolar I?
Has to have met criteria for mania, although previous episodes may have been hypomanic or depressive
What type of bipolar represents the classic form of manic-depressive psychosis?
Bipolar I
What is needed to diagnose bipolar II?
Current/past hypomanic episode and current/past depressive episode
Has never met criteria for manic episode
What is the most common form of bipolar disorder?
Bipolar II = accounts for 2/3 of bipolar disorders
What is bipolar III?
Pseudo-unipolar = hypomanic episodes only occur following use of antidepressants to treat depression
How is bipolar disorder defined by the ICD-10?
Characterised by 2 or more episodes in which mood and activity levels are disturbed consisting of hypomania, mania or depression
How do episodes of mania and hypomania dictate diagnosis?
Repeated episodes of hypomania/mania only are classified as bipolar
First episode of hypomania/mania on a background of recurrent depression means its bipolar and not depression
What is hypomania?
Level of disturbance below mania
What does the distinction between mania and hypomania rely on?
Subjective interpretation of symptom severity
What is needed for an elevated mood to be classed as a hypomanic episode?
Elevated mood or irritability abnormal for the person and sustained for at least 4 consecutive days
What is the criteria for diagnosing a hypomanic episode?
At least 3 = Increased talkativeness
Increased physical activity or physical restlessness
Decreased need for sleep
Difficulty in concentrating
Increased sexual energy
Mild spending sprees or other types of reckless behaviour
What is needed for an elevated mood to be classed as a manic episode?
Mood predominantly elevated or expansive and definitely abnormal for the person, prominent and sustained for at least one week, severe interference to function
What is the criteria for diagnosing a manic episode?
At least 3 = Increased talkativeness Increased activity or physical restlessness Flight of ideas or racing thoughts Loss of normal social inhibitions Decreased need for sleep Inflated self-esteem Reckless behaviour whose risks aren't recognised Constant changes in activity Marked sexual energy
What are some features of the mental state examination of a bipolar patient?
Bright clothes, distractibility, overfamiliarity, increased talkativeness, punning, clang associations, increased thought flow, flight of ideas, loosening of association, grandiosity
What is the epidemiology of bipolar disorder?
Lifetime prevalence of 1-4% = less common than anxiety and depression
1 year prevalence of 1-2.5%
When does bipolar disorder usually present?
Usually late teens or early 20s
What does a positive family history mean for the severity of bipolar disorder?
Usually earlier onset
Episodes precipitated by lower levels of stress
What does onset of bipolar disorder in a patient aged >60 usually mean?
Rare = associated with treatment resistance, progressive decline in functioning and underlying organic disease
What are some common comorbid disorders of bipolar disorder?
Anxiety disorders = especially panic disorder, OCD and generalised anxiety disorder
Alcohol/drug misuse and eating disorders
Schizoaffective disorder and schizophrenia
Personality disorders = especially borderline PD
How common are subsyndromal symptoms in bipolar disorder?
Pretty common = up to 75% of mood disturbance is subsyndromal
How long do patients with bipolar typically spend with mood disturbances?
Patients with bipolar I and II spend about 50% of time with syndromal mood disturbances
What is the most common mood disturbance in bipolar disorder?
Depression = 30-50%
How frequent are periods of elevated mood in patients with bipolar disorder?
Not very common = less than 15% of time spent high in BP-I and less than 5% in patients with BP-II
What are some predictors of poor outcomes in adolescents with bipolar disorder?
Early onset, low socioeconomic status, subsyndromal mood symptoms, long illness duration, rapid mood fluctuations, mixed presentations, psychosis, comorbid disorders, family psychopathology
Can bipolar disorder increase the risk of suicide?
Yes = higher risk that unipolar depression or schizophrenia
