Bipolar and Related Disorders Flashcards
Bipolar I Disorder
It is necessary to meet the following criteria for a manic episode. The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes
Bipolar I Disorder-Manic Episode
A:Distinct period of abnormally & persistently elevated, expansive or irritable mood and abnormally & persistently increased goal-directed activity or energy. Lasting at least 1 week and present most of the day, everyday (or any duration if hospitalization is necessary)
B: During the period of mood disturbance & increased energy or activity, 3 or more of the following sx ( 4 if the mood is irritable) are present to a significant degree & a noticeable change in usual behavior:
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
6. increased in goal-directed activity
7. Excessive involvement in activities that have a high potential for painful consequences
C. Mood disturbance is sufficiently severe to cause marked impairment or to necessitate hospitalization to prevent harm to self or others or there are psychotic features
D. Episode is not attributable to to the physiological effects of a substance or other medical condition
Note: A full manic episode that emerges during antidepressant treatment but persist at a fully syndromal level beyond the physiological effect is sufficient evidence for a manic episode
Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required
Bipolar I Disorder-Hypomanic Episode
A: Distinct period of abnormally & persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day
B. During the period of mood disturbance & increased energy and activity, 3 or more of the following sx (4 if mood is only irritable) have persisted & represent a noticeable change from usual behavior and have been present to a significant degree:
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
6. increased in goal-directed activity
7. Excessive involvement in activities that have a high potential for painful consequences
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
D. The disturbance in mood and the change in functioning are observable by others
E. The episode is not severe enough to cause marked impairment or to necessitate hospitalization. if there are psychotic features the episode is manic
F: Episode is not attributable to the physiological effects of a substance
Note; A full manic episode that emerges during antidepressant treatment but persists at a fully syndromal level beyond the physiological effect is sufficient evidence for a hypomanic episode diagnosis. Caution is indicated so that one or two sx (particularly increased irritability, edginess or agitation) are not taken as sufficient for diagnosis of hypomanic episode
Note: Hypomanic episodes are common in bipolar I disorder but are not required for the dx
Bipolar I Disorder-Major Depressive Disorder
A: Five (or more) sx that have been present during the same 2-week period and represent a change from previous functioning; at least one of the sx is either (1) depressed mood or (2) loss of interest or pleasure
1.Depressed mood most of the day, nearly every day indicated by report or observation of others-can be irritable mood in children or adolescents
2.Markedly diminished interest or pleasure in all, almost all activities most of the day, nearly every day (reported or observed)
3. Significant weight loss (5% of body weight in a month)-In children failure to make expected weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day (observable by others not just reported)
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly everyday (not just self blame or guilt about being sick)
8. Diminished ability to think or concentrate, or indecisiveness, near everyday (reported or observed by others)
9. Recurrent thoughts of death (not just fear of dying), recurrent SI w/o specific plan or a suicide attempt or a plan to commit suicide
B. The sx cause significant distress or impairment in important areas of functioning
C. The episode is not due to physiological effects of a substance or other medical condition
Note: Criteria A-C constitute a major depressive episode. it is common but not required for the diagnosis of bipolar I disorder
Note: Response to a significant loss may include feelings of intense sadness, rumination about the loss, insomnia, poor appetite & weight loss. Clinical judgement should be exercised
Bipolar I Disorder: Specify
W/ anxious distress
W/ mixed features
W/ rapid cycling
W/ melancholic features
W/ atypical features
W/ mood-congruent psychotic features
W/ mood incongruent psychotic features
W/ catatonia
W/ peripartum onset
W/ seasonal pattern
Bipolar Disorder II
It is necessary to meet the following criteria for a current or past hypomanic episode AND the following criteria for a current or past major depressive episode
A: Criteria have been met for at least one hypomanic episode and at least one major depressive episode
B: There has never been a manic episode
C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
D. The sx of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in important areas of functioning
Cyclothymic Disorder
A: For at least 2 years ( at least 1 year in children & adolescents) there have been numerous periods w/ hypomanic sx that don’t meet criteria for a hypomanic episode & numerous periods w/ depressive sx that don’t meet criteria for a major depressive episode
B: During the 2 year period ( 1 in children & adolescents), the hypomanic & depressive periods have been present for at least half the time & the individual has not been w/o the sx for more than 2 months at a time
C: Criteria for a major depressive episode, manic or hypomanic episode have never been met
D: The sx in Criteria A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
E: The sx are not due to the physiological effects of a substance oter medical conditions]
F. The sx cause clinically significant distress or impairment in important areas of functioning
Substance /Medication-Induced Bipolar and Related Disorder
A: A prominent & persistent disturbance in mood that predominates in the clinical picture & is characterized by elevated, expansive, or irritable mood, w/ or w/o depressed mood, or markedly diminished interest or pleasure in all, or almost all, activities
B: There is evidence from the history, physical examination, or lab findings of both 1 and 2:
1. The sx in Criteria A developed during or soon after substance intoxication or withdrawal or after exposure to medication
2. The involved substance/medication is capable of producing the sx in Criteria A
C: The disturbance is not better explained by a bipolar or related disorder that is not substance/medication-induced. Evidence of an independent bipolar or related disorder could include the following: The sx precedes the onset of substance/medication use; the sx persist for a substantial period of time (about 1 month) after the cessation or there is other evidence suggesting the existence of an independent dx
D: The disturbance does not occur exclusively during the course of delirium
E: The disturbance cause clinically significant distress or impairment in important areas of functioning
Substance /Medication-Induced Bipolar and Related Disorder: Specify If
With onset during intoxication
With onset during withdrawal
Bipolar & Related Disorder Due to Another Medical Condition
A: A prominent & persistent period of abnormally elevated, expansive, or irritable mod & abnormally increase activity or energy that predominates in the clinical picture
B: Evidence from the history, physical examination, or lab findings that the disturbance is the direct consequence of another medical condition
C: The distur
Bipolar & Related Disorder Due to Another Medical Condition
A: A prominent & persistent period of abnormally elevated, expansive, or irritable mod & abnormally increase activity or energy that predominates in the clinical picture
B: Evidence from the history, physical examination, or lab findings that the disturbance is the direct consequence of another medical condition
C: The disturbance is not better explained by another mental disorder
D: The disturbance does not occur exclusively during the course of delirium
E: The disturbance causes clinically significant distress or impairment in important areas of functioning or necessitates hospitalization to prevent harm to self or others, or there are psychotic features
Other Specified Bipolar or Related Disorder
Presentation in which sx characteristics of a bipolar or related disorder that causes clinically significant distress or impairment in important areas of functioning but do not meet the full criteria. Used in situations where the specific reason is communicated
Examples:
Short duration hypomanic episode (2-3 days) & major depressive episode
Hypomanic episodes w/ insufficient sx & major depressive episode
Hypomanic episode w/o prior major depressive episode
Short duration cyclothymia (less than 24 months)
Unspecified Bipolar and Related Disorder
Presentation in which sx characteristics of a bipolar or related disorder that causes clinically significant distress or impairment in important areas of functioning but do not meet the full criteria. Used in situations where the specific reason is NOT communicated
Specifiers for Bipolar and Related Disorders: Specify IF-W/ Anxious Distress
W/ Anxious Distress: The presence of at least two of the following sx during the majority of days of the current or most recent episode of mania, hypomania or depression:
1. Feeling keyed up or tense
2. Feeling unusually restless
3. Difficulty concentrating b/c of worry
4. Fear that something awful may happen
5. Feeling that the individual might lose control of themselves
Current Severity:
Mild-two sx
Moderate- three sx
Moderate severe- four or five sx
Severe: four or five w/ motor agitation
Specifiers for Bipolar and Related Disorders: Specify IF-W/ Mixed features
With mixed features: can apply to the current manic, hypomanic or depressive episode in bipolar I or bipolar II disorder
Manic or hypomanic episode, w/ mixed features:
A. Full criteria are met for a manic episode or hypomanic episode & at least 3 of the following sx are present during the majority of days of the current or most recent episode of mania or hypomania:
1. Prominent dysphoria (unease/ dissatisfaction) or depressed mood as indicated by report or observation
2. Diminished interest or pleasure in all or almost activities (reported or observed)
3. Psychomotor retardation nearly every day (observable by others)
4.Fatigue or loss of energy
5. Feelings of worthlessness or excessive or inappropriate guilt
6. Recurrent thoughts of death (not just fear of dying)
B. Mixed sx are observable by others and is not their usual behavior
C: For individual’s whose sx meet full episode criteria for both mania and depression simultaneously, the dx should be manic episodes w/ mixed features due to marked impairment & clinical severity of full mania
D. The mixed sx are not due to the physiological effects of a substance
