Abnormal Mood - Elevated Mood Flashcards
(33 cards)
Different classifications of bipolar disorders?
DSM (describes course and pattern):
• Bipolar I and Bipolar II
• Cyclothymic disorder
ICD (describes episode severity):
• Hypomania
• Mania with psychotic features
• Mania without psychotic features
What is bipolar I?
MANIA + DEPRESSION
Represents the ‘classic’ form of manic-depressive psychosis
They must have met criteria for MANIA, although previous episodes may have been hypomanic and/or depressive
NOTE - bipolar I is not just mania; most patients will have had episodes of major depression
What is bipolar II?
HYPOMANIA + DEPRESSION
Represents the most common form of illness
They have NEVER met the criteria for a manic episode; they will have had a current or past hypomanic episode AND current or past depressive episode
NOTE - bipolar II is not a milder form; it results in just as much disability, mainly via chronic depressive episodes
What is cyclothymia?
Short periods of mild depression and hypomania; never reaches the severity or duration of major depressive or full mania episodes
Patients have milder symptoms than occur in full-blown bipolar disorder
What is bipolar III?
AKA pseudounipolar
Hypomanic episodes only occur following use of anti-depressants for depression
NOTE - there are potentially more types of bipolar, i.e: IV or V; there is already controversy over bipolar III’s existence
How to distinguish bipolar from major depressive disorder (MDD)?
This is based purely on the current episode and there may be little to distinguish mixed episodes
Mixed states can occur in both BPAD and depression
DSM specifiers in BPAD?
- 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 pattern
DSM specifiers in MDD?
- With anxious distress
- With mixed features
- With melancholic features
- With atypical features
- With mood-congruent psychotic features
- With mood-incongruent psychotic features
- With peripartum onset
- With seasonal pattern
NOTE - this is identical to the specifiers for BPAD, except there is no ‘with rapid cycling’ or ‘with catatonia’
Define bipolar affective disorder (BPAD)
Disorder characterised by 2 or more episodes in which the patient’s mood and activity levels are significantly disturbed
This disturbance consists, on some occasions, of hypomania or mania and, on others, of depression
Repeated episodes of hypomania or mania are classified as bipolar
Differentiating depression and bipolar disorder?
A single episode of hypomania or mania is bipolar disorder, even if the patient has not been depressed yet
The 1st episode of hypomania on a background of recurrent depression means that it is bipolar disorder and not depression
Diagnostic criteria for a hypomanic episode?
Mood is elevated or irritable, to a degree that is definitely abnormal for the patient concerned, and is sustained for at least 4 consecutive days
At least 3 of the following signs must be present, leading to some interference with personal functioning in daily living:
- Increased activity or physical restlessness
- Increased talkativeness
- Difficulty in conc. or distractibility
- Decreased need for sleep
- Increased sexual energy
- Mild spending sprees or other types of reckless or irresponsible behaviour
Diagnostic criteria for a manic episode?
Mood must be predominantly elevated,
expansive or irritable, and definitely abnormal
for that patient
Mood change
must be prominent and sustained for at least 1
week (unless severe enough to require hospital admission)
At least 3 of the following signs must be present (4 if the mood is merely irritable), leading to severe interference with personal functioning in daily living:
- Increased activity or physical restlessness
- Increased talkativeness (PRESSURE OF SPEECH)
- Flight of ideas or the subjective experience of racing thoughts
- Loss of normal social inhibitions resulting in behaviour which is inappropriate to the circumstances
- Decreased need for sleep
- Inflated self-esteem or grandiosity
- Distractibility or constant changes in activities/plans
- Behaviour which is foolhardy or reckless, with risks the subject does not recognize, e.g: spending sprees, foolish enterprises, reckless driving
- Marked sexual energy or sexual indiscretions
Explain mania without psychotic symptoms
Absence of hallucinations or delusions, although perceptual disorders may occur (e.g: subjective hyperacusis, which is an appreciation of colours as
specially vivid, etc)
Explain mania with psychotic symptoms
Delusions or hallucinations are present, other than those listed as typical schizophrenic, i.e: delusions,
other than those that are
completely impossible or
culturally inappropriate, and
hallucinations, that are not in the 3rd person or giving a running commentary
Most common examples are
those with grandiose, self-referential, erotic or persecutory content
Similarities and differences between hypomania and mania?
ADD TABLE
Comparing diagnotic criteria for hypomania and mania?
Hypomania symptoms have a duration of 4 days WHEREAS mania symptoms have a duration of 1 week (unless hospitalised)
Hypomania only requires 3/7 additional symptoms (in DSM-5, this is 4/7 if mood is irritable) WHEREAS mania requires 3/9, for ICD-10 (4/9 if mood is irritable), or 3/7 for DSM-5 (4/7 if mood is irritable)
Hypomania has symptoms that are:
• Abnormal for the individual concerned (ICD-10)
• Unequivocal change…not severe enough to cause hospitalisation (DSM-5)
WHEREAS
Mania has symptoms that:
• Cause severe interference with functioning (ICD-10)
• Marked impairment or hospitalisation (DSM-5)
Conditions on the bipolar spectrum?
ADD IMAGE
Prevalence and incidence of bipolar disorder?
Lifetime prevalence of 1-4%
Prevalence of BP I is about 1/3rd of BPAD in general
Onset of bipolar disorder?
Usually in late teens or early 20s (approx. 10 years earlier than unipolar depression)
FH of BPAD often results in earlier onset and episodes are precipitated by lower levels of stress
Onset >60 years of age is rare and often assoc. with:
• Treatment resistance
• Progressive decline in function
• Underlying organic cause
Co-morbidities that may occur alongside BPAD?
Anxiety disorders, part. panic disorder, generalised anxiety disorder and OCD
Alcohol and drug misuse
Personality disorders, esp. borderline personality disoders
Eating disorders
Schizoaffective disorder
Schizophrenia
Describe genetics of BPAD and schizophrenia
Not much difference between genetics of BPAD and schizophrenia, i.e: if a patient has an FH of one, the risk of both is increased
Genes inv. with BPAD?
Multiple genes, each with low penetrance
Complex gene-gene and gene-environment interactions
Acute states in bipolar disorder?
Hypomania / mania
Depression
Maintenance states in bipolar disorder?
Predominantly hypomania
Predominantly depressive
Mixed affective states
Rapid cycling
