Session-9 Bipolar and Related Disorders

Question 1

DSM-IV-TR: What is the criteria for an MDE?

Answer 1

5 or more symptoms apparent for a duration of at least two weeks; at least 1 of the symptoms includes either depressed mood or loss of interest or pleasure, and represents a change from previous functioning

note: Mood Episodes; that determine a range of disorders you can have; first you must get into what the criteria are for the different episode types; these must be known by heart.
1. The first one; major depressive episode; you have to have 5 or more symptoms of depressive phenomonology apparent for duration of at least 2 weeks. Anhedonia (means losing interest, lost of pleasure in things).

Question 2

DSM-IV-TR: What is the criteria for Manic Episode?

Answer 2

a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week, along with 3 symptoms (or 4 if the mood is only irritable)

Question 3

DSM-IV-TR: What is the criteria for Hypomanic Episode?

Answer 3

distinct period of elevated, expansive, or irritable mood lasting throughout at least 4 days that is different from usual non-depressed mood, along with 3 other symptoms (4 if the mood is only irritable)

note: Hypo (means lower) Hypomanic- means a little less than manic.

Question 4

DSM-IV-TR: What is the criteria for Mixed Episode?

Answer 4

criteria met for both major depressive episode (except 2-week duration requirement) and manic episode nearly every day for at least a 1-week period, along with other indicators (e.g., marked impairment in functioning; symptoms not due to a substance)

Question 5

What are the DSM-IV-TR Bipolar Disorders?

Answer 5

Bipolar I Disorder (many specifiers: see p. 383)

Bipolar II Disorder (Recurrent Major Depressive Episodes With Hypomanic Episodes) (many specifiers, including Hypomanic and Depressed: see p. 393)

Cyclothymic Disorder

Bipolar Disorder NOS

Question 6

DSM-IV-TR: What is the mood episode requirement for Bipolar I?

Answer 6

occurrence of 1 or more manic or mixed episodes. Often there is also 1 or more major depressive episodes of the full 2 weeks, but this is not required for the Bipolar I diagnosis. Hint: if criteria are met for a manic episode, choose Bipolar I over Bipolar II

Question 7

What is the mood episode requirement for Bipolar II?

Answer 7

occurrence of 1 or more major depressive episodes and at least 1 hypomanic episode

note: Bipolar one captures mania mostly, you must have a manic episode- big mania is bipolar 1
Bipolar 2 more depressive with a little mania

Question 8

What is the mood episode requirement for Cyclothymic Disorder?

Answer 8

for at least 2 years, there is the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet the criteria for a Major Depressive Episode

Question 9

What is the mood episode requirement for Bipolar Disorder NOS?

Answer 9

includes disorders that do not meet criteria for any specific Bipolar Disorder

note:Bipolar is technically a type of depression, depression can be just depression only that gets you into the major depressive episode world, depression with hypomania gets you into the bipolar world (uni-major depressive and bipolar is when you have both happening at the same time)

Question 10

What are major differential Issues for Bipolar I (DSM-IV-TR)?

Answer 10

Bipolar I Disorder:
Mood Disorder Due to a General Medical Condition: diagnose if depressive, manic, mixed, or hypomanic episodes are due to the physiological consequences of a medical condition.

Major Depressive Disorder/Dysthymic Disoder: diagnoses one of these if there is no lifetime history of at least 1 Manic or Mixed Episode.

Bipolar II: diagnose if there is no indication of a manic or mixed episode.

Cyclothymic Disorder: diagnose when there are numerous periods of hypomanic symptoms that do not meet criteria for a Manic Episode and periods of depressive symptoms that do not meet symptom or duration criteria for a Major Depressive Episode.

Question 11

What are major differntial issues for bipolar II (DSM-IV-TR)?

Answer 11

Bipolar II Disorder:
Mood Disorder Due to a General Medical Condition.
Substance-Induced Mood Disorder.
Major Depressive Disorder: diagnose if there is not a lifetime history of at least 1 Hypomanic Episode.

Question 12

What are major differntial issues for Cyclothymic Disorder (DSM-IV-TR)?

Answer 12

Bipolar I Disorder, With Rapid Cycling and Bipolar II, With Rapid Cycling: you diagnose these when criteria are met for a Major Depressive, Manic, or Mixed Episode (by definition, for Cyclothymic Disorder these criteria are NOT met). The specifier “With Rapid Cycling” requires that full mood episodes are present.
Borderline Personality Disorder: often characterized by marked shifts in mood; if criteria are met for BPD and Cyclothymic Disorder, diagnose both.

Question 13

What is included in the DSM-5 “Bipolar and Related Disorders”?

Answer 13

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 14

What are the DSM-5 Bipolar I Specifiers?

Answer 14

With Anxious Distress
With Mixed Features 
With Rapid Cycling
With Melancholic Features 
With Atypical Features
With Mood-Congruent Psychotic Features 
With Mood-Incongruent Psychotic Features 
With Catatonia
With Peripartum Onset 
With Seasonal Onset

Question 15

What are the DSM-5 Bipolar II Specifiers?

Answer 15

Includes the same list as Bipolar I

But you also specify course if full criteria for a Mood Episode are not current met: In Partial Remission or In Full Remission.

Question 16

DSM-5 Revisions: Bipolar Disorders: When is the new specifier “with anxious distress” used?

Answer 16

You can use this specifier for Depressive Disorders and for the bipolar and related disorders

this specifier is to identify patients with anxiety symptoms that are not part of the bipolar diagnostic criteria

Question 17

DSM-5 Revisions:

Are bipolar disorders still considered under the umbrella “Mood Disorders”?

Answer 17

No: Bipolar and Depressive disorders are now split up and positioned in their own Diagnostic Categories.

Question 18

DSM-5 Revisions:

What is the new category called for bipolar disorders?

Answer 18

“Bipolar and Related Disorders”

Question 19

DSM-5 Revisions:

What is the criteria change for Manic and Hypomanic episodes?

Answer 19

Criterion A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood

(DSM-IV-TR Criterion A for a manic episode is: “a distinct period of abnormally or persistently elevated, expansive or irritable mood, lasting at least 1 week…”)

Question 20

DSM-5 Revisions:

What is bipolar severity based on?

Answer 20

Specify current severity based on number of criteria symptoms, the severity of those symptoms and the degree of functional disability: see descriptions of mild, moderate, and severe.

Question 21

DSM-5 Revisions:

DSM-IV-TR Bipolar I: what was Mixed Episode (mania and major depressive episodes) replaced with?

Answer 21

Mixed Episode was deleted in DSM-5 and replaced with the new specifier “With Mixed Features”

“With Mixed Features” is applied to episodes of mania or hypomania when depressive features are present, and to episodes of depression in the context of major depressive disorder or bipolar disorder when features of mania/hypomania are present.

Question 22

DSM-5: When can “other specified bipolar and related disorder” be used?

Answer 22

Can now be used to identify patients with a past history of major depressive episode who meet all criteria for hypomania except the duration criterion (at least 4 consecutive days).

It can also be used when too few symptoms of hypomania are present to meet criteria for full bipolar II syndrome, although the duration is sufficient at 4 or more days.

Question 23

DSM-5: What are the major differential considerations for Bipolar I?

Answer 23

Major Depressive Disorder: diagnose when there is no history of past episodes of mania or hypomania.

Bipolar II: Diagnose when there is no current or past history of mania.

GAD, Panic Disorder, PTSD, or other anxiety disorders: these should always be considered as potential differentials.

Personality Disorders: Many have substantial overlap with bipolar disorders, including BPD, since mood lability and impulsivity are common in both conditions. IF there is a clear indication of a distinct episodic nature of symptoms, hedge toward a diagnosis of a bipolar disorder.

Question 24

DSM-5: What are major differential considerations for Bipolar II?

Answer 24

Major Depressive Disorder

Cyclothymic Disorder: diagnose if there are numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that do not meet symptom or duration criteria for a major depressive episode.

Schizophrenia Spectrum and Other Related Psychotic Disorders: diagnose if there are periods of psychotic symptoms that occur in the absence of prominent mood symptoms.

Question 25

DSM-5: What are Major Differential Considerations for Cyclothymic Disorder?

Answer 25

Bipolar I Disorder with Rapid Cycling and Bipolar II Disorder with Rapid Cycling

Borderline Personality Disorder