Cyclothymic D/O + rest of bipolar chapter (DSM)

Question 1

criterion A for cyclothymic disorder

Answer 1

for at least TWO YEARS (at least ONE in kids and teens) there have been NUMEROUS periods with hypomanic symptoms that do NOT meet criteria for a hypomanic episode and numerous episodes with depressive symptoms that do not meet criteria for a major depressive episode

Question 2

criterion B for cyclothymic disorder

Answer 2

during the required 2 year period (1 year in kids and teens), the hypomanic and depressive periods have been present for at least HALF THE TIME and the individual has not been WITHOUT the symptoms for more than TWO MONTHS at a time

Question 3

criterion C for cyclothymic disorder

Answer 3

criteria for a major depressive, manic or hypomanic episode have NEVER BEEN MET

Question 4

criterion D for cyclothymic disorder

Answer 4

the symptoms in criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder or other specified or unspecified schizophrenia spectrum and other psychotic disorder

Question 5

criterion E for cyclothymic disorder

Answer 5

symptoms are not attributable to the physiological effects of a substance or another medical condition

Question 6

criterion F for cyclothymic disorder

Answer 6

symptoms cause CLINICALLY SIGNIFICANT distress or impairment in social, occupational or other important areas of functioning

Question 7

what specifier may accompany cyclothymic disorder

Answer 7

with anxious distress

Question 8

what is the essential feature of cyclothymic disorder

Answer 8

CHRONIC, FLUCTUATING mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from each other

hypomanic sx are insufficient in number, severity, pervasiveness or duration to meet full criteria for a hypomanic episode (same for the depressive symptoms)

Question 9

what is the time criteria for cyclothymic disorder

Answer 9

a two year period in which person has not been without symptoms for more than 2 months at a time and has symptoms for at least half the time

Question 10

what aspect of cyclothymic disorder may lead to the impairment required to make the diagnosis

Answer 10

may develop as a result of long periods of cyclical, often unpredictable mood changes i.e person may be regarded as temperamental, moody, unpredictable, inconsistent or unreliable

Question 11

what is the lifetime prevalence of cyclothymic disorder

Answer 11

0.4-1%

(prevalence in mood disorders clinic 3-5%)

Question 12

is cyclothymic disorder more common in males or females

Answer 12

equally common in both

Question 13

when does cyclothymic disorder usually begin

Answer 13

in adolescence or early adulthood

sometimes considered a temperamental predisposition to other disorders in bipolar section of DSM

Question 14

what is the usual course of cyclothymic disorder

Answer 14

insidious onset and persistent course

Question 15

what is the risk that someone with cyclothymic disorder will eventually develop bipolar I or II disorder

Answer 15

15-50% risk

Question 16

among children with cyclothymic disorder what is the mean age of onset

Answer 16

6.5 years

Question 17

what disorders are more common amongst those who have a first degree relative with cyclothymic disorder

Answer 17

MDD
bipolar I
bipolar II

may also be an increased familial risk of SUDs

cyclothymic disorder may be more common in those with a first degree relative with bipolar I

Question 18

ddx of cyclothymic disorder

Answer 18

bipolar and related disorder due to another medical condition

depressive disorder due to another medical condition

sub/med induced bipolar or depressive disorder

bipolar I with rapid cycling

bipolar II with rapid cycling

borderline PD

Question 19

can both cyclothymic disorder and borderline PD be diagnosed in the same person

Answer 19

yes, if criteria for both are met

Question 20

list common comorbidities with cyclothymic disorder

Answer 20

SUDs

sleep disorders

ADHD

Question 21

criterion A for substance/medication induced bipolar and related disorder

Answer 21

a prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive or irritable mood with or without depressed mood, or markedly diminished interest or pleasure in all, or almost all activities

Question 22

criterion B for substance/medication induced bipolar and related disorder

Answer 22

there is evidence from the history, physical exam, or lab findings of both of the below:

1. the symptoms in criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication
   AND
2. the involved substance/med is capable of producing the symptoms in criterion A

Question 23

criterion C for substance/medication induced bipolar and related disorder

Answer 23

disturbance not better explained by a bipolar or related disorder that is not substance/med related

Question 24

what evidence might suggest that the substance/medication induced bipolar and related disorder is in fact not related to a substance or med

Answer 24

the symptoms precede the onset of the sub/med use

the symptoms persist for a substantial period of time (i.e about 1 month) after the cessation of acute withdrawal or severe intox

or there is other evidence suggesting the existence of an independent bipolar type illness unrelated to substances

Question 25

criterion D for substance/medication induced bipolar and related disorder

Answer 25

disturbance does not occur exclusively during the course of delirium

Question 26

criterion E for substance/medication induced bipolar and related disorder

Answer 26

disturbance causes clinically significant distress or impairment in social, occupational or other areas of functioning

Question 27

what specifiers are there for substance/medication induced bipolar and related disorder

Answer 27

with onset during intoxication with onset during withdrawal

Question 28

what is the key exception for substance/medication induced bipolar and related disorder

Answer 28

case of hypomania/mania that occurs after antidepressant/ECT use and persists beyond the physiological effects of the med/treatment--> this is considered an indicator of true bipolar disorder and not a sub/med induced one

Question 29

what substances and medications are typically considered to be associated with substance/medication induced bipolar and related disorder

Answer 29

stimulant class of drugs phencyclidine steroids (others continue to emerge, like bath salts)

Question 30

how might a phencyclidine induced mania initially present

Answer 30

a delirium with affective features which becomes an atypically appearing manic or mixed manic state

Question 31

over what time frame after ingestion would phencyclidine related bipolar disorder present

Answer 31

quickly--> usually within hours or at the most, a few days, or ingestion or inhalation

Question 32

how quickly would a stimulant induced bipolar picture present

Answer 32

minutes to 1 hour after one or several ingestions or injections

Question 33

how long does a stimulant induced bipolar picture typically last

Answer 33

typically only 1-2 days and the resolves

Question 34

how might a steroid or other immunosuppresant induced mania present

Answer 34

usually follows several days of steroid ingestion higher doses appear to have greater likelihood of producing mania/bipolar sx

Question 35

ddx substance/medication induced bipolar and related disorder

Answer 35

other bipolar disorders substance intoxication substance induced delirium medication side effect

Question 36

criterion A for bipolar and related disorder due to another medical condition

Answer 36

a prominent and persistent period of abnormally elevated, expansive or irritable mood and abnormally increased activity or energy that predominates in the clinical picture

Question 37

criterion B for bipolar and related disorder due to another medical condition

Answer 37

there is evidence from the history, physical examination or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition

Question 38

criterion C for bipolar and related disorder due to another medical condition

Answer 38

the disturbance is not better explained by another mental disorder

Question 39

criterion D for bipolar and related disorder due to another medical condition

Answer 39

disturbance does not occur exclusively during the course of a delirium

Question 40

criterion E for bipolar and related disorder due to another medical condition

Answer 40

disturbance causes clinically significant distress or impairment etc OR **necessitates hospitalization to prevent harm to self or others or there are psychotic features**

Question 41

what are the specifiers assoc with bipolar and related disorder due to another medical condition

Answer 41

with manic features--> full criteria not met for manic or hypomanic episode with manic-or-hypomanic like episode--> full criteria are met except criterion D for a manic episode and except for criterion F for hypomanic episode with mixed features--> sx of depression also present but do not predominate in the clinical picture

Question 42

what are the *best known* medical conditions that can cause bipolar and related disorder due to another medical condition

Answer 42

cushing's disease multiple sclerosis stroke and TBI *the list of the conditions that can cause mania/hypomania type picture is "never complete"--> "the clinicians best judgment is the essence of this diagnosis"

Question 43

how does bipolar and related disorder due to another medical condition usually present

Answer 43

usually onset is ACUTE or SUBACUTE within first weeks or month of the onset of the associated medical condition *not always the case if related to worsening or relapse of chronic illness may remit just before or just after the medical condition remits, especially when tx of mania/hypomanic sx is effective

Question 44

if the cushings disease is cured or arrested, do we generally think the mania/hypomania will recur or no?

Answer 44

believed generally that it will not recur

Question 45

if mania/hypomania occurs in the context of static brain injuries or other CNS diseases, do we generally think the mood sx will recur or no?

Answer 45

may be episodic/recurring in these situations

Question 46

ddx bipolar and related disorder due to another medical condition

Answer 46

delirium catatonia acute anxiety med-induced manic or depressive syndromes

Question 47

when would you use the dx "other specified bipolar and related disorder"

Answer 47

presentations in which symptoms characteristic of a bipolar and related disorder that cause clinically significant distress or impairment in social, occupational or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the bipolar and related class i.e short duration hypomanic episodes and MDEs

Question 48

mixed features associated with a MDE have been found to be a significant risk factor for what

Answer 48

development of bipolar I or II

Question 49

for those with rapid cycling, must there be a certain length of time between mood episodes?

Answer 49

no minimum time between episodes if sequential episodes are on opposite polarities (i.e hypomanic to depressed)--> if the episodes are of the same polarity, must be demarcated by either partial or full remissions of at least TWO MONTHS between them

Question 50

what makes "melancholic features" different from just regular depression/anhedonia

Answer 50

there is a near-complete absence of the capacity for pleasure not merely a diminution --> experienced as qualitatively different from that experienced during a non-melancholic episode psychomotor changes are nearly always present and often noted by others

Question 51

what % of women will experience the onset of a MDE during pregnancy or in the weeks or months following delivery

Answer 51

3-6%

Question 52

what % of "postpartum" depression actually begins before delivery

Answer 52

50%

Question 53

postpartum mood episodes (either depressed or manic) with PSYCHOTIC features occur how commonly

Answer 53

1/500 ot 1/1000 deliveries

Question 54

risk of postpartum episodes with psychotic features is particularly increased in which women

Answer 54

women with prior postpartum mood episodes those with prior hx of depressive or bipolar disorder those with family history of bipolar disorders

Question 55

infanticide is most often associated with what psychiatric symptoms in a post partum woman

Answer 55

postpartum psychotic episodes that are characterized by COMMAND hallucinations to kill the infant or delusions that the infant is possessed

Question 56

once a woman has had a postpartum episode with psychotic features what is the risk of recurrence with each subsequent delivery

Answer 56

between 30-50%

Question 57

what does it mean to have a "Seasonal pattern" as per the DSM specifier

Answer 57

a lifetime pattern of mood episodes where there is a regular seasonal pattern of AT LEAST ONE types of episode (i.e mania, hypomania or depression)--> the other types of episodes may be have a seasonal pattern ie seasonal manias but not depressions full remissions also occur at characteristic times of year

Question 58

define "in partial remission" in bipolar disorders

Answer 58

symptoms of immediately preceeding manic, hypomanic or major depressive episode ARE PRESENT but full criteria are not met, or there is a period of LESS THAN TWO MONTHS without any significant symptoms of a manic, hypomanic or MDE following the end of such an episode

Question 59

define "in full remission" in bipolar disorders

Answer 59

during the past TWO MONTHS, no significant signs or symptoms of the disturbance were present

Question 60

define mild manic episode

Answer 60

minimum symptom criteria met for manic episode

Question 61

define moderate manic episode

Answer 61

very significant increase in activity or impairment in judgment

Question 62

define severe manic episode

Answer 62

almost continual supervision required in order to prevent physical harm to self or others

Question 63

define mild MDE

Answer 63

"Few, if any, symptoms in excess of those required to meet the diagnostic criteria are present, the intensity of the symptoms is distressing but manageable, and the symptoms result in minor impairment in social or occupational functioning."

Question 64

define moderate MDE

Answer 64

"The number of symptoms, intensity of symptoms, and/or functional impairment are between those specified for “mild” and “severe.”"

Question 65

define severe MDE

Answer 65

"The number of symptoms is substantially in excess of those required to make the diagnosis, the intensity of the symptoms is seriously distressing and unmanageable, and the symptoms markedly interfere with social and occupational functioning."