Bipolar and Related Disorders: Bipolar I Disorder Flashcards
What is bipolar I disorder?
bipolar I disorder includes
- at least one manic episode
- occurence of spontaneous depression, manias, and hypomanias
- pattern of cycling between mania, hypmania, and depression
For a diagnosis of bipolar I disorder, which criteria is necessary to meet; manic, hypomanic, and/or major depressive episode?
manic episode
For a diagnosis of bipolar I disorder, can a manic episode be preceded by and hypomanic or major depressive episodes?
Yes
For a diagnosis of bipolar I disorder, how many criterias are set for manic episode?
4 (A-D)
What is the Criteria A for manic episode?
distinct period of:
- abnormally and persistently elevated, expansive, or irritable mood AND
- abnormally and persistently increased activity or energy,
- lasting at least 1 week AND
- present most of the day, nearly every day (or any duration if hospitalization is necessary)
What is the Criteria B for manic episode?
- how many sypmtoms must be meet and to what degree
- how many syptoms are there and what are they
During the period of mood disturbance and increased energy or activity:
- three or more symptoms, OR
- four symptoms, if ONLY an irritable mood present
- present to a significant degree & a noticeable change from usual behavior
7 Symptoms
- Inflated self-esteem or grandiosity
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking
- Flight of ideas or subjective experience that thoughts are racing
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity)
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
What is the Criteria C for manic episode?
severe mood disturbance causing:
- marked impairment in social or occupational functioning OR
- hospitalization to prevent harm to self or others, OR
- there are psychotic features
What is the Criteria D for manic episode?
episode not attributable:
- to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) OR
- a medical condition
For a diagnosis of bipolar I disorder, how many manic episodes are required for a diagnosis?
at least one manic episode
How long must symptoms last for; for manic episode?
lasting at least 1 week
How long must a symptom be present for manic episode?
present most of the day, nearly every day
How many symptoms must be present for a manic episode?
3 or more or 4 if the mood is ONLY irritable
What are the defining features (symptoms) of a manic episode?
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas/thoughts are racing
- distractibility
- increase in goal-directed activity or psychomotor agitation
- excessive involvement in activities with high potential for painful consequences
How many criterias are set for hypomanic episode?
6 (A-F)
What is the Criteria A for hypomanic episode?
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 of the day, nearly every day
What is the Criteria B for hypomanic episode?
- how many sypmtoms present and to what degree
- how many syptoms are there and what are they
During the period of mood disturbance and increased energy and activity:
- three or more symptoms
- four symptoms, if ONLY irritable mood is present
- persisted, a noticeable change from usual behavior & present to a significant degree
7 Sypmtoms
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
What is the Criteria C for hypomanic episode?
episode associated with unequivocal change in functioning that is uncharacteristic, when not symptomatic
What is the Criteria D for hypomanic episode?
disturbance in mood and change in functioning are observable by others
What is the Criteria E for hypomanic episode?
episode not severe enough:
- to cause marked impairment in social or occupational functioning OR
- to hospitalize
- If psychotic features, the episode is manic
What is the Criteria F for hypomanic episode?
episode not attributable:
- to physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) OR
- medical condition
For a diagnosis of bipolar I disorder, how many hypomanic episodes are required for a diagnosis?
they are common but NOT required
How long must symptoms last for; for hypomanic episode?
lasting at least 4 consecutive days
How long must a symptom be present for hypomanic episode?
present most of the day, nearly every day
How many symptoms must be present for a hypomanic episode?
3 or more or 4 if the mood is ONLY irritable
What are the defining features (symptoms) of a hypomanic episode?
- inflated self-esteem or grandiosity
- decreased need for sleep
- more talkative than usual or pressure to keep talking
- flight of ideas/thoughts are racing
- distractibility
- increase in goal-directed activity or psychomotor agitation
- excessive involvement in activities with high potential for painful consequences
How many criterias are set for major depressive episode?
3 (A-C)
What is the Criteria A for major depressive episode?
- how many sypmtoms present and to what degree
- how many syptoms are there and what are they
- five or more symptoms
- present during the same 2-week period AND
- represent a change from previous functioning;
-
at least one of the symptoms is either
- depressed mood OR
- loss of interest or pleasure
-
at least one of the symptoms is either
9 Sypmtoms
DO NOT include symptoms clearly attributable to another medical condition.
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, or hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation).
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
- Insomnia or hypersomnia nearly every day.
- Psychomotor agitation or retardation nearly every day (observable by others; not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
- Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
What is the Criteria B for major depressive episode?
symptoms cause clinically significant
- distress or impairment in social, occupational, or other important areas of functioning
What is the Criteria C for major depressive episode?
episode not attributable;
- to the physiological effects of a substance OR
- medical condition
For a diagnosis of bipolar I disorder, how many major depressive episodes are required for a diagnosis?
they are common but NOT required
How long must symptoms last for; for major depressive episode?
during the same 2-week period
How long must a symptom be present for major depressive episode?
present most of the day, nearly every day
How many symptoms must be present for major depressive episode?
5 or more with at least one of the symptoms is either
- depressed mood or
- loss of interest or pleasure
What are the defining features (symptoms) of a major depressive episode?
- depressed mood
- diminished interest or pleasure in all activities
- significant weight loss or weight gain, or decrease or increase in appetite
- insomnia or hypersomnia
- psychomotor agitation or retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive or inappropriate guilt
- diminished ability to think or concentrate, or indecisiveness
- recurrent thoughts of death or recurrent suicidal ideation
What is the difference between a manic and hypomanic episode?
Manic episocde:
- symptoms lasting at least 1 week
- mood disturbance is sufficiently severe to cause marked impairment
Hypomanic episode:
- symptoms lasting at least 4 consecutive days
- episode is not severe enough to cause marked impairment
What is lability?
rapid shifts in mood over brief periods of time
What does a depressred mood look like in children (major depressive episode)?
Depressed mood may be seen as an irritalbe mood
What does the mood in a manic episode look like?
euphoric, excessively cheerful, “feeling on top of the world”
What does a manic episode look like in children?
- happiness, silliness, goofiness
- qualities are recurrent, and inappropriate to the contexxt and beyond what is expected for the developmetnal level of the child
For a child or adolescent to be diagnosed with major depressive episode, significant weight loss or weight gain may look like what?
instead of weight gain or weight loss consider failure to make expected weight gains
During a manic episode individiuals believe they are ill and need treatment and do not resist efforts to be treated. Ture or False
False
60% of manic episode occur immediatley before what?
major depressive episode
Females are more likely to experience rapid cycling or mixed states, Ture or False
True
Males are more likely to experience depressive episode in bipolar I disorder. True or False
False
Inflated self-esteem is typically present, ranging from uncritical self-confidence to marked grandiosity, and may reach delusional proportions in hypomanic episodes. True or False
True
Grandiose delusions (e.g., of having a special relationship to a famous person) are common in hypomanic episode. True or False
True
How does Grandoise delusion look like in children?
overestimation of abilities and belief that
- for example, they are the best at a sport or the smartest in the class is normal;
- however, when such beliefs are present despite clear evidence to the contrary or
- the child attempts feats that are clearly dangerous and, most important, represent a change from the child’s normal behavior,
Decreased sleep is the most common feature in hypomanic episodes? True or False
True
What is an increase in goal-directed activity in manic and hypmanic episode?
- consists of excessive planning and participation in multiple activities
- including sexual, occupational, political, or religious activities
How does an increase in goal-directed activity in manic and hypmanic episode look like in chidlren?
difficult to ascertain in children
- child takes on many tasks simultaneously
- starts devising elaborate and unrealistic plans for projects
- develops previously absent and developmentally inappropriate sexual preoccupations
- then Criterion B might be met based on clinical judgment
What is the onset age of the first manic, hypomanic, or major depressive episode for bipolar I disorder.
18 years
When do individuals with bipolar I disorder who have multiple (four or more) mood episodes (major depressive, manic, or hypomanic) receive the specifier “with rapid cycling.”
within 1 year
Bipolar disorder is more common in high-income countries than in low-income countries. True of False
True
A family history of bipolar disorder is the strongest risk factors for bipolar disorders. True or False
True
Bipolar disorder is hereditary. True or False
True
Subsequent manic episodes are more likely to include psychotic features. True or False
True
Who is more likely to experience depressive symptoms in indinviduals with bipolar I or II females or males?
Females
The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. True or False
True
How are the diagnosis of bipolar I disorder differentiated from bipolar II disorder?
by determining whether there have been any past episodes of mania
Major depressive disorder may also be accompanied by manic and/or hypomanic episode?
accompanied by hypomanic or manic symptoms
How are the diagnosis of bipolar I disorder differentiated from generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or other anxiety disorders?
- careful history of symptoms is needed to differentiate
- assess the episodic nature of the symptoms described
- to consider symptom triggers
How are the diagnosis of bipolar I disorder differentiated from substance/medication-induced bipolar disorder?
based on symptoms that remain once substances are no longer being used
How are the diagnosis of bipolar I disorder differentiated from personality disorders?
symptoms must represent a distinct episode, and the noticeable increase over baseline required for the diagnosis of bipolar disorder must be present
How are the diagnosis of bipolar I disorder differentiated from disorders with prominent irritability?
children and adolescentsr disorder diagnose only when a clear episode of mania or hypomania are present
when any child is being assessed for mania, it is essential that the symptoms represent a clear change from the child’s typical behavior
How are the diagnosis of bipolar I disorder differentiated from disorders attention-deficit/hyperactivity disorder?
clarifies whether the symptom(s) represents a distinct episode
If a child’s irritability is persistent and severe should the the diagnosis be bipolar I or disruptive mood dysregulation disorder?
disruptive mood dysregulation disorder would be more appropriate
What is the bipolar I disorder overall criteria?
Bipolar I Disorder
- at least one manic episode
- occurrence of the manic and major depressive episode(s) are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
What are the specifiers?
Specify:
- anxious distress
- mixed features
- rapid cycling
- melancholic features
- atypical features
- mood-congruent psychotic features
- mood-incongruent psychotic features
- catatonia
- peripartum onset
- seasonal pattern
How should the diagosis be recorded?
- bipolar I disorder,
- type of current or most recent episode,
- severity/psychotic/remission specifiers,
- followed by as many specifiers without codes as apply to the current or most recent episode
Specify current or most recent episode:
- Manic
- Depressed
Specify severity:
- Mild
- Moderate
- Severe
Psychotic:
- with psychotic features
Specify course:
- In partial remission
- In full remission
