Bipolar & Related Disorders

Question 1

Bipolar I Disorder

Answer 1

Necessary to meet criteria for a current or past Manic Episode:
[mood disturbance AND increased activity/energy]

A. Distinct period of abnormally and persistently elevated, expansive, or irritable mood and increase in goal directed activity or energy lasting at least 1 week (present most of the day, nearly every day)

B. During the period of mood disturbance and increased energy, 3 (or more) of the following symptoms are present to a significant degree and represent a noticeable change from usual behavior:

• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative; pressure to keep talking
• flight of ideas; subjective experience that thoughts are racing
• distractibility (attention drawn easily to unimportant or irrelevant external stimuli)
• increase in goal-directed activity
• psychomotor agitation
• excessive involvement in activities that have a high potential for painful consequences (impulsive behaviors such as spending, sexual indiscretions, business investments, etc)

Question 2

Bipolar II Disorder

Answer 2

[there has NEVER been a MANIC episode]

Necessary to meet criteria for current or past Hypomanic Episode AND criteria for a current or past Depressive Episode:

HYPOMANIC EPISODE {shorter, condensed manic episode}
A. [same criteria as Criterion A for Manic Episode] … lasting at least 4 consecutive days
B. [same criteria as Criterion B for Manic Episode]
C. Associated with an unequivocal change in functioning that is uncharacteristic
D. Disturbance in mood and change in functioning is noticeable by others

MAJOR DEPRESSIVE EPISODE
A. 5 (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; [at least 1 symptom is either depressed mood or loss of interest or pleasure]
- depressed mood most of the day, nearly ever day; objective or subjective data
- markedly diminished interest or pleasure in almost all activities most of the day, nearly every day
- significant weight loss or appetite disturbance
- insomnia or hypersomnia nearly every day
- psychomotor agitation
- fatigue or loss of energy nearly every day
- feelings of worthlessness; excessive inappropriate guilt
- diminished ability to think or concentrate; indecisiveness
- recurrent thoughts of death; suicidal ideation

B. Cause significant distress or impairment to important areas of functioning

Question 3

Cyclothymic Disorder

Answer 3

Chronic, fluctuating mood disturbance involving numerous periods of Hypomanic symptoms and period of Depressive symptoms that are distinct from each other

During initial 2-year period, symptoms must be persistent and any symptom-free interval must not last more than 2 months

[1 year period in children and adolescents]

Question 4

Risk Factors

Answer 4

• more common in high-income countries
• family history is strongest and most consistent risk factor
• once individual has episode, likelihood increases for subsequent episodes
• increase risk of psychotic features in mania
• females hold higher risks re: Bipolar I

Question 5

Manic Symptoms

Answer 5

Mood and energy disturbances

• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative; pressure to keep talking
• flight of ideas; subjective experience that thoughts are racing
• distractibility (attention drawn easily to unimportant or irrelevant external stimuli)
• increase in goal-directed activity
• psychomotor agitation
• excessive involvement in activities that have a high potential for painful consequences (impulsive behaviors such as spending, sexual indiscretions, business investments, etc)

Question 6

Depressive Symptoms

Answer 6

• depressed mood most of the day, nearly ever day; objective or subjective data
• markedly diminished interest or pleasure in almost all activities most of the day, nearly every day
• significant weight loss or appetite disturbance
• insomnia or hypersomnia nearly every day
• psychomotor agitation
• fatigue or loss of energy nearly every day
• feelings of worthlessness; excessive inappropriate guilt
• diminished ability to think or concentrate; indecisiveness
• recurrent thoughts of death; suicidal ideation

Question 7

Hypomanic

Answer 7

Elevated, expansive, or irritable mood that is less severe than full-blown manic symptoms

Not severe enough to interfere with functioning

Not accompanied by psychotic symptoms