Bipolar and related disorders Flashcards
main diagnostic criteria for bipolar 1
must meet criteria for at least one manic episode. Does not necessarily have to have had a depressive episode
manic episode criteria
persistently elevated/irritable mood present most of the day nearly every day and increased activity/energy for at least a week w/ at least 3 of the following
-inflated self-esteem
-decreased need for sleep
-more talkative than usual
-flight of ideas/racing thoughts
-distractibility
-increased goal-directed behavior or psychomotor agitation
-indiscretion
difference between mania and hypomania
hypomania only needs to last 4 days and does not cause marked impairment
what if there are psychotic features
the episode is manic by defintion
criteria for major depressive episode
at least 5 in the same 2 week time period:
-depressed mood most of the day nearly every day
-marked loss of interest/pleasure
-significant weight gain/loss or increase/decrease in appetite
-insomnia/hypersomnia nearly every day
-psychomotor agitation/retardation nearly every day observable by others
-fatigue/loss of energy nearly every day
-decreased concentration/indecisiveness nearly every day
-recurrent thoughts of death
when are severity specifiers needed in bipolar disorder
if full criteria for mania/hypomania/depressive episode are met
when are remission specifiers necessary in bipolar disorder
when full criteria for mood episode not met
what often heralds the beginning of a manic episode
decreased need for sleep
Age of onset for bipolar in US
typically between 20-30 but can occur anytime
definition of rapid cycling
4+ mood episodes in previous 12 months
medical conditions that can mimic bipolar symptoms
Cushing’s disease
MS
stroke
TBI
anti-NMDA receptor encephalitis
most common substances that induce mania
stimulants
phencyclidine
steroids
difference in onset for bipolar and ADHD
ADHD onset is prior to age 12
most common comorbid disorders w/ bipolar
anxiety
ADHD
substance abuse
diagnostic criteria for bipolar 2
must meet criteria for current/past hypomanic episode AND current/past depressive episode and 3+/7
what are the 7 mood symptoms characteristic of mania
-inflated self-esteem/grandiosity
-decreased need for sleep
-more talkative than usual
-flight of ideas/racing thoughts
-distractibility
-increased goal-directed behavior
-indiscretion
how many diagnostic codes are there for bipolar 2
only 1.
should indicate in writing severity, psychotic features, course, and any other specifiers
difference in depressive episodes in bipolar 1 and 2
depressive episodes tend to be more frequent and lengthier in bipolar 2
which bipolar more commonly presents w/ mixed features
bipolar 2
why is bipolar dx delayed, and typically by how long
because there are often multiple depressive episodes prior to first hypomanic/manic episode. Delayed by up to a decade
characteristics associated with higher rates of functional recovery
more education
fewer years of illness
being married
what are two times that symptoms may be exacerbated in women
premenstrual and perimenopausal
diagnostic criteria for cyclothymic disorder
multiple episodes of hypomanic/depressive sx that do not meet full criteria over a period of at least 2 years (1 in children/adolescents)
how often are symptoms present in cyclothymic disorder
at least half the time and patient has not been sx free for a period longer than 2 months
when to use other SPECIFIED bipolar and related disorder
when sx are characteristic and cause clinically significant distress but do not meet criteria and clinician choses to specify why diagnostic criteria not met
when to use UNSPECIFIED bipolar and related disorder
sx characteristic of disorder and cause clinically significant distress and clinician choses NOT to specify why diangostic criteria not met
what are some medical conditions that can mimic mania
Cushing’s disease
MS
stroke
TBI
bipolar specifier: with anxious distress
2+ of the following:
-feeling tense
-feeling restless
-difficulty concentrating d/t worry
-fear that something awful will happen
-feeling they might lose control
severity ratings for “with anxious distress” specifier
mild - 2 symptoms
moderate - 3 symptoms
severe - 4-5 symptoms
bipolar specifier: mania with mixed features
full criteria for manic/hypomanic episode plus at least 3 of the following
-prominent depressed mood
-loss of interest/pleasure
-psychomotor retardation
-fatigue/loss of energy
-feelings of worthlessness
-recurrent thoughts of death or SI
bipolar specifier: depressive w/mixed features
full criteria for depressive episode and at least 3:
-elevated/expansive mood
-inflated self-esteem
-more talkative/pressured speech
-flight of ideas/racing thoughts
increased energy or goal-directed activities
-increased indescretion
bipolar specifier: with rapid cycling
at least 4 mood episodes in previous 12 months
bipolar specifier: with melancholic features
at least one during most severe period of depressive episode:
-profound despair or empty mood
-depression regularly worse in morning
-early morning awakening
-significant anorexia/weight loss
-marked psychomotor agitation/retardation
-excessive/inappropriate guilt
bipolar specifier: w/ atypical features
mood reactivity (brightens in response to positive events)
and at least 2 of the following:
-weight gain/increased appetite
-hypersomnia
-leaden paralysis
-pattern of interpersonal rejection sensitivity that results in significant impairment
bipolar specifier: with psychotic features
delusions/hallucinations present at any point
mood-congruent psychotic features applied to mania
content of all delusions/hallucinations consistent w/ typical themes of grandiosity, invulnerability, etc. and may include suspiciousness/paranoia
mood-incongruent psychotic features applied to manic episode
content does not involve typical themes or is a mixture of mood-congruent and mood-incongruent
mood-congruent psychotic features applied to depressive episode
content consistent w/ typical depressive themes
mood-incongruent psychotic features applied to depressive episode
content not consistent w/ typical depressive themes or is a mix of mood-congruent and mood-incongruent
bipolar specifier: with peripartum onset
occuring at any time during pregnancy or within 4 weeks postpartum
bipolar partial remission status
symptoms present but full criteria not met or there is a period of less than 2 months w/o symptoms following the previous episode
bipolar full remission
no symptoms for at least 2 months
diagnostic criteria for bipolar if presenting mood is irritable rather than expansive
must have 4 other manic symptoms
what is associated with mixed features in bipolar disorder
poorer outcomes and increased suicide attempts
what medication is associated with poor response when mixed features are present
lithium
how is schizoaffective disorder differentiated from bipolar
schizoaffective disorder has periods where psychotic features are present during and in the absence of mood episodes. If psychotic sx are only during mood episodes dx id bipolar 1 w/ psychotic features
what is the main differentiating factor between bipolar and disruptive mood dysregulation disorder
mood in disruptive mood dysregulation disorder is persistently irritable and severe in the absence of manic/hypomanic episodes
what personality disorders are frequently associated with bipolar disorder
borderline
schizotypal
antisocial
specifiers for bipolar 2 when current mood episode
-with anxious distress
-with mixed features
-with rapid cycling
-with peripartum onset
-with seasonal pattern
which type of bipolar tends to have higher lethality of suicide attempts
bipolar 2
duration of symptoms for cyclothymic disorder in children/adolescents
1 year as opposed to 2 years for adults
what if full criteria for mania and depression are met simultaneously
dx is manic episode with mixed features
