Bipolar and Related Flashcards
Manic Episode, lasting at least
1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).
Manic Episode “DIG FAST”
Distractractibility
Impulsivity
Grandiosity
Flight of Ideas
Activity
Sleep
Talkative
Major Depressive Episode, following symptoms have been present during the same
Five (or more) of the following symptoms have been present during the same 2week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
In recording the name of a diagnosis, terms should be listed in the following order:
bipolar disorder
type of current episode (or most recent episode if bipolar I disorder is in partial or full remission)
severity/psychotic/remission specifiers, followed by as many of the following specifiers without codes as apply to the current episode (or the most recent episode if bipolar I disorder is in partial or full remission)
In Bipolar, specify if: 9
With anxious distress
With mixed features
With rapid cycling
With melancholic features
With atypical features
With mood-congruent psychotic features (applies to manic episode and/or major depressive episode)
With mood-incongruent psychotic features (applies to manic episode and/or major depressive episode)
With catatonia With peripartum onset
With seasonal pattern
One of the most common features is a decreased need for sleep, which is distinct from insomnia (during which the individual wants to sleep or feels the need to sleep but is unable to)
Manic episode
For individuals whose symptoms meet full episode criteria for both mania and depression simultaneously, the diagnosis should be
Manic episode, with mixed features
occurrence of at least four mood episodes during the previous 12 months
Bipolar D/o With rapid cycling
This specifier is applied when these features predominate during the majority of days of the current major depressive episode (or the most recent major depressive episode if bipolar I or bipolar II disorder is currently in partial or full remission).
With atypical features
Delusions or hallucinations are present at any time in the current manic or major depressive episode in bipolar I disorder (or the most recent manic or major depressive episode if bipolar I disorder is currently in partial or full remission) or in the current major depressive episode in bipolar II disorder (or the most recent major depressive episode if bipolar II disorder is currently in partial or full remission).
With psychotic features
If psychotic features are present, specify if
mood-congruent or mood-incongruent
This specifier is applied to the current manic,
hypomanic, or major depressive episode in bipolar I disorder (or the most recent manic, hypomanic, or major depressive episode if bipolar I disorder is currently in partial or full remission) or to the current hypomanic or major depressive episode in bipolar II disorder (or the most recent hypomanic or major depressive episode if bipolar II disorder is currently in partial or full remission) if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
With peripartum onset
This specifier is applied to the current manic or major depressive episode in bipolar I disorder (or the most recent manic or major depressive episode if bipolar I disorder is currently in partial or full remission) or to the current major depressive episode in bipolar II disorder (or the most recent major depressive episode if bipolar II disorder is currently in partial or full remission) if catatonic features are present during most of the episode.
With catatonia
Peripartum-onset depressive disorders must be distinguished from the much more common
“maternity blues,” or what is known in lay terms as “baby blues.” ; do not cause functional impairment and that are likely caused by physiological changes occurring after delivery.
This specifier applies to the lifetime pattern of mood episodes. The essential feature is a regular seasonal pattern of at least one type of episode (i.e., mania, hypomania, or depression). The other types of episodes may not follow this pattern.
With seasonal pattern
within the bipolar disorders group, a seasonal pattern of major depressive episodes appears to be more likely in
bipolar II disorder than in bipolar I disorder
the first episode of bipolar disorder is often
depressive
the most frequent symptoms experienced across the long-term course of bipolar I disorder
depressive symptoms
When the individual presents in an episode of major depression, it is therefore important to actively probe for
a history of mania or hypomania
Factors that might indicate that the diagnosis is bipolar I disorder rather than major depressive disorder in an individual presenting with a current depressive episode include
family history of bipolar disorder
onset of illness in early 20s
numerous past episodes
presence of psychotic symptoms
history of lack of response to antidepressant treatment or the emergence of a manic episode during antidepressant treatment
There may be heightened levels of ____ during hypomanic episodes in some individuals with a bipolar II disorder.
creativity; hence undermines adherence to seeking treatment
individuals with bipolar II disorder have multiple (four or more) mood episodes (hypomanic or major depressive) within the previous 12 month
rapid cycling
pattern is associated with a poorer prognosis
rapid cycling
common in women with bipolar disorder, especially in those with bipolar II disorder.
Premenstrual syndrome and premenstrual dysphoric disorder
For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.
Cyclothymic Disorder
During the above 2-year period (1 year in children and adolescents), Criterion A symptoms have been present for at least ** and the individual has not been without the symptoms for more than ** at a time.
half the time ; 2 months
There is a 15%– 50% risk that an individual with cyclothymic disorder will subsequently develop
bipolar I disorder or bipolar II disorder; diagnostic conversion rates are higher in youth than in adults.
Mood instability in borderline personality disorder occurs in the domains of
anxiety, irritability, and sadness
Substances/medications that are typically considered to be associated with substance/medicationinduced bipolar and related disorder include
the stimulant class of drugs, as well as phencyclidine and steroids; however, a number of potential substances continue to emerge as new compounds are synthesized (e.g., so-called bath salts).
A diagnosis of substance/medication-induced bipolar and related disorder either with onset during intoxication or with onset during withdrawal should be made instead of a diagnosis of substance intoxication or substance withdrawal when
the euphoric or irritable mood or increased energy symptoms are predominant in the clinical picture and are sufficiently severe to warrant clinical attention.
A lifetime history of one or more major depressive episodes in individuals whose presentation has never met full criteria for a manic or hypomanic episode but who have experienced two or more episodes of shortduration hypomania that meet the full symptomatic criteria for a hypomanic episode but that only last for 2–3 day. The episodes of hypomanic symptoms do not overlap in time with the major depressive episodes, so the disturbance does not meet criteria for major depressive episode, with mixed features.
Short-duration hypomanic episodes (2–3 days) and major depressive episodes
A lifetime history of one or more major depressive episodes in individuals whose presentation has never met full criteria for a manic or hypomanic episode but who have experienced one or more episodes of hypomania that do not meet full symptomatic criteria (i.e., at least 4 consecutive days of elevated mood and one or two of the other symptoms of a hypomanic episode, or irritable mood and two or three of the other symptoms of a hypomanic episode).
Hypomanic episodes with insufficient symptoms and major depressive episodes
One or more hypomanic episodes in an individual whose presentation has never met full criteria for a major depressive episode or a manic episode.
Hypomanic episode without prior major depressive episode
Multiple episodes of hypomanic symptoms that do not meet criteria for a hypomanic episode and multiple episodes of depressive symptoms that do not meet criteria for a major depressive episode that persist over a period of less than 24 months (less than 12 months for children or adolescents) in an individual whose presentation has never met full criteria for a major depressive, manic, or hypomanic episode and does not meet criteria for any psychotic disorder.
Short-duration cyclothymia (less than 24 months)
The presence of at least two of the following symptoms during the majority of days of the current manic, hypomanic, or major depressive episode
Feeling keyed up or tense. 2. Feeling unusually restless.
3. Difficulty concentrating because of worry.
4. Fear that something awful may happen.
5. Feeling that the individual might lose control of himself or herself.
Mild: Two symptoms.
Moderate: Three symptoms.
Moderate-severe: Four or five symptoms.
Severe: Four or five symptoms with motor agitation.
With anxious distress
