Bipolar disorders

Question 1

A 33 year-old female presents to the ER after police were notified she was attempting to lead a religious crusade in the airport by approaching strangers who were just arriving to the city. After collateral is obtained from her husband, you learn that she flew to Boston from California after 2 weeks without need for sleep and speaking of a secret mission she had to pursue, as advised by the CIA (she has worked as an elementary school teacher for the last 10 years). In the ER, she speaks of her mission with euphoria and pressured speech, and is easily distracted by the other patients coming in and out. If medical causes for her behavior are ruled-out, which of the following diagnoses would be considered most likely?
	A. Bipolar I Disorder
	B. Bipolar II Disorder
	C. Delusional Disorder 
	D. Major Depressive Disorder
	E. Narcissistic Personality Disorder

Answer 1

A. Bipolar I Disorder

The patient presents within the context of a manic episode. She meets the criteria as defined by the DSM-V of having “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…”. Additionally, she displays >3 of the 7 necessary symptoms for the diagnosis of a manic episode (grandiosity, decreased need for sleep, more talkative than usual, distractibility, increase in goal-directed activity, and excessive involvement in activities that have a high potential for painful consequences). If she had an irritable mood, rather than being euphoric, she would need to display 4 or more of these symptoms. Additionally, it can be assumed that it has impacted functioning AND that medical causes were ruled out.

Question 2

for a bipolar 1 disorder what is required?

Answer 2

at least one manic episode

most likely have more than one

Question 3

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

Answer 3

manic episode

Question 4

DIGFAST

Answer 4

Distractibility
Insomnia
Grandiosity
Flight of ideas
Activities/ agitation
Speech
Thoughtlessness

Question 5

Bipolar II disorder requires at least one of each of these two epsiodes

Answer 5

hypomanic and major depressive episode

Question 6

A distinct period of an abnormally and persistently elevated, expansive, or irritable mood lasting for at least 4 days

Answer 6

hypomanic episode

Question 7

cyclothymic disorder

Answer 7

less severe than Bipolar II but it is where hypomania and depression alternate without meeting the criteria for classification

Question 8

how long does cyclothymic disorder last in adults?

what about in children?

Answer 8

2 yr. in adults

1 yr. in adults

Question 9

is substance abuse disorder high in bipolar disorders?

Answer 9

yep, 61%

Question 10

will a hypomanic episode cause a marked social and/or occupational impairment leading to possible hospitalization

Answer 10

Nope!