Mood Disorders - Bipolar Disorder

Question 1

recognize the increase in prevalence in hospital discharge diagnoses and outpatient diagnoses but no increase in large scale epidemiological studies

Answer 1

• Great increase seen in the diagnosis assignment of this disorder
• Hospital discharges
• Clinic diagnoses that there was a huge influx
• Mid 90s growth
• Hardly ever truly diagnosed bipolar in history

Question 2

DSM-5 diagnostic criteria

Answer 2

A) Distinct period of elevated, expansive or irritable mood > 1 week (or any duration of hospitalization required)

B) Symptoms (3, or 4 if irritable mood only) at the same time as criterion A
- decreased need for sleep
- increase in risk taking
- grandiosity

C) marked impairment (functioning, hospitalization, or psychosis)

Question 3

diagnostic types

Answer 3

Manic episode
- Elevated, expansive, irritable mood for at least 1 week (shorter if hospitalized)
- 3 symptoms of 4 if mood only irritable

Mixed episode (mania and depression at the same time)

Hypomanic
- Symptoms for at least 4 days
- little less than manic

Bipolar I

Bipolar II

Cyclothymia
- 1 year or more of sx, no more than 2 months symptom free

Question 4

Mood Cycles Graph
(mania, hypomania, euthymia, dysthymia, depression, mixed episodes)

Answer 4

Mania
- highest positive point

Hypomania
- second highest positive point
- below mania

Euthymia
- normal mood
- constant line in the middle

Dsyhymia
- second lowest negative point
- above depression

Depression
- lowest negative point

Mixed Episode
- multiple waves at once
- a high and a low together

Question 5

Pediatric Bipolar Disorder: 3 Diagnostic Dilemmas

Answer 5

1. The centrality of irritability
   - Recommending a diagnosis of BP if the child meets DSM criteria with irritability as a core symptom, even in the abscess of elation, grandiosity, and episodicity
   - Versus unmodified DSM criteria
2. Absence of “pure” BP disorder
   - Almost always comorbid, making it difficult to discern what’s really going on
3. Episode length

Question 6

comorbidities

Answer 6

• ADHD → 10-75%
• Psychosis → 16-60%
• ODD → 46-75%
• Conduct Disorder → 6-37%
• Anxiety Disorder → 13-56%
• Substance Abuse → 0-40%

Question 7

powerful indicators of BP (separates from other psychiatric conditions)

Answer 7

ELATION / EUPHORIA
- More than would up on sugar at a birthday party
- Inappropriate affect / response to negative/morbid material

GRANDIOSITY
- May seem boastful or oppositional rather than “magical powers”

Decreased need for sleep
- Up late or early often with increased goal directed behavior

Hypersexualitiy
- Drawings, inappropriate touching, exposing self

Question 8

mania vs adhd

Answer 8

ONLY Mania:
- elevated/expansive mood
- grandiosity
- FOI/racing thoughts

BOTH Mania and Adhd:
- irritability
- high risk activities
- decreased need for sleep (although mild in ADHD - more restless)

Question 9

earlier vs later onset effect

Answer 9

Increase in comorbidities in earlier onset Bipolar Disorder

MEANING:
The older you are, the fewer comorbidities you get diagnosed with !!!!!!!

Question 10

Disruptive Mood Dysregulation Disorder (DMDD)

Answer 10

• Severe recurrent temper outbursts (verbal or behavioral)
• Temper outbursts are inconsistent with developmental level
• 3 or more times per week
• Mood between temper outburst is persistently irritable or angry most of the day, most days

MADE SO it is not confused for ADHD
- whole new section
- now listed under Depressive D/O

Question 11

atypical presentation of child Bipolar Disorder

Answer 11

• Predominant mood often irritable
• Irritability may be persistent, severe, violent
• Short duration of frequent
• Lack of proper mania
• Complex cycling