Bi-polar and related disorders Flashcards
What are the key features of a manic episode in Bipolar I Disorder?
Distinct period of abnormally and persistently elevated, expansive, or irritable mood and increased activity or energy lasting at least 1 week (or any duration if hospitalization is necessary).
Includes at least 3 of the following (4 if mood is only irritable):
1- Inflated self-esteem or grandiosity
2- Decreased need for sleep
3- More talkative than usual or pressured speech
4- Flight of ideas or racing thoughts
5- Distractibility
6- Increased goal-directed activity or psychomotor agitation
7- Excessive involvement in activities with a high potential for painful consequences
What distinguishes Bipolar I Disorder from Bipolar II Disorder?
Bipolar I Disorder requires the occurrence of at least one manic episode.
Bipolar II Disorder involves at least one hypomanic episode and one major depressive episode. There is no history of a manic episode in Bipolar II.
How is a hypomanic episode different from a manic episode
Hypomanic episodes last at least 4 consecutive days, compared to 1 week for manic episodes.
Symptoms are less severe and do not cause significant impairment in social or occupational functioning.
Hospitalization is not required for hypomanic episodes, and there are no psychotic features.
What are the diagnostic criteria for a major depressive episode in Bipolar Disorder
At least 5 of the following symptoms during a 2-week period, with at least one being either depressed mood or loss of interest/pleasure:
Depressed mood most of the day, nearly every day
Markedly diminished interest or pleasure in almost all activities
Significant weight loss or gain or changes in appetite
Insomnia or hypersomnia
Psychomotor agitation or retardation
Fatigue or loss of energy
Feelings of worthlessness or excessive/inappropriate guilt
Diminished ability to think or concentrate, or indecisiveness
Recurrent thoughts of death or suicide
What specifiers can be added to a Bipolar Disorder diagnosis
With anxious distress
With mixed features
With rapid cycling (at least 4 mood episodes in the past year)
With melancholic features
With atypical features
With psychotic features (mood-congruent or mood-incongruent)
With catatonia
With peripartum onset
With seasonal pattern
What is rapid cycling in Bipolar Disorder
Rapid cycling refers to the occurrence of 4 or more mood episodes (manic, hypomanic, or depressive) within a 12-month period. It is associated with more severe illness and can be more challenging to treat.
What are common comorbidities seen with Bipolar Disorder
Anxiety disorders (e.g., generalized anxiety disorder, panic disorder)
Substance use disorders
ADHD
Eating disorders
Medical conditions such as migraines or metabolic syndrome
What tools or assessments might be used to screen for Bipolar Disorder
Mood Disorder
Questionnaire (MDQ)
Young Mania Rating Scale (YMRS)
Hamilton Depression
Rating Scale (HDRS) for depressive symptoms
What is the prevalence of Bipolar Disorder in the general population
Bipolar I Disorder: ~1%
Bipolar II Disorder: ~1.1%
Onset is typically in late adolescence or early adulthood.
What is the minimum duration of manic versus hypomanic episodes?
Manic Episode: Minimum of 1 week, or any duration if hospitalization is required.
Hypomanic Episode: Minimum of 4 consecutive days.
What are the severity criteria for manic versus hypomanic episodes
Manic Episode: Causes marked impairment in social or occupational functioning, may require hospitalization, or includes psychotic features.
Hypomanic Episode: Does not cause significant impairment in social or occupational functioning, does not require hospitalization, and does not include psychotic features.
What gender differences are encountered in Bipolar Disorders?
Bipolar I Disorder: Equal prevalence among men and women.
Bipolar II Disorder: More common in women.
Women are more likely to experience depressive episodes, while men are more likely to have manic episodes.
What age differences are encountered in Bipolar Disorders?
Typical onset is in late adolescence or early adulthood, with Bipolar I often presenting earlier than Bipolar II.
Bipolar disorder in children and adolescents may present as severe mood dysregulation or irritability.
Older adults may present with mixed features or secondary bipolar disorder due to medical conditions or medications.
Bipolar and related disorder due to another medical condition results most often from what kind of medical disorders?
Neurological Disorders: Examples include stroke, traumatic brain injury, epilepsy, Huntington’s disease, and multiple sclerosis.
Endocrine Disorders: Examples include Cushing’s syndrome and hyperthyroidism.
Infectious Diseases: Examples include HIV/AIDS and syphilis.
What type of psychiatric medications most commonly trigger substance/medication-induced bipolar and related disorder?
Antidepressants: Particularly SSRIs, SNRIs, and tricyclic antidepressants.
Steroids: Such as corticosteroids like prednisone.
Stimulants: Including amphetamines or other psychostimulants.
Dopaminergic Agents: Such as levodopa used for Parkinson’s disease.
