Elevated Mood

Question 1

how does DSM describe elevated mood disorders

Answer 1

• bipolar I and bipolar II

- cyclothymic disorder

Question 2

how does ICD-10 describe elevated mood disorders

Answer 2

• Hypomania
• Mania with psychotic features
• Mania without psychotic features

Question 3

what is bipolar I

Answer 3

clear v manic episodes, but may have had previous hypomanic or depression episodes

Question 4

what is bipolar II

Answer 4

current hypomanic episodes and current or past depressive episodes

never met the criteria for manic episodes

most common

Question 5

what is bipolar III

Answer 5

hypomanic episodes only occur following use of antidepressants for depression

Question 6

what is hypomania

Answer 6

a level of disturbance below mania

Question 7

what is bipolar disorder (ICD-10)

Answer 7

2 or more episodes or hypomania, mania or depression

Question 8

how to differentiate by depression and bipolar

Answer 8

bipolar - a single episode of hypomania or mania is bipolar disorder even if they’ve only had depression in the passed or haven’t been depressed yet

depression - no mania or hypomania episodes

Question 9

how do you describe hypomania

Answer 9

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

3 of the following signs + interferes with personal function:

1. increased activity or physical restlessness
2. increased talkativeness
3. difficulty concentrating/distractibility
4. decreased need for sleep
5. increased sexual energy
6. mild spending sprees or other types of reckless or irresponsible behaviour

Question 10

how do you describe a manic episode

Answer 10

mood predominantly elevates or irritable
must be sustained for at least 1 week

at least 3 of the following - leading to severe interference with personal functioning

1. increased activity or physical restlessness
2. increased talkativeness
3. flight of ideas or the subjective experience of thoughts racing
4. loss of normal social inhibitions leading to inappropriate behaviour
5. decreased need for sleep
6. inflated self esteem or grandiosity
7. distractibility or constant changes in activity or plans
8. behaviour which is foolhardy or reckless eg. spending sprees, foolish enterprise, reckless driving
9. marked sexual energy or sexual indiscretions

Question 11

MSE appearance & behaviour in hypomania

Answer 11

bright clothes
distractibility
loss of normal social inhibitions/over familiarity

Question 12

MSE speech in hypomania

Answer 12

Increased talkativeness

Punning and clang associations

Question 13

MSE thoughts in hypomania

Answer 13

Increased flow (lots of thoughts)
flight of ideas & loosening of associations
grandiosity

Question 14

when is the usually onset of bipolar disorder

Answer 14

late teens or early 20s - approximately 10 years earlier than unipolar depression

Question 15

what are common bipolar cormorbidities

Answer 15

Anxiety disorders 
Alcohol and drug misuse 
Personality disorders (bpd)
Eating disorders 
Schizoaffective disorder 
Schizophrenia

Question 16

is there a genetic risk for bipolar?

Answer 16

Yes

shared genetic risk for bipolar and schizophrenia

Question 17

what causes the most impairment in BPII

Answer 17

the large depressive symptoms - depressed 50% of the time - mood elation is <5% of the time

Question 18

what causes the most impairment in BPI

Answer 18

large depressive episodes and some other manic/hypomanic episodes (10% of time)

Question 19

what predicts poor outcome in bipolar disorder

Answer 19

Early onset 
Low socioeconomic status 
Subsyndromal mood symptoms 
Long duration 
Rapid mood fluctuation 
Mixed presentation 
Psychosis 
Comorbid disorders 
Family psychopathology

Question 20

bipolar disease has the highest suicide risk true/false

Answer 20

true - in general an increased risk above other mental disorders

Question 21

quick differentiation between BPI and BPII

Answer 21

BPI- mania + depression

BPII- hypomania + depression