Bipolar disorder Flashcards
Bipolar I Disorder
- manic episode required (1 or more per lifetime)
- will likely have more than 1 manic episode during lifetime
- commonly have
other types of episodes (depressive, hypomania, etc.) thru life that sometimes precede or proceed manic episodes. - no other types of episodes required to make dx except MANIA!
manic episode/mania
- a distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 1-WEEK or less IF a patient must be hospitalized.
- during this same period, 3/7 DIGFAST symptoms persist and cause impairment in social and/or occupational functions.
- not otherwise explained by physiological effects of a substance.
DIGFAST
DISTRACTABILITY
INSOMNIA (Either no sleep at all or very minimal sleep)
GRANDOSITY (an unrealistic sense of superiority, inflated self-esteem)
FLIGHT OF IDEAS (observable OR patient’s subjective feeling of having racing thoughts)
ACTIVITIES/AGITATION (increase in goal-directed activity or psychomotor agitation
SPEECH (more talkative than usual or pressure to keep talking)
THOUGHTLESSNESS (engaging in potentially harmful activities, transactions)
Mood
A pervasive, sustained emotion or feeling tone that influences a person’s behavior and influences their perception of the world.
- Sometimes observed (sadness).
- Sometimes can only be felt by the patient (i.e. hopelessness).
- Examples: depressed, sad, empty, melancholic, distressed, irritable, elated, euphoric, manic, gleeful, etc.
- Dynamic, to a degree.
If mood is only irritable and not euphoric, _/7 DIGFAST symptoms are required for diagnosis of bipolar disorder I.
If mood is only irritable and not euphoric, 4/7 DIGFAST symptoms are required for diagnosis of bipolar disorder I.
If there is psychosis or hospitalization with other sx, it is considered _____.
If there is psychosis or hospitalization with other sx, it is considered MANIA.
(vs. hypomania).
Bipolar II Disorder
at least 1 of each throughout lifetime:
- hypomanic episode
- major depressive episode
Hypomanic episode
A distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 4 DAYS.
- during same period, 3/7 DIGFAST sx persist,
OR 4/7, as with mania, if mood is only irritable and not euphoric. - change in functioning, but NO marked social and/or occupational impairment (no hospitalization).
- not otherwise explained by physiological effects of a substance.
Major Depressive Episode
At least 5/9 following sx, during at least a 2-week period, with at least 1/5 sx being depressed mood or loss of pleasure:
- Depressed mood
- Decreased interest and/or pleasure in most activities
- Decrease in appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue, loss of energy
- Feelings of worthlessness and/or excessive guilt
- Difficulty in thinking, concentrating, or indecisiveness
- Recurrent thoughts of death
- Significant distress or impairment in functioning.
- Episode NOT attributable to substances and/or a medical condition.
Cyclothymic Disorder
Less severe, milder Bipolar II Disorder.
- alternating hypomania and depression, without ever fully meeting criteria for either episode.
- lasts at least 2 yr in adults.
- lasts at least 1 yr in children and adolescents.
- CHANGES in mood are ABRUPT, occur within hours.
Lifetime Prevalence Rates (%)
Bipolar 1 Disorder
0-2.4 %
Bipolar II Disorder
0.3-4.8 %
Cyclothymia
0.5-6.3 %
Hypomania
2.6-7.8 %
Major Depressive Disorder
5-17 %
Clinical Features Predictive of Bipolar Disorder (vs. MDD)
- Early age at onset
- Psychotic depression before 25 y/o
- Postpartum depression, especially if psychotic too
- Recurrent depression (5+ episodes)
- Depression with psychomotor retardation
- Atypical features (reverse vegetative signs)
- Seasonality
- FHx Bipolar Illness
High-density, three-generation pedigrees
- Trait mood lability (cyclothymia)
- Hypomania associated w/ antidepressants
- Repeated (at least 3x) loss of efficacy of antidepressants after initial response
- Depressive mixed states
Major Depression Disorder
sex mean age onset age range of onset marital status socioeconomic and culture
2x greater in women than men
30 y/o
20-50 y/o (inc in youth)
more comm in divorced/separated
no correlation to socioeconomic/culture
Bipolar I Disorder
sex mean age onset age range of onset marital status socioeconomic and culture
M=W
40 y/o
5/6-50 y/o
more common in divorced and single
inc incidence in upper socioeconomic groups
Major Depression Disorder: lifetime prevalence of comorbidities
substance use disorder: 27%
panic disorder: 10%
obsession-compulsive disorder: (12%)
