Elated Mood Flashcards
what schemes categorise bipolar disorder
DSM (course and pattern: bipolar I, II and cyclothymic disorder)
ICD (episode severity: hypomania, mania with psychotic features, mania without psychotic features)
what is bipolar I
episodes of mania with previous hypomanic and/ or depressive epsiodes
what is bipolar II
current or past hypomanic episode AND current/ past depressive episode
has never met criteria for a manic episode
which type of bipolar is more common
II
what largely causes disability in bipolar II
chronic depressive episodes
what is bipolar III
aka pseudo unipolar
hypomanic episodes that only occur following the use of antidepressants (to treat depression)
what are the differences between an depressive episode in BPAD and Major depression disorder
MDD does have rapid cycling or catatonia
may be nothing the distinguish them
define bi polar affective disorder
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
what are repeated episodes of hypomania/ mania classified as
only bipolar (not BPAD)
when does a diagnosis of depression change to one of bipolar disorder
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)
what is hypomania
a level of disturbance below mania
what symptoms must be present for a diagnosis of hypomania
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;
what symptoms must be present to diagnose a manic episode
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.
describe mania without psychotic symptoms
the absence of hallucinations or delusions
perceptual disorders may occur (vivid colours, hyperacusis)
describe mania with psychotic symptoms
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
name some distinguishing points between hypomania and mania
in mania you can have inflated self esteem or grandiosity and can have flight of ideas or the subjective experience of thoughts racing
what is hyperthymia
when mood always slightly elevated
what is cylcothymia
low grade cycling to your mood
who gets bipolar disorder
onset usually in teens/ early 20s
FHx of BPAD mean earlier onset
what does onset of BPAD over the age of 60 usually mean
rare
often associated with treatment-resistance, progressive decline in functioning, and an underlying organic cause
what condition are commonly co morbid with BPAD
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)
what is the course of bipolar disorder
very messy and hard to predict
do you spend more time in depression in BP I or II
II
how much time roughly is spent in different states in BP I and II
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
what are predictors of poor outcome in adolescent BPAD
Early-onset Low socioeconomic status Subsyndromal mood symptoms Long duration of illness Rapid mood fluctuation Mixed presentations Psychosis Comorbid disorders Family psychopathology
are men or women with BPAD more likely to commit suicide
men
differentiate BP I and II
bipolar I (mania + depression) and bipolar II (hypomania + depression)
