Bipolar and Related Disorders

Question 1

Manic Episode

Answer 1

• a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased goal-directed activity or energy
• lasts at least 1 week, present for most of the day nearly ever day
• 3 or more of the following symptoms:
  1. Inflated self-esteem/ grandiosity
  2. Decreased need for sleep
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective racing thoughts
  5. Distractibility
  6. Increase in goal-directed activity
  7. Excessive involvement in activities that have a high potential for painful consequences (buying sprees, sexual indiscretions, foolish business investments)
• causes impairment in social and occupational functioning OR to need hospitalization to prevent harm OR psychotic features
• Episode is not attributable to the physiological effects of substance of abuse, or a medical condition
• At least one lifetime manic episode is required for diagnosis of bipolar I disorder

Question 2

Hypomanic Episode

Answer 2

• a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy
• lasts at least 4 days, presents for most of the day nearly ever day
• 3 or more of the following symptoms:
  1. Inflated self-esteem/ grandiosity
  2. Decreased need for sleep
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective racing thoughts
  5. Distractibility
  6. Increase in goal-directed activity
  7. Excessive involvement in activities that have a high potential for painful consequences (buying sprees, sexual indiscretions, foolish business investments)
• causes impairment in social and occupational functioning OR to need hospitalization to prevent harm OR psychotic features
• episode is associated with unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
• the disturbance in mood and the change in functioning are observable by others
• episode is not sever enough to cause marked impairment in social or occupational functioning or to need hospitalization
• Episode is not attributable to the physiological effects of substance of abuse, or a medical condition
• hypomanic episodes are common in bipolar I disorder but not required for the diagnosis of bipolar I disorder

Question 3

BP I: Major Depressive Episode

Answer 3

5 or more of the following symptoms have been present during the same 2 week period AND at least one of the symptoms is either : depressed mood OR loss of interest or pleasure [ not including symptoms from other medical conditions]

1. Depressed mood most of the days nearly ever day
2. Marked diminished interest or pleasure in almost all or all activities
3. Significant weight loss when not dieting or weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate or indecisiveness, nearly every day
9. Recurrent thoughts of death

Question 4

Bipolar I Disorder

Answer 4

Criteria was met for at least one manic episode

- a manic and major depressive episode is not better explained by any psychotic disorder

Question 5

Differential Diagnosis: Major Depressive disorder

Answer 5

May be accompanied by hypomanic or manic symptoms; depends on history, symptoms may be associated with either major depressive disorders or bipolar disorder

Question 6

Differential Diagnosis: Other Depressive disorder

Answer 6

Bipolar I and Bipolar II are determined by episodes of mania. Other disorders should be differentiated from bipolar I and II by episodes of depressive symptoms fail to meet the full criteria for conditions

Question 7

Bipolar II

Answer 7

• criteria have been met for at least one hypomanic episode and at least one major depressive episode
• never has been a manic episode
• occurrence of hypomanic episodes and major depressive episodes in not better explained by other psychotic disorders
• the symptoms of depression or the unpredictability caused by frequent alternation between periods of depression and hypomania causes clinical significant distress or impairment in other functioning

Question 8

Hypomanic Episode

Answer 8

• a distinct period of abnormally and persistently elevated, expansive or irritable mood and abnormally and persistently increased activity or energy
• lasts at least 4 days, presents for most of the day nearly ever day
• 3 or more of the following symptoms:
  1. Inflated self-esteem/ grandiosity
  2. Decreased need for sleep
  3. More talkative than usual or pressure to keep talking
  4. Flight of ideas or subjective racing thoughts
  5. Distractibility
  6. Increase in goal-directed activity
  7. Excessive involvement in activities that have a high potential for painful consequences (buying sprees, sexual indiscretions, foolish business investments)
• causes impairment in social and occupational functioning OR to need hospitalization to prevent harm OR psychotic features
• disturbance in mood and change in function are observable by others
• episode is associated with unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
• episode is not sever enough to cause marked impairment in social or occupational functioning or to need hospitalization
• Episode is not attributable to the physiological effects of substance of abuse, or a medical condition

Question 9

BP II Major Depressive Episode

Answer 9

5 or more of the following symptoms have been present during the same 2 week period AND at least one of the symptoms is either : depressed mood OR loss of interest or pleasure [ not including symptoms from other medical conditions]

1. Depressed mood most of the days nearly ever day
2. Marked diminished interest or pleasure in almost all or all activities
3. Significant weight loss when not dieting or weight gain
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation nearly every day
6. Fatigue or loss of energy nearly every day
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate or indecisiveness, nearly every day
9. Recurrent thoughts of death
   - symtoms cause clinical distress in social and occupational settings

Question 10

Cyclothymic Disorder

Answer 10

a chronic fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms

• For 2 years have been numerous hypomanic and depressive symptoms but fail to meet criteria
• the periods of symptoms have been present at least half the time
• fails to meet major depressive, manic or hypermanic criteria
• not better explained by psychotic disorders
• cause distress in function

Question 11

Substance/ Medication- Induced Bipolar and Related

Answer 11

• prominent and persistent disturbance in mood is characterized by elevated, expansive or irritable mood with or without depressed mood, markedly diminished interest or pleasure in all, or almost all activities
• evidence from history that: symptoms developed after intoxiation AND involved substance medication is capable of producing the Criteria
• not better explained by bipolar
• does not occur exclusively during course of delirium
• Disturbance causes distress in function

Question 12

Bipolar & Related Disorders Due to Another Medical Condition

Answer 12

• prominent and persistent disturbance in mood is characterized by elevated, expansive or irritable mood with or without depressed mood, markedly diminished interest or pleasure in all, or almost all activities
• evidence from history that disturbance is consquence from medical condition
• not better explained by another mental disorder
• does not occur exclusively during delerium
• disturbance causes distress in function