DSM Facts Flashcards
What is a manic episode with mixed features associated with?
Mixed features are associated with:
1) poorer outcome
2) increased suicide attempts
3) poorer lithium response
What is the “with rapid cycling” specifier in Bipolar 1 associated with/risk factors for this?
Individuals with bipolar I disorder who have multiple (four or more) mood episodes (major depressive, manic, or hypomanic) occurring in the prior 12 months receive the specifier “with rapid cycling.
It is a common variant associated with:
1) poorer outcomes.
2) More common in women.
3) Hypothyroidism,
4) antidepressant use
5) and substance abuse
Environmental risk factors for Bipolar 1?
Childhood adversity (including early emotional trauma, parental psychopathology, and family conflict)
History of childhood adversity in bipolar 1 is associated with what?
1) appears to predispose to early onset of bipolar disorder
2) poorer prognosis
3) worse clinical picture that may include medical or psychiatric comorbidities, suicide, and associated psychotic features
In Bipolar 1, what is a risk factor for a depressive relapse? what about a manic relapse?
recent life stress and other negative life events
manic - goal-attainment life events (e.g., getting married, completing a degree).
in bipolar 1, what are women more likely to have than men?
1) Women may be more likely to experience rapid cycling and mixed states
2) patterns of comorbidity that differ from those of men, including higher rates of lifetime eating disorders
3) They also have a higher lifetime risk of alcohol use disorder than do men and a much greater likelihood of alcohol use disorder than do women in the general population.
Risk of mood episodes during and 4 weeks after pregnancy if you have bipolar?
During: There does not appear to be an increased risk of mood episodes in pregnant women with bipolar disorder except in those who discontinue medications for pregnancy.
After: In contrast, there is strong and consistent evidence for an increased risk of mood episodes (both depression and mania) in women with bipolar I disorder in the postpartum period.
Men vs women suicide risk in bipolar 1?
While suicide attempts are higher in women, lethal suicide is more common in men with bipolar disorder.
Risk factors for suicide attempts/completions in bipolar 1?
1) A past history of suicide attempt
and
2) percent days spent depressed in the past year are associated with greater risk of suicide attempts or completions.
3) alcohol use disorder comorbidity
Rates of alcohol use disorder co-morbidities with bipolar?
Nearly half of individuals whose symptoms meet criteria for bipolar disorder have an alcohol use disorder
why is there a risk of misdiagnosing bipolar as depression? (3 reasons)
1) the first episode of bipolar disorder is often depressive,
2) depressive symptoms are the most frequent symptoms experienced across the long-term course of bipolar I disorder, and
3) the problem for which individuals typically seek help is depression.
Factors that might indicate that the diagnosis is bipolar I disorder rather than major depressive disorder in an individual presenting with a current depressive episode include:
1) family history of bipolar disorder
2) onset of illness in early 20s
3) numerous past episodes,
4) presence of psychotic symptoms
5) history of lack of response to antidepressant treatment or the emergence of a manic episode during antidepressant treatment (e.g., medication, electroconvulsive therapy).
Most common comorbidities with bipolar 1?
anxiety disorders, alcohol use disorder, other substance use disorder, and attention-deficit/hyperactivity disorder
fun fact: bipolar is very likely to have comorbidities, with a majority of individuals having a history of three or more disorders.
CANMAT says: SUDs, impulse control disorders, anxiety disorders, and personality disorders
(especially cluster B disorders) particularly common
what largely accounts for the shortened life expectancy in bipolar disorder?
Individuals with bipolar I disorder also have high rates of serious co-occurring and often untreated medical conditions, which largely explain the shortened life expectancy of those with bipolar disorder.
Comorbidities appear in multiple organ systems, with cardiovascular and autoimmune diseases, obstructive sleep apnea, metabolic syndrome, and migraine more common among individuals with bipolar disorder than in the general population. Comorbid overweight/obesity is a particular concern for individuals with bipolar disorder and is associated with poor treatment outcomes.
What depressive symptoms are more common in Bipolar II vs MDE?
Atypical depressive symptoms (hypersomnia, hyperphagia) are common in both disorders, but more so in those with bipolar II disorder.
