Session Eleven (Bipolar Depression) Flashcards
According to the DSM, what are the 3 categories of BD?
- Type 1 (diagnosis requires 1+ manic episode)
- Type 2 (diagnosis requires 1+ depressive episode and 1+ hypomanic episode)
- Sub-threshold
What is the lifetime prevalence and mean age of onset of BD?
- 2.4%
- Mean age of onset is 25 years old
Which forms of BD are more common in men/women
- Women; T2
- Men; T1 and sub-threshold
Outline the DSM-5 criteria for diagnosing Type 1 BD?
A) At least one manic episode
B) Not better explained by Sz, Sz-like disorders, delusional disorders, other psychotic disorders
Outline the DSM-5 criteria for diagnosing Type 2 BD?
A) At least one hypomanic episode + at least one major depressive episode
B) Never experienced a fully manic episode
C) Not better explained by Sz, Sz-like disorders, delusional disorders, other psychotic disorders
D) The symptoms/ the jumping between states causes significant distress or impairment in social or occupational functioning
How does ICD-10 diagnose BD?
Much simpler than DSM, does not have two types:
- Repeated (2+) episodes in which the patients mood and activity levels are significantly disturbed
- This disturbance consisting some times of elevation in mood and increased energy (mania or hypomania) and other times consisting of lowering of mood energy and activity (depression)
How does DSM distinguish between Manic and Hypomanic episodes?
- Main difference is duration, Mania = 1 week, Hypomania = 4 days
- A further important distinction is mania is present all day every day during this period whereas hypomania is more fluctuant.
- Mania is severe enough to cause significant disturbance to personal or professional life or require hospitalisation, Hypomania is not
- Because Hypomania is more akin to normal behaviour, the diagnosis specifies the patient must be noticeably different to those around them.
Outline the diagnostic criteria and symptoms of a Manic Episode?
A) Requires a period of elevated, expansive OR irritable mood with increases in activity and goal-related behaviour for 1 week+
AND
B) 3 of the following symptoms during the time of elevated mood (must also be different from patient norm):
- Inflated self esteem/grandiosity
- Decreased need for sleep
- More talkative than usual
- Flights of ideas or racing thoughts
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in potentially harmful behaviours such as sexual promiscuity, poor business choices, or spending sprees.
C) Has to cause marked impairment or distress
D) Can’t be explained by substances or other psych disorders (N.B. if patient goes on an antidepressant and becomes manic this can just be poor diagnosis and patient likely is BD)
Outline the DSM diagnostic criteria for a Hypomanic Episode?
A) Period of abnormally elevated mood lasting 4 days
B) 3 of the following symptoms during the time of elevated mood (must also be different from patient norm):
- Inflated self esteem/grandiosity
- Decreased need for sleep
- More talkative than usual
- Flights of ideas or racing thoughts
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in potentially harmful behaviours such as sexual promiscuity, poor business choices, or spending sprees.
C) Episode is markedly different from normal behaviour
D) Disturbance is noticeable by others
E) Episode is not severe enough to cause marked impairment in social or hospitalisation
Outline the key symptoms of Mania/Hypomania (according to DSM-5)?
- Inflated self esteem/grandiosity
- Decreased need for sleep
- More talkative than usual
- Flights of ideas or racing thoughts
- Distractibility
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in potentially harmful behaviours such as sexual promiscuity, poor business choices, or spending sprees.
How is a Manic Episode diagnosed according to ICD-10?
A) Mood change which is predominantly elevated, prominent and sustained for at least a week OR requires hospitalisation
B) 3 of the following symptoms (4 if irritable);
- Increased activity or physical restlessness
- Increased talkativeness
- Flight of ideas
- Loss of mortal social inhibitions resulting in behaviour which is inappropriate to the circumstances
- Decreased need for sleep
- Inflated self esteem
- Distractibility
- Foolhardy or reckless behaviour (spending sprees, reckless driving)
- Marked sexual energy or sexual indiscretions
How is a Hypomanic Episode diagnosed according to ICD-10?
A) Elevated or irritated mood that is abnormal for the person concerned for 4+ days
B) 3 of the following;
- increased activity or physical restlessness
- increased talkativeness
- difficulty in concentrating
- decreased need for sleep
- increased sexual energy
- mild spending sprees and other mild irresponsible behaviour
- increased sociability or over-familiarity (NOT total loss of inhibitions as in mania)
(N.B: do not see flight of ideas, inflated self esteem as in mania)
How does ICD distinguish between Mania and Hypomania?
- Again length, 4 days vs 1 week
- Some interference with personal living but not debilitating
- Only mild reckless behaviour
- Increased sociability but without totally losing social inhibitions
- No flight of ideas
- No grandiosity
What is a “Mixed Episode” in ICD-10?
- An episode characterised by either a mixture or a rapid alteration between hypomanic, manic and depressive symptoms
- Both manic and depressive symptoms must be prominent most of the time during a period of at least 2 weeks
What symptoms rating scales are used to assess Mania?
- YMRS, most useful clinically. 11 items scored either 0-4 or 0-8. More weight given to behaviour, thought content, speech, irritability. Not useful for milder symptoms.
When patients begin to describe a hallucination, what is it important to establish?
Modality of the hallucination.
If they tell you they are hearing voices are they hearing them like they hear you (auditory) or is it more like idea implantation.
What medications/conditions can be linked to mania?
Long term steroid use can commonly lead to mania as well as depression.
Conditions to look out for:
- Lupus
- MS
- Other rheum
- Other inflammatory
How does DSM diagnose a Major Depressive Episode?
A) At least one of Depressed mood most of the day most days OR Anhedonia
B) 4 Additional symptoms (can be anhedonia or low mood)
Physical symptoms:
- Significant weight or appetite loss
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
Cognitive symptoms:
- Worthlessness or guilt
- Diminished ability to think, indecisiveness
- Recurrent thoughts of death, suicidal ideation
C) Symptoms cause significant distress or impairment in social, occupational life
D) Not attributed to other conditions, substances or grief
