Bipolar and Related Disorders

Question 1

Manic Episode

Answer 1

Manic Episode (at least one required for bipolar I)
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally and persistently increased activity/energy, lasting at least 1 week for most of the day nearly every day (or any duration if hospitalization
B. During the period of mood disturbance and increased energy, 3+ of the following (4 if the mood is irritable:
● Grandiosity
● Decreased need for sleep
● Pressured speech
● Racing thoughts
● Distractibility
● Increase in goal-directed or psychomotor activities
● Excessive involvement in risk-taking activities
C. Disturbance severe enough to cause marked impairment or to necessitate hospitalization and prevent harm to self or others; psychotic features
D. Not due to drugs or medical condition

Question 2

Hypomanic Episode

Answer 2

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood, and increased activity or energy for 4 consecutive days and present most of the day nearly every day.
B. During the disturbance, the presence of 3+ of the following (4 if it’s irritable mood)
● Same as mania
C. Episode is associated with an unequivocal change in functioning that is uncharacteristic of individual when not symptomatic
D. Mood disturbance and functional change are observable by others
E. Episode not severe enough to cause marked impairment in functioning or to warrant hospitalization; no psychotic features
F. Not due to effects of a drug

Question 3

Bipolar 1

Answer 3

A. At least one manic episode
B. Major Depressive Episode is common but NOT required for diagnosis
B. Not due to another disorder

Question 4

Bipolar 2

Answer 4

A. At least one hypomanic episode
B. At least one major depressive episode
C. No manic disorders ever
Not due to another disorder

Question 5

Bipolar Key Concerns

Answer 5

o Comorbid substance use
o Suicide risk
o High heritability
o Of those diagnosed with Bipolar II, 5-10% go on to develop I
o High risk of harm to self or others
o In children it’s likely to be the dysregulated mood disorder

Question 6

Methods to Assess Bipolar

Answer 6

o Unstructured clinical interview
o MSE
o SCID-5 Mood disorders
o BASC-3/Conners CBRS for kids
o PAI
o MMPI-3 specifically EID

Question 7

Bipolar Treatment

Answer 7

o Consult with medical doctor for mood stabilizers – best way to treat bipolar
o Once on medications, CBT can work to address some of the negative patterns of thinking, do some reality checking, set goals, etc
o CAMS might be needed to manage suicidality
o Might need some motivational interviewing (people with bipolar disorders do not always like treatment because it balances them out by removing the mania)

Question 8

Bipolar Specifiers that can be used

Answer 8

Mild
Moderate
Severe
With anxious distress
With mixed features
With rapid cycling
With melancholic features
With Atypical features
With catatonia
With Seasonal Pattern

Question 9

Cyclothymic Disorder

Answer 9

A. For at least 2 years (1 for children and adolescents), there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode, and numerous depressive symptoms that do not meet criteria for a major depressive episode
B. During that period, they hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time
C. Never met criteria for depressive, manic, or hypomanic episode
D. Not better explained by another mental health disorder
E. Not better explained by drugs or medical reason
F. Clinically significant distress or impairment