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4. Mood Disorders > Cyclothymic D/O + rest of bipolar chapter (DSM) > Flashcards

Cyclothymic D/O + rest of bipolar chapter (DSM) Flashcards

1
Q

criterion A for cyclothymic disorder

A

for at least TWO YEARS (at least ONE in kids and teens) there have been NUMEROUS periods with hypomanic symptoms that do NOT meet criteria for a hypomanic episode and numerous episodes with depressive symptoms that do not meet criteria for a major depressive episode

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2
Q

criterion B for cyclothymic disorder

A

during the required 2 year period (1 year in kids and teens), 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 TWO MONTHS at a time

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3
Q

criterion C for cyclothymic disorder

A

criteria for a major depressive, manic or hypomanic episode have NEVER BEEN MET

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4
Q

criterion D for cyclothymic disorder

A

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

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5
Q

criterion E for cyclothymic disorder

A

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

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6
Q

criterion F for cyclothymic disorder

A

symptoms cause CLINICALLY SIGNIFICANT distress or impairment in social, occupational or other important areas of functioning

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7
Q

what specifier may accompany cyclothymic disorder

A

with anxious distress

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8
Q

what is the essential feature of cyclothymic disorder

A

CHRONIC, FLUCTUATING mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from each other

hypomanic sx are insufficient in number, severity, pervasiveness or duration to meet full criteria for a hypomanic episode (same for the depressive symptoms)

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9
Q

what is the time criteria for cyclothymic disorder

A

a two year period in which person has not been without symptoms for more than 2 months at a time and has symptoms for at least half the time

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10
Q

what aspect of cyclothymic disorder may lead to the impairment required to make the diagnosis

A

may develop as a result of long periods of cyclical, often unpredictable mood changes i.e person may be regarded as temperamental, moody, unpredictable, inconsistent or unreliable

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11
Q

what is the lifetime prevalence of cyclothymic disorder

A

0.4-1%

(prevalence in mood disorders clinic 3-5%)

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12
Q

is cyclothymic disorder more common in males or females

A

equally common in both

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13
Q

when does cyclothymic disorder usually begin

A

in adolescence or early adulthood

sometimes considered a temperamental predisposition to other disorders in bipolar section of DSM

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14
Q

what is the usual course of cyclothymic disorder

A

insidious onset and persistent course

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15
Q

what is the risk that someone with cyclothymic disorder will eventually develop bipolar I or II disorder

A

15-50% risk

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16
Q

among children with cyclothymic disorder what is the mean age of onset

A

6.5 years

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17
Q

what disorders are more common amongst those who have a first degree relative with cyclothymic disorder

A

MDD
bipolar I
bipolar II

may also be an increased familial risk of SUDs

cyclothymic disorder may be more common in those with a first degree relative with bipolar I

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18
Q

ddx of cyclothymic disorder

A

bipolar and related disorder due to another medical condition

depressive disorder due to another medical condition

sub/med induced bipolar or depressive disorder

bipolar I with rapid cycling

bipolar II with rapid cycling

borderline PD

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19
Q

can both cyclothymic disorder and borderline PD be diagnosed in the same person

A

yes, if criteria for both are met

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20
Q

list common comorbidities with cyclothymic disorder

A

SUDs

sleep disorders

ADHD

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21
Q

criterion A for substance/medication induced bipolar and related disorder

A

a prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive or irritable mood with or without depressed mood, or markedly diminished interest or pleasure in all, or almost all activities

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22
Q

criterion B for substance/medication induced bipolar and related disorder

A

there is evidence from the history, physical exam, or lab findings of both of the below:

  1. the symptoms in criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
    AND
  2. the involved substance/med is capable of producing the symptoms in criterion A
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23
Q

criterion C for substance/medication induced bipolar and related disorder

A

disturbance not better explained by a bipolar or related disorder that is not substance/med related

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24
Q

what evidence might suggest that the substance/medication induced bipolar and related disorder is in fact not related to a substance or med

A

the symptoms precede the onset of the sub/med use

the symptoms persist for a substantial period of time (i.e about 1 month) after the cessation of acute withdrawal or severe intox

or there is other evidence suggesting the existence of an independent bipolar type illness unrelated to substances

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25
Q

criterion D for substance/medication induced bipolar and related disorder

A

disturbance does not occur exclusively during the course of delirium

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26
Q

criterion E for substance/medication induced bipolar and related disorder

A

disturbance causes clinically significant distress or impairment in social, occupational or other areas of functioning

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27
Q

what specifiers are there for substance/medication induced bipolar and related disorder

A

with onset during intoxication

with onset during withdrawal

28
Q

what is the key exception for substance/medication induced bipolar and related disorder

A

case of hypomania/mania that occurs after antidepressant/ECT use and persists beyond the physiological effects of the med/treatment–> this is considered an indicator of true bipolar disorder and not a sub/med induced one

29
Q

what substances and medications are typically considered to be associated with substance/medication induced bipolar and related disorder

A

stimulant class of drugs

phencyclidine

steroids

(others continue to emerge, like bath salts)

30
Q

how might a phencyclidine induced mania initially present

A

a delirium with affective features which becomes an atypically appearing manic or mixed manic state

31
Q

over what time frame after ingestion would phencyclidine related bipolar disorder present

A

quickly–> usually within hours or at the most, a few days, or ingestion or inhalation

32
Q

how quickly would a stimulant induced bipolar picture present

A

minutes to 1 hour after one or several ingestions or injections

33
Q

how long does a stimulant induced bipolar picture typically last

A

typically only 1-2 days and the resolves

34
Q

how might a steroid or other immunosuppresant induced mania present

A

usually follows several days of steroid ingestion

higher doses appear to have greater likelihood of producing mania/bipolar sx

35
Q

ddx substance/medication induced bipolar and related disorder

A

other bipolar disorders

substance intoxication

substance induced delirium

medication side effect

36
Q

criterion A for bipolar and related disorder due to another medical condition

A

a prominent and persistent period of abnormally elevated, expansive or irritable mood and abnormally increased activity or energy that predominates in the clinical picture

37
Q

criterion B for bipolar and related disorder due to another medical condition

A

there is evidence from the history, physical examination or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition

38
Q

criterion C for bipolar and related disorder due to another medical condition

A

the disturbance is not better explained by another mental disorder

39
Q

criterion D for bipolar and related disorder due to another medical condition

A

disturbance does not occur exclusively during the course of a delirium

40
Q

criterion E for bipolar and related disorder due to another medical condition

A

disturbance causes clinically significant distress or impairment etc
OR
necessitates hospitalization to prevent harm to self or others or there are psychotic features

41
Q

what are the specifiers assoc with bipolar and related disorder due to another medical condition

A

with manic features–> full criteria not met for manic or hypomanic episode

with manic-or-hypomanic like episode–> full criteria are met except criterion D for a manic episode and except for criterion F for hypomanic episode

with mixed features–> sx of depression also present but do not predominate in the clinical picture

42
Q

what are the best known medical conditions that can cause bipolar and related disorder due to another medical condition

A

cushing’s disease

multiple sclerosis

stroke and TBI

*the list of the conditions that can cause mania/hypomania type picture is “never complete”–> “the clinicians best judgment is the essence of this diagnosis”

43
Q

how does bipolar and related disorder due to another medical condition usually present

A

usually onset is ACUTE or SUBACUTE within first weeks or month of the onset of the associated medical condition

*not always the case if related to worsening or relapse of chronic illness

may remit just before or just after the medical condition remits, especially when tx of mania/hypomanic sx is effective

44
Q

if the cushings disease is cured or arrested, do we generally think the mania/hypomania will recur or no?

A

believed generally that it will not recur

45
Q

if mania/hypomania occurs in the context of static brain injuries or other CNS diseases, do we generally think the mood sx will recur or no?

A

may be episodic/recurring in these situations

46
Q

ddx bipolar and related disorder due to another medical condition

A

delirium

catatonia

acute anxiety

med-induced manic or depressive syndromes

47
Q

when would you use the dx “other specified bipolar and related disorder”

A

presentations in which symptoms characteristic of a bipolar and related disorder that cause clinically significant distress or impairment in social, occupational or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the bipolar and related class

i.e short duration hypomanic episodes and MDEs

48
Q

mixed features associated with a MDE have been found to be a significant risk factor for what

A

development of bipolar I or II

49
Q

for those with rapid cycling, must there be a certain length of time between mood episodes?

A

no minimum time between episodes if sequential episodes are on opposite polarities (i.e hypomanic to depressed)–> if the episodes are of the same polarity, must be demarcated by either partial or full remissions of at least TWO MONTHS between them

50
Q

what makes “melancholic features” different from just regular depression/anhedonia

A

there is a near-complete absence of the capacity for pleasure not merely a diminution –> experienced as qualitatively different from that experienced during a non-melancholic episode

psychomotor changes are nearly always present and often noted by others

51
Q

what % of women will experience the onset of a MDE during pregnancy or in the weeks or months following delivery

A

3-6%

52
Q

what % of “postpartum” depression actually begins before delivery

A

50%

53
Q

postpartum mood episodes (either depressed or manic) with PSYCHOTIC features occur how commonly

A

1/500 ot 1/1000 deliveries

54
Q

risk of postpartum episodes with psychotic features is particularly increased in which women

A

women with prior postpartum mood episodes

those with prior hx of depressive or bipolar disorder

those with family history of bipolar disorders

55
Q

infanticide is most often associated with what psychiatric symptoms in a post partum woman

A

postpartum psychotic episodes that are characterized by COMMAND hallucinations to kill the infant or delusions that the infant is possessed

56
Q

once a woman has had a postpartum episode with psychotic features what is the risk of recurrence with each subsequent delivery

A

between 30-50%

57
Q

what does it mean to have a “Seasonal pattern” as per the DSM specifier

A

a lifetime pattern of mood episodes where there is a regular seasonal pattern of AT LEAST ONE types of episode (i.e mania, hypomania or depression)–> the other types of episodes may be have a seasonal pattern

ie seasonal manias but not depressions

full remissions also occur at characteristic times of year

58
Q

define “in partial remission” in bipolar disorders

A

symptoms of immediately preceeding manic, hypomanic or major depressive episode ARE PRESENT but full criteria are not met, or there is a period of LESS THAN TWO MONTHS without any significant symptoms of a manic, hypomanic or MDE following the end of such an episode

59
Q

define “in full remission” in bipolar disorders

A

during the past TWO MONTHS, no significant signs or symptoms of the disturbance were present

60
Q

define mild manic episode

A

minimum symptom criteria met for manic episode

61
Q

define moderate manic episode

A

very significant increase in activity or impairment in judgment

62
Q

define severe manic episode

A

almost continual supervision required in order to prevent physical harm to self or others

63
Q

define mild MDE

A

“Few, if any, symptoms in excess of those required to meet the diagnostic criteria are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning.”

64
Q

define moderate MDE

A

“The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for “mild” and “severe.””

65
Q

define severe MDE

A

“The number of symptoms is substantially in excess of those required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning.”

4. Mood Disorders (17 decks)

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