Week 1 - C - Abnormal mood - Bipolar disorder - Bipolar 1,2, Cyclothmyic - Hypomania, mania with/without psychotic symptoms Flashcards
What classification symptoms are used for bipolar disorder? What do they differ in describing?
The two classification symptoms are the ICD-10 and the DSM-5
ICD 10 describes the episode severity in the bipolar disorder
DSM 5 descirbe the course and pattern of the bipolar disorder
As ICD 10 describe the episode severity, what are the different classifications here? As DSM 5 describes the course and pattern of the episode , what are the different patterns here?
ICD 10- describe the episode severity
- * Hypomania
- * Mania with psychotic symptoms
- * Mania without psychotics symptoms
DSM-5 describe the course and pattern of the episode
- * Bipolar 1 and 2
- * Cyclothymic disorder
Lets start with bipolar disorders under the DSM-5 categories ie Bipolar I,II and cyclothymic disorder What is the main difference between bipolar 1 and 2?
The main differences between bipolar I and II lies in the severity of the manic episodes
Bipolar I has manic episodes whereas bipolar II has hypomanic episodes
The severity of depression in both however is the same
Describe both Bipolar I and Bipolar II in terms of the DSM 5 (diagnostic and statistical manual of mental disorders 5)?
Bipolar I Has to have met criteria for mania (will discuss the criteria shortly) although previous episodes, may have been hypomanic and/or depressive
Bipolar II Current or past hypomanic episode AND current or past depressive episode, Has never met the criteria for mania
What is the difference with regards to depression for the diagnosis of bipolar I and II? What is the most common form of bipolar?
Bipolar I needs a manic episode to occur, but in the past could have been hypomanic and/or depressive
Bipolar II Current or past hypomanic episodes AND current or past depressive episodes
Bipolar II is the most common form of bipolar disorder
Bipolar II needs a depressive episode to have occurred
* Bipolar I is not just mania – most people will have had episodes of major depression * Bipolar II is not a milder form of illness – it results in just as much disability, largely via chronic depressive episodes
What is the type of bipolar disorder where there are more than 4 mood swings inside a 12 month period?
Rapid cycling bipolar disorder is when there are four or more distinct episodes of mood swings occurring within a 12 month period - can occur in bipolar I and II disorder
The mood swings are not as severe as those in full bipolar disorder, but may continue for longer. This can, sometimes, develop into full bipolar disorder. - usually presents with hypomania and mild depression alternating What is this known as?
This would be cyclothymia - when there is hypomania alternating with mild depression
Picture shows DSM IV criteria but is still useful for understanding the different categories of bipolar disorder If the patient only has hypomanic epidoses but not any depressive episodes, what is their classification?
Bipolar disorder not otherwise specified
What is the difference between bipolar disorder and bipolar affective disorder?
When there are recurrent episodes of hypomania or mania only, without the depression - this is bipolar disorder
For a diagnosis of bipolar affective disorder - need to have depressive episodes present as well - usually alternating with the hypo/manic episodes
DSM-5 is majorly used to classify bipolar in the USA
ICD-10 is majorly used to classify bipolar in Europe / Rest of the World
How does the ICD-10 define bipolar disorder?
A disorder characterized by two or more episodes in which the patients mood and activity levels are significantly disturbed, this disturbance consisting on some occasions of hypomania, or mania and on others, depression.
When can you classify the patient as bipolar disorder and not depression?
A single episode of hypomania or mania is bipolar disorders even if you have not had any depressive episodes - with depressive episodes, can then classifiy as bipolar I, II, or cyclothymia (with the depressive episodes, can say the person has bipolar affective disorder)
The first episode of hypomania or mania on a background of recurrent depressive episodes is bipolar disorder and no longer depression
Need to be able to differentiate between hypomania and mania - both have severe depression so need to be able to tell if bipolar I or II based on severity of the elated moods What is a hypomanic episode defined as? (has two parts for the classification as hypomania)
The mood is elevated or irritable that is definitely abnormal for the individual concerned & sustained for at least 4 days
Three of the following signs must also be present out of the 7 options that impact on daily living
- * 1.increased activity or physical restlessness
- * 2. increased talkativeness
- * 3. difficulty concentration or distractibility
- * 4. decreased need for sleep
- * 5. increased sexual energy
- * 6. Increased sociability or over familiarity
- * 7. Mild spending sprees, reckless behaviours
What is a manic episode defined as?
A manic episode is define as mood that is predominantly elevated, expansive or irritable and definitely abnormal for the individual concerned. This mood change must be prominent and maintained for at least 1 week
And associated with three of the following 9 features (4 if irritable)
The distinction between hypomania and mania is a difficult one as it relies on subjective interpretations of symptom severity How long must symptoms persist in both?
In hypomania, the mood must be elevated or irritable to a degree abnormal for the individual for 4 consecutive days
In mania - the mood must be predominantly elevated, expansive or irritable which s definitely abnormal for 7 consecutive days (unless hospitalized)
What is bipolar with psychotic symptoms?
This is where there are psychotic symptoms but not psychotic symptoms listed as typical shizphrenia
What would be the delusions and hallucinations in bipolar with psychotic disorders?
Delsuions would be self referential ie grandiose delusions or erotic
Hallucinations would not be in the third person or providing or a running commentary so they would be in the 2nd person
Usually both occur during the depressive episodes of bipolar
What is the prevalence of bipolar disorder I in bipolar affective disease?
1/3rd of patients have this
When is the onset of bipolar disorder usually?
Onset is usually in late teens to early 20s
How does a family history of bipolar affect the onset?
Usually presents earlier and precipitated by lower levels of stress
What other co-morbidities is bipolar disease associated with?
Anxiety disorders
Alcohol and drug misuse
Personality disorder
eating disorders
Schizophrenia
What is roughly the heritability of bipolar disorder? What does having a first degree relative do to the likelihood of mental disorders? (for unipolar depression state the percentage)
The hertiability is roughly 80%
Having a first degree relative with bipolar disorder is associated with a 20-30% risk of unipolar depression
Having a first degree relative also increases the risk of schizoaffective disorder
Name some predictors of poor outcome in adolescence ?
* Early onset
* Low socioeconomic status
* Long duration of illness
* Rapid mood fluctuation
* Mixed presentations
* Pyschosis
* Comorbid disorders
Bipolar disorder is a lifelong condition with significant impairment in functioning * The most robust differentiation is between bipolar I (mania + depression) and bipolar II (hypomania + depression) * In both types, depression is common * Because of this, previous episodes of elated mood are often missed
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