Bipolar and Related Disorders Flashcards
Bipolar I Disorder Diagnostic Criteria
Must meet criteria for a manic episode, which may have been preceeded or be followed by hypomanic or major depressive episodes:
A. A distinct period of abnormally and persistently elevated, exspansive, or irritable mood and abnormally/persistently elevated activity or energy, lasting ≥1 week most of the day, nearly every day (or until hospitalized).
B. During that period, ≥3 if the following symptoms (≥4 if mood is irritable), and are a noticeable change from baseline:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (reported or observed)
6. Increase in goal-directed activity (socially, at work/school, or sexually) or psychomotor agitation
7. Excessive involvement in highly risky/painful consequences activities
C. Causes clinically significant functional impairment or requires hospitalization to prevent harm to self or others, or because there are psychotic features
D. Not attributable to substances/medication/medical condition
Note: Criteria A-B must be met, and at least one manic episode is not better explained by psychosis spectrum disorders.
Bipolar I Disorder Specifiers
Severity:
* Mild
* Moderate
* Severe
Other features:
* With anxious distress
* With mixed features
* With rapid cycling
* With melancholic features
* With atypical features
* With mood-congurent psychotic features
* With mood incongruent psychotic features
* With catatonia
* With peripartum onset
* With seasonal pattern
Remission Status:
* In partial remission
* In full remission
Hypomanic Episode Criteria
A. A distinct period of abnormally/persistently elevated, expansive or irritable mood and abnormally/persistently increased energy, lasting ≥4 consecutive days, most of the day, nearly every day.
B. During this period ≥3 of the following symptoms (≥4 if mood is irritable), and are a noticeable change from baseline
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking
4. Flight of ideas or subjective experience of racing thoughts
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in highly risky/painful consequences activities
C. Unequivocal change from baseline
D. Changes are observable by others
E. Not severe enough to cause marked functional impairment or result in hospitalization; no psychotic features.
F. Not attributable to substances/medication/another medical condition
Age of onset considerations with Bipolar I
First manic episodes most commonly have onset is age 20-30. Diagnosis in children is complicated because of developmental stages and first episodes occurring in mid- to late-life should prompt consideration of other medical conditions or substance effects (although first episodes have been recorded as late as 60s-70s).
Comorbidity of manic and major depressive episodes
- 90% of people who experience a manic episode will go on to experience an MDE
- 60% of manic episodes occur immediately before MDEs
- About half of individuals with bipolar I exhibit a predominant polarity, with the slight majority of those being predominant mania
Differentiation of Bipolar I from anxiety disorders
- Anxious ruminations can sometimes be mistaken for flight of ideas and vice-versa; efforts to minimize anxious feelings may be mistaken for impulsivity
- Assessing the episodic nature of symptoms can be most helpful (i.e., manic episodes are usually distinct and relatively brief)
- Anxiety may be tied to more specific triggers
Differentiation of Bipolar I from schizoaffective disorder
- In schizoaffective disorder, delusions/hallucinations occur for ≥ 2 weeks in the absence of a manic or major depressive episode
- In Bipolar I, with psychotic features, the psychotic symptoms have occurred exclusively during manic or major depressive episodes
Differentiation of Bipolar I from ADHD
- Age of onset for ADHD is earlier than Bipolar I (i.e., childhood vs. late adolescence/early adulthood)
- Symptoms of mania in Bipolar I occur in distinct episodes
Differentiation of Bipolar I from DMDD
- Typically manic episodes are accompanied by characteristic symptoms besides irritability (e.g., grandiosity, decreased need for sleep, pressured speech)
- DMDD is less episodic, whereas manic episodes represent a clear change from baseline for distinct periods
Differentiation of Bipolar I from personality disorders
Mood lability and impulsivity are more episodic in bipolar (i.e., must represent a change from baseline to be considered a manic episode)
Bipolar II Disorder Diagnostic Criteria
A. Must meet criteria for ≥1 past/current hypomanic episode and ≥1 past/current MDE
B. There has never been a manic episode.
C. ≥1 hypomanic episode and ≥1 MDE are not better explained by psychosis-spectrum disorders
D. Symptoms of depression or unpredictability of changing/episodic mood states causes clinically significant distress/functional impairment
Bipolar II Specifiers
Current or most recent episode:
* Hypomanic
* Depressed
If current/most recent episode = hypomanic:
* Remission status:
* In partial remission
* In full remission
* Additional features:
* With anxious distress
* With mixed features
* With rapid cycling
* With peripartum onset
* With seasonal pattern
If current/most recent episode = depressed:
* Additional features:
* With mixed features
* With rapid cycling
* With melancholic features
* With atypical features
* With mood-congruent psychotic features
* With mood-incongruent psychotic features
* With catatonia
* With peripartum onset
* With seasonal pattern
* Remission status
* In partial remission
* In full remission
* Severity
* Mild
* Moderate
* Severe
Cyclothymic Disorder Diagnostic Criteria
A. For ≥2 years (≥1 year in children and teens), there have been numerous periods of hypomanic and depressive symptoms that do not meet criteria for hypomanic episodes or MDEs
B. During that period, symptoms have been present for ≥1/2 the time, and the individual has not been without symptoms for ≥2 months at a time.
C. Criteria for an MDE or manic/hypomanic episode have never been met.
D. Symptoms not better explained by psychosis-spectrum disorders
E. Not due to substances/medication/other medical condition.
F. Causes clinically significant distress/functional impairment (either over the short or long term)
Specify if:
* With anxious distress
Differentiations between cyclothymic disorder and BPD
- Self-damaging behaviours occur in the context of hypomanic symtpoms in cyclothymic disorder
- Mood instability in BPD occurs only with anxiety, irritability, and sadness
- Mood instability in cyclothymic disorder can occur with the above, but also occurs with elation, euphoria, and/or increased energy (i.e., not seen in BPD)
Both diagnoses can be given if criteria for both are met.
Substance/Medication-Induced Bipolar and Related Disorder Diagnostic Criteria
A. Prominent/persistent change in mood that predominates the clinical picture, characterized by abnormally elevated/expanive or irritable mood and abnormally increased activity/energy.
B. Evidence from history/examination/lab findings of both 1 and 2:
1. Symptoms develooped during or soon after substance/medication intoxication/exposure/withdrawal
2. The involved substance/medication is capable of producing the symptoms.
C. Not better esplained by other bipolar disorders.
D. Does not occur exclusively during delirium.
E. Caused clinically significant distress/functional impairment.
