Abnormal Mood - Mania

Question 1

How does the DSM-V describe bipolar disorder?

Answer 1

Describes course and pattern
Includes specifiers (e.g with anxious distress)
Categories = bipolar I, bipolar II, cyclothymic disorder

Question 2

How does the ICD-10 describe bipolar disorder?

Answer 2

Describes episode severity

Categories = hypomania, mania with psychotic features, mania without psychotic features

Question 3

What is needed to diagnose bipolar I?

Answer 3

Has to have met criteria for mania, although previous episodes may have been hypomanic or depressive

Question 4

What type of bipolar represents the classic form of manic-depressive psychosis?

Answer 4

Bipolar I

Question 5

What is needed to diagnose bipolar II?

Answer 5

Current/past hypomanic episode and current/past depressive episode
Has never met criteria for manic episode

Question 6

What is the most common form of bipolar disorder?

Answer 6

Bipolar II = accounts for 2/3 of bipolar disorders

Question 7

What is bipolar III?

Answer 7

Pseudo-unipolar = hypomanic episodes only occur following use of antidepressants to treat depression

Question 8

How is bipolar disorder defined by the ICD-10?

Answer 8

Characterised by 2 or more episodes in which mood and activity levels are disturbed consisting of hypomania, mania or depression

Question 9

How do episodes of mania and hypomania dictate diagnosis?

Answer 9

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

Question 10

What is hypomania?

Answer 10

Level of disturbance below mania

Question 11

What does the distinction between mania and hypomania rely on?

Answer 11

Subjective interpretation of symptom severity

Question 12

What is needed for an elevated mood to be classed as a hypomanic episode?

Answer 12

Elevated mood or irritability abnormal for the person and sustained for at least 4 consecutive days

Question 13

What is the criteria for diagnosing a hypomanic episode?

Answer 13

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

Question 14

What is needed for an elevated mood to be classed as a manic episode?

Answer 14

Mood predominantly elevated or expansive and definitely abnormal for the person, prominent and sustained for at least one week, severe interference to function

Question 15

What is the criteria for diagnosing a manic episode?

Answer 15

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

Question 16

What are some features of the mental state examination of a bipolar patient?

Answer 16

Bright clothes, distractibility, overfamiliarity, increased talkativeness, punning, clang associations, increased thought flow, flight of ideas, loosening of association, grandiosity

Question 17

What is the epidemiology of bipolar disorder?

Answer 17

Lifetime prevalence of 1-4% = less common than anxiety and depression
1 year prevalence of 1-2.5%

Question 18

When does bipolar disorder usually present?

Answer 18

Usually late teens or early 20s

Question 19

What does a positive family history mean for the severity of bipolar disorder?

Answer 19

Usually earlier onset

Episodes precipitated by lower levels of stress

Question 20

What does onset of bipolar disorder in a patient aged >60 usually mean?

Answer 20

Rare = associated with treatment resistance, progressive decline in functioning and underlying organic disease

Question 21

What are some common comorbid disorders of bipolar disorder?

Answer 21

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

Question 22

How common are subsyndromal symptoms in bipolar disorder?

Answer 22

Pretty common = up to 75% of mood disturbance is subsyndromal

Question 23

How long do patients with bipolar typically spend with mood disturbances?

Answer 23

Patients with bipolar I and II spend about 50% of time with syndromal mood disturbances

Question 24

What is the most common mood disturbance in bipolar disorder?

Answer 24

Depression = 30-50%

Question 25

How frequent are periods of elevated mood in patients with bipolar disorder?

Answer 25

Not very common = less than 15% of time spent high in BP-I and less than 5% in patients with BP-II

Question 26

What are some predictors of poor outcomes in adolescents with bipolar disorder?

Answer 26

Early onset, low socioeconomic status, subsyndromal mood symptoms, long illness duration, rapid mood fluctuations, mixed presentations, psychosis, comorbid disorders, family psychopathology

Question 27

Can bipolar disorder increase the risk of suicide?

Answer 27

Yes = higher risk that unipolar depression or schizophrenia