Mood Disorders

Question 1

Bipolar and Related Disorders

Answer 1

Characterized by intense, alternating episodes of mania and depression that go far beyond normal mood swings – they are:
Bipolar I Disorder
Bipolar II Disorder
Cyclothymic Disorder
Substance/Medication-Induced Bipolar and Related Disorder
Bipolar and Related Disorder Due to Another Medical Condition
Other Specified Bipolar and Related Disorder
Unspecified Bipolar and Related Disorder

Question 2

Bipolar Disorders

Answer 2

Characteristic feature of the bipolar disorders is the tendency for an individual to experience manic (or hypomanic) episodes alternating with major depressive episodes

Mania is a distinct period during which the predominant mood is either elevated, expansive or irritable, and increased activity or energy with several associated symptoms (i.e.: inflated self-esteem, a decreased need for sleep, pressured speech, racing thoughts, distractibility, hyperactivity or agitation, and excessive involvement in potentially dangerous activity)

Overall the mood disturbance is less severe in hypomanic episodes

Question 3

Variations of Bipolar Disorders

Answer 3

• A first episode may be either depressive or manic
• The presenting pattern of bipolar disorder is unpredictable—and subsequent episodes, if they occur, remain variable
• Consider the bipolar disorders as a spectrum - individuals can present with a range of symptoms from mild (cyclothymia), to moderate (bipolar II), or more severe (bipolar I)

Question 4

Bipolar I Disorder

Answer 4

Refers to severe manic episodes accompanied by one or more periods of major depressive episodes (which can have psychotic features)
The assessment:
The person must show at least 3 symptoms of mania (or 4 if the mood is only irritable) that last for more than one week

These symptoms are considered from a list of 7 symptoms including inflated self-esteem, decreased need for sleep, more talkative than usual or pressured speech, flight of ideas, distractibility, and increased goal directed activity or psychomotor activity, excessive involvement in activities that have a high potential for painful consequences such as unrestrained buying sprees

Total of 5 symptoms are required for a major depressive episode (either symptoms of a depressed mood or a loss of interest in pleasure) and also look for unusual changes in appetite or sleep, significantly decreased energy levels or fatigue, feelings of worthlessness, difficulty concentrating, and suicidal thoughts

Question 5

Bipolar II Disorder

Answer 5

Refer to the case of Carol Bishop highlighting bipolar II disorder. Refers to the same pattern of symptoms, but the major distinction is in the degree of severity - typically, this disorder does not lead to psychotic behavior or require hospitalization

Generally characterized by one or more depressive episodes with at least one hypomanic episode that generally lasts approximately 4 days

Similar to bipolar I, it also requires 3 (or 4 symptoms for those with irritable mood) from the 7 characteristic symptoms required

Question 6

Bipolar Disorder Specifiers

Answer 6

Course and severity can be specified

Types specified based on the presentation are:
Anxious distress
Mixed features
Rapid cycling
Melancholic features – applies to Bipolar I only
Atypical features – also applies to Bipolar I only
Psychotic features
Catatonia
Peripartum onset
Seasonal pattern

Question 7

Cyclothymic Disorder

Answer 7

Refers to a chronic or cyclic mood disturbance that has many of the same features found in major depressive episodes and considered a milder form of bipolar II disorder
Assessment:
This pattern must last for a two-year period (1 year for children and adolescents) and the individual is not free of its specific manifestations for more than 2 months
Symptomatic features of mood swings typically alternate in an irregular fashion, lasting for days or weeks