Bipolar and related disorders

Question 1

Manic episode

Answer 1

For diagnosis of bipolar 1 disorder is necessary to meet the following criteria for manic episode (may have been preceded/followed by hypomanic or major depressive episode)

Manic episode:
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most the day, nearly every day (or any duration if hospitalization is necessary)
B. During the period mood disturbance and increased energy or activity, 3 or more of the following symptoms (4 if mood is only irritable) are present to a significant degree and represent an noticeable change from 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 as reported or observed
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in activities that have a high potential for painful consequences
C. The mood disturbance is sufficiently severe to cause marketed impairment in social or occupational functioning or to necessary hospitalization to prevent harm to self or others, or there are psychotic features
D. Episode is not attributable to the physiological effects of a substance or to another medical condition
Note: A full manic episode that emerges during antidepressant treatment (medication, ECT) but persist at fully syndrome level beyond a physiological effect of that treatment is sufficient evidence for a manic episode and therefore, a bipolar 1 diagnosis
Note: At least one lifetime manic episode is required for diagnosis of bipolar 1 disorder

Question 2

Hypomanic episode disorder

Answer 2

A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most the day, nearly every day
B. During the. Of mood disturbance and increased energy and activity, 3 or more of the following symptoms (4 if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, have been present to a significant degree:
1. Inflated self-esteem or grandiosity

C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
D. Disturbance in mood and the change in functioning are observable by others
E. The episode is not severe enough to cause market impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features the episode is, by definition manic
F. Episode is not attributable to the physiological effects of a substance
Note: A full hypomanic episode that emerges during antidepressant treatment but persisted a Foley syndrome all level be on the physiological effect of the treatment is sufficient evidence for hypomanic episode. However caution is indicated to that one or 2 symptoms particularly increased irritability, edginess or agitation following antidepressant use, are not taken as sufficient diagnosis of a hypomanic episode
Note: Bipolar 2 diagnosis also requires diagnosis for major depressive episode

Question 3

Bipolar I disorder

Answer 3

A. Criteria have been met for at least one manic episode
B. Recurrence of the manic or and major depressive episode is not been explained by a diagnosis on the schizophrenia spectrum

Question 4

Bipolar II disorder

Answer 4

A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode
B. There is never been a manic episode
C. The current of the hypomanic episode and major depressive episode is not been explained by a diagnosis on the schizophrenia spectrum
D. The symptoms of depression or unpredictability caused by frequent alternation between periods of depression and hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

Question 5

Bipolar specifiers

Answer 5

With anxious distress
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