Flashcards in 10. Specific Disorders - Bipolar and Related Disorders Deck (28):
In the DSM-5, what are the Bipolar and Related Disorders?
1. Bipolar I Disorder
2. Bipolar II Disorder
3. Cyclothymic Disorder
4. Substance/Medication-Induced Bipolar and Related Disorder
5. Bipolar and Related Disorder Due to Another Medical Condition
6. Other Specified Bipolar and Related Disorder
7. Unspecified Bipolar and Related Disorder
How is Bipolar I Disorder characterized?
Bipolar I Disorder is characterized by one or more Manic or Mixed Episodes, usually accompanied by Major Depressive Episodes.
How is Bipolar II Disorder characterized?
Bipolar II Disorder is characterized by one or more Major Depressive Episodes accompanied by at least one Hypomanic Episode.
Note - it is no longer considered a "milder" form of bipolar I disorder. Individuals tend to stay longer in depressive episodes and mood instability typically results in serious impairment in work and social functioning.
How is Cyclothymic Disorder characterized?
The diagnosis of cyclothymic disorder is given to adults who experience at least 2 years (for children, a full year) of both hypomanic and depressive periods without ever fulfilling the criteria for an episode of mania, hypomania, or major depression.
How is Substance/Medication-Induced Bipolar and Related Disorder characterized?
Substance/Medication-Induced Bipolar and Related Disorder is characterized by a prominent and persistent disturbance in mood that is judged to be a direct physiological consequence of a drug of abuse, a medication, another somatic treatment for depression, or toxin exposure.
How is Bipolar and Related Disorder Due to Another Medical Condition characterized?
It is characterized by a prominent and persistent disturbance in mood that is judged to be a direct physiological consequence of a general medical condition.
How is Other Specified Bipolar and Related Disorder characterized?
The recognition that many individuals, particularly children and, to a lesser extent, adolescents, experience bipolar-like phenomena that do not meet the criteria for bipolar I, bi polar II, or cyclothymic disorder is reflected in the availability of the other specified bipolar and related disorder category. Indeed, specific criteria for a disorder involving short-duration hypomania are provided in Section III in the hope of encouraging further study of this disorder.
To meet criteria for Bipolar I disorder, what do you need?
You need to meet criteria for a manic episode.
Quickly summarize the diagnostic criteria for a manic episode.
See p. 124
A. Mood alteration (elevated, expansive, or irritable mood) and goal-directed activity lasting at least 1 week and present most of the day nearly every day,
B. 3 or more symptoms, or 4 if mood is only irritable
C. Marked impairment in social or occupational functioning, or hospitalization
D. R/O substances or other medical conditions
Quickly summarize the diagnostic criteria for a hypomanic episode.
See p. 124
A. Abnormally and persistently elevated, expansive, or irritable mood and increased activity or energy, lasting at least 4 consecutive days and present most of the day every day
B. 3 or more symptoms, or 4 if mood is only irritable
C. Change in functioning not typical of the person when not symptomatic
D. Changes observable by others
E. NO marked impairment in social or occupational functioning, or hospitalization. If there are psychotic features it's manic!!
F. R/O substances or other medical conditions
Quickly summarize the diagnostic criteria for a major depressive episode.
See p. 125
A. 5 or more symptoms (out of 9) present during a 2 week period that is a change from previous functioning, with at least one of them 1) depressed mood or 2) loss of interest/pleasure
B. Clinically significant distress impacting functioning
C. R/O substances or other medical conditions
Specifically, what are the criteria for Bipolar I disorder?
A. Criteria have been met for at least one manic episode
B. R/O schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder
What is mean age of onset for Bipolar I disorder?
What % of individuals who have a single manic episode go on to have recurrent episodes?
More than 90% of individuals who have a single manic episode go on to have recurrent mood episodes.
Approximately 60% of manic episodes occur immediately before a major depressive episode. Individuals with bipolar I disorder who have multiple (four or more) mood episodes (major depressive, manic, or hypomanic) within 1 year receive the specifier "with rapid cycling."
What is known about the expression of bipolar disorder in different cultures?
Not a lot, largely due to the translation of measures without cross-cultural validation.
Afrio-Caribbeans lower than Whites and African-Americans.
What are gender related diagnostic issues?
Females more likely to be rapid cyclers, and co-morbidity with lifetime eating disorders.
Females with bipolar I or II are more likely to have eating disorders than males, and higher risk of alcohol use disorder.
What is know about suicide risk and bipolar I disorder?
They are 15x more likely. Bipolar disorder accounts for 25% of all suicides. Past history of attempts associated with greater risk of future attempts and completion.
What is important for differential diagnosis of bipolar I disorder?
Major depressive disorder - It can be accompanied by manic or hypomanic symptoms, but they are at shorter duration than required for mania or hypomania. Have to rely on past history of episodes of mania/hypomania. Irritability can also be present in both.
Other bipolar disorders - I and II are differentiated by whether there was a past episode of mania. I and II are differentiated from other specified and unspecified by if manic, hypomanic, and depressive symptoms met full criteria for episodes.
GAD/panic disorder/PTSD/other anxiety disorders - anxious rumination can be mistaken for racing thoughts, and efforts to minimize anxiety can be seen as impulsive behavior. To r/o PTSD, identify symptom triggers.
Substance/medication induced bipolar
ADHD - careful in adolescents and kids
Personality disorders - BPD has significant overlap. Symptoms must represent distinct episodes.
Disorders with prominent irritability
What is known about the co-morbidity of Bipolar I disorder and other disorders?
Most frequent co-occurrences are with anxiety disorders in 75% of individuals, ADHD, disruptive/impulse control/conduct disorder, and substance use disorder occur in over half of individuals with bipolar disorder. More than half have alcohol use disorder.
Briefly, what are the criteria for Bipolar I disorder?
A. Criteria met for at least one hypomanic episode and at least one major depressive episode
B. NO manic episodes
C. R/O psychotic disorders
D. Clinically significant impairment due to frequent alternation between depression and hypomania
Average onset of Bipolar II disorder?
Average age of onset is mid 20's. This is slightly later for Bipolar I but earlier than major depressive disorder.
What is important to know about the progression of Bipolar II?
The illness often begins with a depressive episode, and isn't recognized until a hypomanic episode occurs. Anxiety, SA, or ED may precede diagnosis.
Lifetime hypomanic and depressive episodes higher for Bipolar II than for major depressive disorder or bipolar I disorder.
BUT individuals with bipolar I are more likely to have hypomanic episodes than II.
Depressive episodes get longer over time.
What about gender differences in Bipolar II.
Although for bipolar I they seem about equal, bipolar II findings are mixed. II MIGHT be more common in females.
What is important to know about differential diagnosis of Bipolar II?
MDD - Especially hard to determine when considering irritability
Cyclothymic Disorder - Distinguished by the presence of one or more major depressive episodes in Bipolar II. If a major depressive episode happens after two years of having cyclothymia, a diagnosis of Bipolar II is given. In cyclothymia there are numerous periods of hypomania and bipolar that don't meet criteria for a major depressive episode.
Schizophrenia spectrum - For schizo, psychosis w/o mood Sx
Panic disorder/other anxiety disorders
ADHD - May be misdiagnosed as bipolar II. Often because they are not being clarified as to whether they are distinct episodes.
Personality disorders - distinct episodes, and Sx over baseline
Other bipolar disorders - For I, must be mania. For others, determine if fully syndromal hypomania and depression.
Comorbidity of Bipolar II?
60% have 3 or more co-occuring disorders
Anxiety disorder is most common (75%)
Substance abuse (37%)
14% have at least one lifetime eating disorder, with
BED over bulimia or anorexia
What is the prevalence of cyclothymia?
.4 to 1%
Equally common in males and females, but females more often present for treatment.
Begins earlier in life, and is more chronic.
15-50% risk of developing bipolar disorder, I or II.
What are important R/O for differential diagnosis of cyclothymia?
Bipolar and related disorder due to another medical condition
depressive disorder due to another medical condition
Substance/medication induced bipolar and related disorder
substance/medication induced depressive disorder
Bipolar I disorder, with rapid cycling
Bipolar II disorder, with rapid cycling
Borderline personality disorder