Elated Mood

Question 1

what schemes categorise bipolar disorder

Answer 1

DSM (course and pattern: bipolar I, II and cyclothymic disorder)
ICD (episode severity: hypomania, mania with psychotic features, mania without psychotic features)

Question 2

what is bipolar I

Answer 2

episodes of mania with previous hypomanic and/ or depressive epsiodes

Question 3

what is bipolar II

Answer 3

current or past hypomanic episode AND current/ past depressive episode

has never met criteria for a manic episode

Question 4

which type of bipolar is more common

Answer 4

II

Question 5

what largely causes disability in bipolar II

Answer 5

chronic depressive episodes

Question 6

what is bipolar III

Answer 6

aka pseudo unipolar

hypomanic episodes that only occur following the use of antidepressants (to treat depression)

Question 7

what are the differences between an depressive episode in BPAD and Major depression disorder

Answer 7

MDD does have rapid cycling or catatonia

may be nothing the distinguish them

Question 8

define bi polar affective disorder

Answer 8

two or more episodes in which the patients mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of hypomania or mania and on others depression

Question 9

what are repeated episodes of hypomania/ mania classified as

Answer 9

only bipolar (not BPAD)

Question 10

when does a diagnosis of depression change to one of bipolar disorder

Answer 10

The first episode of (hypo)mania on a background of recurrent depression means that it’s bipolar disorder and not depression anymore

A single episode of hypomania or mania is bipolar disorder (even if you haven’t been depressed yet)

Question 11

what is hypomania

Answer 11

a level of disturbance below mania

Question 12

what symptoms must be present for a diagnosis of hypomania

Answer 12

The mood is elevated or irritable to a degree that is definitely abnormal for the individual concerned and sustained for at least 4 consecutive days

at least three of these, which interfere with personal daily functioning:

• increased activity or physical restlessness;
• increased talkativeness;
• difficulty in concentration or distractibility;
• decreased need for sleep;
• increased sexual energy;
• mild spending sprees, or other types of reckless or irresponsible behaviour;

Question 13

what symptoms must be present to diagnose a manic episode

Answer 13

Mood must be predominantly elevated, expansive or irritable, and definitely abnormal for the individual concerned. The mood change must be prominent and sustained for at least 1 week (unless it is severe enough to require hospital admission)

At least three of the following signs must be present (four if the mood is merely irritable), leading to severe interference with personal functioning in daily living:
Increased activity or physical restlessness;
Increased talkativeness (‘pressure of speech’);
-Flight of ideas or the subjective experience of thoughts racing;
-Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances;
-Decreased need for sleep;
-Inflated self-esteem or grandiosity;
-Distractibility or constant changes in activity or plans;
-Behaviour which is foolhardy or reckless and whose risks the subject does not recognize e.g. spending sprees, foolish enterprises, reckless driving;
-Marked sexual energy or sexual indiscretions.

Question 14

describe mania without psychotic symptoms

Answer 14

the absence of hallucinations or delusions

perceptual disorders may occur (vivid colours, hyperacusis)

Question 15

describe mania with psychotic symptoms

Answer 15

Delusions or hallucinations are present, other than those listed as typical schizophrenic (i.e. delusions other than those that are completely impossible or culturally inappropriate and hallucinations, that are not in the third person or giving a running commentary)
The commonest examples are those with grandiose, self- referential, erotic or persecutory content

Question 16

name some distinguishing points between hypomania and mania

Answer 16

in mania you can have inflated self esteem or grandiosity and can have flight of ideas or the subjective experience of thoughts racing

Question 17

what is hyperthymia

Answer 17

when mood always slightly elevated

Question 18

what is cylcothymia

Answer 18

low grade cycling to your mood

Question 19

who gets bipolar disorder

Answer 19

onset usually in teens/ early 20s

FHx of BPAD mean earlier onset

Question 20

what does onset of BPAD over the age of 60 usually mean

Answer 20

rare

often associated with treatment-resistance, progressive decline in functioning, and an underlying organic cause

Question 21

what condition are commonly co morbid with BPAD

Answer 21

Anxiety disorders (particularly panic disorder, generalized anxiety disorder, and OCD)
Alcohol and drug misuse
Personality disorders (esp. borderline personality disorder)
Eating disorders
Schizoaffective disorder
Schizophrenia (genetic link)

Question 22

what is the course of bipolar disorder

Answer 22

very messy and hard to predict

Question 23

do you spend more time in depression in BP I or II

Answer 23

II

Question 24

how much time roughly is spent in different states in BP I and II

Answer 24

approximately 50% of the time with syndromal mood disturbance
In both types, depression is the most common mood disturbance
In BP I, less than 15% of time being high
in BP II less that 5% being high

up to 75% of mood disturbance is subsyndromal

Question 25

what are predictors of poor outcome in adolescent BPAD

Answer 25

Early-onset
Low socioeconomic status
Subsyndromal mood symptoms
Long duration of illness
Rapid mood fluctuation
Mixed presentations
Psychosis
Comorbid disorders
Family psychopathology

Question 26

are men or women with BPAD more likely to commit suicide

Answer 26

men

Question 27

differentiate BP I and II

Answer 27

bipolar I (mania + depression) and bipolar II (hypomania + depression)