Mania

Question 1

How does the ICD classify bipolar disorders?

Answer 1

Episode severity;
Hypomania
Mania with psychotic features
Mania without psychotic features

Question 2

How does the DSM classify bipolar disorders?

Answer 2

Course and pattern
Bipolar 1
Bipolar 2
Cyclothymic disorder

Question 3

What is bipolar 1?

Answer 3

Meets criteria for mania
Highly disabling episodes
Mania to severe depression

Question 4

What is bipolar 2?

Answer 4

Current or past hypomanic episode and current or past depressive episode
Have NEVER met criteria for manic episode

Question 5

Is bipolar 1 or 2 more common?

Answer 5

2

Question 6

How is bipolar disorder defined in the ICD-10?

Answer 6

A disorder characterized by 2 or more episodes in which the patient’s mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of hypomania or mania and on others as depression

Question 7

Can you have depression with a single episode of mania?

Answer 7

No; a single episode of hypomania or mania is diagnostic of bipolar disorder
It CANNOT be classified as depression if there has been any episodes of (hypo)mania

Question 8

How is a hypomanic episode diagnosed?

Answer 8

Mood elevated or irritable to a degree that is definitely abnormal for the individual and sustained for at least 4 days
At least 3 signs of hypomania that interfere with personal functioning

Question 9

What are the signs of hypomania?

Answer 9

Increased activity or physical restlessness
Increased talkativeness
Difficulty in concentration or distractibility
Decreased need for sleep
Increased sexual energ
Mild spending sprees or other types of reckless or irresponsible behaviour

Question 10

How is a manic episode diagnosed?

Answer 10

Mood must be predominantly elevated, expansive or irritable and definitely abnormal for the individual concerned (or hospital admission)
Mood change must be prominent and sustained for at least 1 week
At least 3 of the signs of a manic episode

Question 11

What are the signs of a manic episode?

Answer 11

Increased activity or physical restlessness
Increased talkativeness
Flight of ideas or 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
Reckless behaviour
Marked sexual energy or sexual indiscretions

Question 12

What can be seen on a quick MSE of bipolar patient in a manic/hypomanic episode?

Answer 12

Appearance and behaviour: bright clothes, distractibility, loss of normal social inhibitions
Speech: increased talkativeness, punning and clang associations
Thoughts: increased flow, flight of ideas, loosening of associations, grandiosity

Question 13

What is present in those who have mania with psychotic symptoms?

Answer 13

Delusions or hallucinations present

Commonly; grandiose, self-referential, erotic or persecutory content

Question 14

Describe hypomania?

Answer 14

Increased activity
Increased talkativeness
Decreased sleep
Increased sociability
Increased sexual energy
Mild overspending
Difficult in concentration or  distractibility

Question 15

Describe mania

Answer 15

Increased activity
Increased talkativeness
Loss of social inhibitions
Marked sexual energy
Foolhardy or reckless behaviour
Distractibility in plans
Inflated self-esteem 
Flight of ideas

Question 16

What is cyclothymia?

Answer 16

Mood swings between short periods of mild depression and hypomania

Question 17

When is a common onset for bipolar disorder?

Answer 17

Late teens or early 20s

10 years earlier than unipolar depression

Question 18

What does a family history of BPAD result in?

Answer 18

Earlier onset and episodes precipitated by lower levels of stress
Genetic anticipation

Question 19

What are common co-morbid disorders with bipolar?

Answer 19

Anxiety; panic disorder, generalised anxiety, OCD
Alcohol and drug misure
Personality disorders esp. borderline personality disorder
Eating disorders
Schizoaffective disorder
Schizophrenia

Question 20

Is there a genetic overlap between BPAD and schizophrenia?

Answer 20

Yes; NRG1, G72, G30

Question 21

What percentage of the lifetime are those with BP disorder asymptomatic?

Answer 21

50%

Question 22

What do those with bipolar disorder suffer with the most; mania or depression?

Answer 22

Spend around 50% of life in chronic depression

Only 1-2% of lifetime in mania

Question 23

Is depression in bipolar disorder receptive to antidepressants?

Answer 23

No - not typically, teds to be treatment resistant

Question 24

What are predictors of poor outcome in adolescent with those who suffer from bipolar disorder?

Answer 24

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

Question 25

Does bipolar disorder confer an increased risk of suicide?

Answer 25

Yes; higher than unipolar depressive disorder