Bipolar + Dissociative Disorders

Question 1

Criteria for Manic Episode?

Answer 1

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 of the day, nearly every day (or any duration is hospitalisation is necessary).
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behaviour:
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 marked impairment in social or occupational functioning or to necessitate hospitalisation to prevent harm to self or others, or there are psychotic features.
D. The episode is not attributable to the physiological effects of a substance or to another medical condition.
Note: Criteria A-D constitute a manic episode. At least one lifetime manic episode is required for the diagnosis of bipolar I disorder.

Question 2

Symptoms of manic episode? ? ? ?

Answer 2

DIGFAST

Distractibility
Indiscretion
Grandiosity
Flight of Ideas
Activity - increase in goal-directed
Sleep - no need for it
Talkativness, pressure

Question 3

How many symptoms are needed for a manic episode

Answer 3

3 + if mood is expansive, elevated and irritable

4+ if mood is only irritable

Question 4

What does decreased sleep look like?

Answer 4

 Feels rested after 1 - 3 hours of sleep
 May be active at night - telephoning people, partying,
etc.
 Maybe exacerbated by use of stimulants

Question 5

Describe what increased energy and activity might look like in mania

Answer 5

Increase in goal-directed activity:
̶
Person is full of ideas on how to improve things that initially seem plausible
Marked increase in goal-related activity – work, social, sexual
The volume of talk and enthusiasm may hide a quite limited range of ideas and themes
Tend to lack judgement, self-criticism: schemes become unrealistic

 OR Psychomotor agitation:
̶ Restless, purposeless, must keep moving, starts next task
before finishing the previous one, not goal directed

Question 6

how long does a manic episode need to last for?

Answer 6

1 week

Question 7

Diagnosis of BP I?

Answer 7

A. Criteria have been met for at least one manic episode (Criteria A - D under “Manic Episode” above).

B. The occurrence of the manic and major depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional dis order, or

Question 8

Do you need a major depressive episode for bP?

Answer 8

no

Question 9

Difference between mania and hypomania?

Answer 9

Mania:

• 1 week or more
• significant functional impairment, OR hospitalisation OR psychotic features
• same number of symptoms req

Hypomania:

• 4 days or more
• not significant functional impairment, no hospitalisation or psychotic features
• must be observable to others
• same number of symptoms req

Question 10

Criteria for BP II?

Answer 10

A. Criteria have been met for at least one hypomanic episode and at least one major depressive episode.

B. There has NEVER BEEN A MANIC EPISODE

C. The occurrence of the hypomanic episode(s) and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

D. The symptoms of depression or the unpredictability caused by frequent alteration between periods of depression and hypomania cause clinically significant distress or impairment in social, occupational, ore other important areas of functioning.

Question 11

Criteria for a hypomanic episode?

Answer 11

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 of the day, nearly every day.

B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behaviour, and have been present to a significant degree:

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 episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.

D. The disturbance in mood and change in functioning are observable by others.

E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalisation. If there are psychotic features, the episode is, by definition, manic.

F. The episode is not attributable to the physiological effects of a substance.

Question 12

Cyclothymic disorder?

Answer 12

A. For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria or a major depressive episode.

B. During the 2 year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.

C. Criteria for a major depressive, manic, or hypomanic episode have never been met.

D. The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.

E. The symptoms are not attributable to the physiological effects of a substance or another medical condition.

F. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Question 13

Common observations at interviews for people who have BP-type disorderS?

Answer 13

 Clothes may be unusual, bold, insufficient, or poorly attended to
 Hoarse voice
 May have lost weight
 Poor impulse control, even in interview
 Increased libido (e.g., risqué jokes, offensive flirting)

Question 14

What are the dissociative disorders?

Answer 14

Dissociative Identity Disorder
Dissociative Amnesia (including Dissociative Fugue) Depersonalization/Derealization Disorder

Question 15

Functions affected in dissociative disorders?

Answer 15

	Consciousness.
	Memory.
	Identity.
	Emotion.
	Perception.
	Body Representation.
	Motor Control.
	Behaviour.

Question 16

malingerers vs real dissociative disorders?

Answer 16

• Help seeking is not frequent, but may be revealed during investigation.
• The personality that seeks treatment is rarely the ‘original’ personality.
• Genuine clients tend to hide symptoms where non-genuine presentations tend to be very ready to show and move between personalities.
• Some research has shown significant observed physiological changes across alters.

Question 17

Dissociative identity disorder?

Answer 17

A. Disruption of identity characterised by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

E. The symptoms are not attributable to the physiological effects of a substance or another medical condition.

Question 18

Dissociative amnesia?

Answer 18

A. An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting.
Note: Dissociative amnesia most often consists of localised or selective amnesia for a specific event or events; or generalised amnesia for identity and life history.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The disturbance is not attributable to the physiological effects of a substance or neurological or other medical condition.
D. The disturbance is not better explained by dissociative identity disorder, posttraumatic stress disorder, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder.

Question 19

Depersonalisation/Derealisation disorder?

Answer 19

A. The presence of persistent or recurrent experiences of depersonalisation, derealisation, or both:
1. Depersonalisation: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions.
2. Derealisation: Experiences of unreality or detachment with respect to surroundings.
B. During the depersonalisation or derealisation experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
E. The disturbance is not better explained by another mental disorder, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, posttraumatic stress disorder, or another dissociative disorder.