Bipolar and Related Disorders: Bipolar II Disorder Flashcards
What is bipolar II disorder?
bipolar II disorder requires
- at least one hypomanic episode
- at least one major depressive episode
For a diagnosis of bipolar II disorder, which criteria is required to be met; hypomanic and/or major depressive episode?
current or past hypomanic and major depressive episode
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 have persisted
- four sypmtoms, if ONLY irritable mood is present
- represent a noticeable change from usual behavior, & have been present to a significant degree
7 Sypmptoms
- 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 is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
What is the Criteria D for hypomanic episode?
disturbance in mood and the change in functioning are observable by others
What is the Criteria E for hypomanic episode?
episode is not severe enough to
- to cause marked impairment in social or occupational functioning OR
- to hospitalize
- If there are psychotic features, the episode is manic
What is the Criteria F for hypomanic episode?
episode is not attributable
- to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) OR
- medical condition
For a diagnosis of bipolar II disorder, how many hypomanic episodes are required for a diagnosis?
at least one hypomanic episode
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 that are clearly attributable to a 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, 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 is 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?
at least one major depressive episode
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
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 bipolar II disorder overall criteria?
Bipolar II Disorder
- at least one hypomanic episode
- at least one major depressive episode
- has never been a manic episode
- occurrence of hypomanic episode(s) 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
- depression symptoms or the 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
How is bipolar II disorder characterized?
recurring mood episodes consisting of
- one or more major depressive episodes AND
- at least one hypomanic episode
How long must a hypmanic episode last, to meet the diagnostic criteria?
last at least 4 days
How long must a major depressive episode last, to meet the diagnostic criteria?
last at least 2 weeks
During mood episode(s), symptoms must be present for how long?
symptoms must be present most of the day, nearly every day, and represent a noticeable change from usual behavior and functioning
Depressive episodes or hypomanic fluctuations must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. True or False
True
Must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning, does this requirement need to be met by hypomanic episodes?
this requirement does not have to be met
A hypomanic episode that causes significant impairment would likely qualify for which diagnosis?
diagnosis of manic episode and a lifetime diagnosis of bipolar I disorder
Recurrent major depressive episodes are more frequent and lengthier in bipolar II in bipolar I. True or False
True
What episodes do individuals with bipolar II typically present to a clinician?
- major depressive episode
- unlikely to complain initially of hypomania
What is a common feature of bipolar II disorder?
impulsivity
What can impulsivity contribute to?
suicide attempts and substance use disorders
What is the average onset age of bipolar II disorder?
mid 20s
Within how many months do individuals with bipolar II disorder have multiple (four or more) mood episodes (hypomanic or major depressive)?
12 months
What is the term for indivdiuals who are expeiencing multiple mood episodes within the previous 12 months?
rapid cycling
What is nonepisodic?
i.e., lacks the well-demarcated periods of altered mood
What is nonepisodic irritability in youth associated with?
an elevated risk for anxiety disorders and major depressive disorder
For a hypomanic episode to be diagnosed, the child’s symptoms must exceed what is expected in a given environment and culture for the child’s developmental stage. True or False
True
The risk of bipolar II disorder tends to be highest among relatives of individuals with bipolar II disorder, as opposed to individuals with bipolar I disorder or major depressive disorder. True or False
True
The most challenging differential diagnosis to consider is major depressive disorder. True or False
True
Major depressive disorder maybe accompanied by hypomanic or manic symptoms that meet full criteria. True or False
False
Major depressive disorder maybe accompanied by hypomanic or manic symptoms that do not meet full criteria (i.e., either fewer symptoms or a shorter duration than required for a hypomanic episode)
How is bipolar II disorder distinguished from cyclothymic disorder?
- the presence of one or more major depressive episodes
- If a major depressive episode occurs after the first 2 years of cyclothymic disorder, the additional diagnosis of bipolar II disorder is given
How is bipolar II disorder distinguished from psychotic disorders?
psychotic disorders (i.e. schizophrenia, schizoaffective disorder, and delusional disorder) are characterized by periods of psychotic symptoms that occur in the absence of prominent mood symptoms.
Do anxiety disorders need to be considered in the differential diagnosis?
Anxiety disorders need to be considered in the differential diagnosis and may frequently be present as co-occurring disorders.
How is bipolar II disorder distinguished from ADHD?
The double counting of symptoms toward both ADHD and bipolar II disorder can be avoided if the clinician clarifies whether the symptoms represent a distinct episode and if the noticeable increase over baseline required for the diagnosis of bipolar II disorder is present.
Whad disorder is often misdiagnosed in children and adolescents?
Attention-deficit/hyperactivity disorder (ADHD)
What ADHD symptoms overlap with symptoms of hypmania?
ADHD sypmtoms: rapid speech, racing thoughts, distractibility, and less need for sleep
How is bipolar II disorder distinguished from personality disorder?
Symptoms must represent a distinct episode, and the noticeable increase over baseline required for the diagnosis of bipolar II disorder must be present.
What personality disorder symptoms overlap with symptoms of bipolar II?
mood lability and impulsivity are common in both
Bipolar II disorder is never associated with one or more co-occurring mental disorders. True or False
False
Bipolar II disorder is more often than not associated with one or more co-occurring mental disorders. True or False
What is the most common co-occuring disorder with indivduals with bipolar II?
anxiety disorders
Which co-occuring disorder do children and adolescents with bipolar II disorder have?
anxiety disorders
What are the specifiers?
Specify current or most recent episode:
- Hypomanic
- Depressed
Specify if:
- anxious distress
- mixed features
- rapid cycling
- melancholic features
- atypical features
- mood-congruent psychotic features
- mood-incongruent psychotic features
- catatonia
- peripartum onset
- seasonal pattern
Specify course if full criteria for a mood episode are not currently met:
- In partial remission
- In full remission
Specify severity if full criteria for a major depressive episode are currently met:
- Mild
- Moderate
- Severe
How should the diagnosis be recorded?
- bipolar II 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:
- Hypomanic
- Depressed
Specify severity if full criteria for a major depressive episode are currently met:
- Mild
- Moderate
- Severe
Specify course if full criteria for a mood episode are not currently met:
- In partial remission
- In full remission
example:
- bipolar II disorder, current episode depressed, moderate severity, with mixed features;
- bipolar II disorder, most recent episode depressed, in partial remission
