Bipolar and Related Disorders

Question 1

Bipolar Disorder

Answer 1

DSM 5 changes

1. Criteria A for manic and hypomanic episodes now includes an emphasis on changes in activity and energy as well as mood.
2. No longer for bipolar 1, mixed episode,: simultaneously meet full criteria for both mania and major depressive episode.
   
   1. with mixed features : added

Bipolar I:

1. occurance of 1 or more Manic or Mixed Eposodes with or w/o a history of 1 or more major Depressive Episodes
   
   1. single manic episode, most recent episode manic, MRE hypomanic, MRE mixed, MRE Depressed.

.4-1.6% prevalence, males and females

early 20’s, 90% with a Manic Episode have additioinal episodes.

Kindling Model: stressful life events are more likely to precipitate the first episode of the Bipolar Disorder than subsequent episodes, but research on this is inconsistent.

Strong Genetic Factor: identical twins (.67-1.0), fraternal (.20), first degree relatives have 4-14% chance of dx, and 5-14% chance of unipolar depression.

Treatment:

1. Li effective in 60-90% of cases with classic Bipolar!
2. but medication compliance is an issue due to:
   
   1. feel better, dont think meds are needed, like the highs of mania, dislike side effects.
3. for those with rapid cycling, do not respond to Li: anti-seizure drugs like carbamazepine or divalproex sodium may work
4. drugs and psychotherapy combined is better.

Question 2

Bipolar II Disorder

hypomania

Answer 2

BP II:

person has had at least 1 Major Depressive Episode and 1 Hypomanic Episode but has never had a Manic or Mixed Episode.

A hypomanic episode is not a disorder in itself, but rather is a description of a part of a type of bipolar II disorder. Hypomanic episodes have the same symptoms as manic episodes with two important differences:

(1) the mood usually isn’t severe enough to cause problems with the person working or socializing with others (e.g., they don’t have to take time off work during the episode), or to require hospitalization; and (2) there are never any psychotic features present in a hypomanic episode.

A hypomanic episode is characterized by a distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days and present for most of the day nearly every day. This hypomanic mood is clearly different from the person’s usual mood.

During the period of mood disturbance, 3 or more of the following symptoms have persisted (4 if the mood is only irritable) and have been present to a significant degree:

• Inflated self-esteem or grandiosity
• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
• More talkative than usual or pressure to keep talking
• Flight of ideas or subjective experience that thoughts are racing
• Distractibility (e.g., attention too easily drawn to unimportant or irrelevant external stimuli)
• Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
• Excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

A hypomanic episode is associated with a change in functioning that is uncharacteristic of the person. For example, the individual may be far more productive or outgoing and sociable than they usually are. This change in functioning and in mood is not subtle — the change is directly noticeable by others (usually friends or family members) during a hypomanic episode.

A hypomanic episode is also not severe enough to cause serious impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features. The observable symptoms of a hypomanic episode must not be due to substance use or abuse (e.g., alcohol, drugs, medications) or caused by a general medical condition (e.g., hyperthyroidism or diabetes).

ONLY .5% prevalence, more common in females

Question 3

Cyclothymic Disorder

Answer 3

Cyclothymic Dx

Presence of fluctuating Hypomanic symptoms and numerous periods of depressive symptoms that are not sufficiently severe to meet the criteria for a Major Depressive Episode.

Duration: at least 2 years for adulds OR 1 year for children and adolescents.