Lecture 5: Bipolar Disorders

Question 1

comment on mortality for bipolar disorder

Answer 1

● Elevated mortality associated with psychiatric disorders, not just from suicide
o Heart disease, cancer, stroke, and accidental injuries also increased

Question 2

Episode types:

Answer 2

manic or hypomanic, depressive, mixed

Question 3

Mania

Answer 3

1 wk. of elevated/irritable mood with at least 3 (4 if irritable) symptoms:
● DIG FAST:
o Distractibility: unable to read, carry on conversation
o Impulsivity: reckless driving, spending sprees
o Grandiosity: having a cure for HIV as literature grad student
o Fast thoughts: “too many ideas to keep straight”
o Activity/agitation: cleaning at 3am, embarking on novel
o Sleep (decreased need): waking at 4am
o Talking rapidly (pressured speech): difficult to interrupt
● Usual DSM exclusions, r/o medical condition
● No 1 week requirement if associated with hospitalization

Question 4

Hypomania

Answer 4

4 days of elevated/irritable mood with at least 3 of DIG FAST criteria
● Observable by others and not associated with significant distress/ impairment
● Hypomania in absence of depression is not a diagnosis per se
● Some argue that hypomania may be adaptive but far more often is an excuse to avoid treatment

Question 5

DIG FAST

Answer 5

o Distractibility: unable to read, carry on conversation
o Impulsivity: reckless driving, spending sprees
o Grandiosity: having a cure for HIV as literature grad student
o Fast thoughts: “too many ideas to keep straight”
o Activity/agitation: cleaning at 3am, embarking on novel
o Sleep (decreased need): waking at 4am
o Talking rapidly (pressured speech): difficult to interrupt

Question 6

Bipolar I v Bipolar II

Answer 6

▪ Bipolar I: at least one episode of mania

▪ Bipolar II: at least one episode of hypomania and one episode of major depression

Question 7

Cyclothymia

Answer 7

2+ years of most days with some depressive/hypomanic sx, fewer than 2 months of euthymia, no depressive or manic episodes

Question 8

Misdiagnosis

Answer 8

o About 1/3 wait 10+ years, must screen carefully for hypomania and remember that comorbidity (substance abuse, anxiety) is common
▪ For hypomania ask about sex, sleep, socializing, speeding, spending, special projects then about associated symptoms

Question 9

Prevalence and age onset

Answer 9

o Prevalence of bipolar I and II: 3%, M = F, peak onset 15-19 years with small secondary peak at age 50 (often associated with other etiologies, CNS lesion or steroids)
o Retrospectively, many adult bipolar patients report early onset of symptoms