Mood Disorders -- Bipolar Flashcards
Manic Episode – overall
elevated, expansive, or irritable mood and increased activity or energy, lasting at least 1 week (or any time if hospitalized)
change from baseline with 3/7 (or 4 if mood is irritable)
Marked impairment or hospitalization
Not from substance or medical condition
Manic Episode Criteria B
B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a significant degree and represent a noticeable change from usual behavior:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e., purposeless non-goal-directed activity).
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
Manic/Hypomanic Episodes and antidepressant treatment
episode that emerges during antidepressant treatment but persists at syndromal level is sufficient evidence for a diagnosis
Hypomanic Episode – overall
A. Elevated, expansive, or irritable mood and increased activity or energy, lasting at least 4 days
B. 3/7 (or 4/7 if mood is irritable) symptoms
C. The episode is a change from baseline
D. The change is observable by others.
E. Not severe enough to cause marked impairment. If there are psychotic features, the episode is, by definition, manic.
F. Not attributable to a substance or medical condition.
Hypomanic Episode Criteria B
- B. During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
- Inflated self-esteem or grandiosity.
- Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).
- More talkative than usual or pressure to keep talking.
- Flight of ideas or subjective experience that thoughts are racing.
- Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
- Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
- Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments).
Differences between Hypomanic and Manic episodes:
- Hypomania is 4 days, manic is a week
- Hypomania does not cause clinically significant impairment
- Hypomania has to be observable change (D), and unequivocal change from baseline (C)
Bipolar I vs Bipolar II
Bipolar I: Manic Episode! (can have others)
–> think 1 for one required type of episode
Bipolar II: Hypomanic and Manic (can’t have manic)
—> thing 2 for two required types of episodes
Bipolar I — Overall
Had at least one manic episode
Not better explained by schizo/psychotic disorders
Bipolar I Coding
Code for course and severity
Course (nature of most recent episode)
- Current or most recent episode manic
-….Hypomanic (*IF HYPOMANIC, then severity doesn’t matter because severity is built into diagnosis)
-….depressed
-….unspecified
Severity:
- If current episode: Mild, moderate, severe, with psychotic features
- Partial or full remission
- Unspecified
NOTE: hypomanic episode can’t have severity!!!* Can be in remission tho
Bipolar II — Overall
At least one hypomanic episode and at least one major depressive episode
There has never been a manic episode.
Episodes not better explained by schizo/psychotic
Depressive episode, or the fluctuation between hypomanic and depressive episode, causes clinically significant impairment or distress (NOT JUST HYPOMANIA, hypomania by definition does not cause distress)
Bipolar II Coding
Only one code! Write specifiers
Specify current or most recent episode: Hypomanic OR Depressed
If full criteria for a mood episode are currently met, Specify severity: Mild, Moderate, Severe
If full criteria are not currently met, Specify course: In partial remission OR In full remission
Cyclothymic Disorder – Overall
On edge of Bipolar II but not quite it
Two years (1 for children) have been numerous periods with hypomanic symptoms, and numerous periods with depressive episode symptoms, but never meet criteria
During 2 years, criterion present for half time, never without for 2 months
never met criteria for manic, hypomanic, or depressive episode
Not better explained by schizo/psychotic
Not from substance/medical condition
Symptoms cause clinically significant distress (*focused on mood variability causing distress)
Disruptive Mood Regulation – overall
Verbal or behavioral outbursts that are unproportional to situation (by intensity, duration)
Outburst not consistent with developmental age
Outbursts occur three or more times per week.
Between outbursts, irritable or angry most of day, noticeable by others
Symptoms present for at least 1 year, without remission (3 months no symptoms)
Symptoms present in 2/3 settings (school, home, with peers) and are severe in 1/3
Diagnosis made between 6-18
By history or observation, he age at onset is before 10 years.
Never had full symptoms of manic or hypomanic episode for more than 1 day (duration excluded)
Symptoms not only during MDD episode, not better explained by another mental disorder (can coexist with some mental disorders)
Not from substance/medical condition
Disruptive Mood Regulation why created?
Created to address over-diagnosis of bipolar I in children
Depressive disorder!
DMR remission length
3 months!
(to account for summer break probably)
