Mood Disorders - Bipolar I & II Flashcards
(36 cards)
menmonic for bipolar symptoms
DIGFAST
Distractibility Insomnia Grandiosity Flight of ideas Activities Speech Thoughtlessness
DSM IV criteria for manic episode
A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
The symptoms do not meet criteria for a Mixed Episode.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
DSM iV crtieria for a mixed episode
The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
DSM IV crtieria for hypomanic episdoe
A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
The disturbance in mood and the change in functioning are observable by others.
The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance or a general medical condition.
DSM crtieria for BP I
Presence of at least one Manic or Mixed Episode
Manic/Mixed Episode(s) are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder NOS
DSM IV certeria for BP II
Presence (or history) of one or more Major Depressive Episodes.
Presence (or history) of at least one Hypomanic Episode.
There has never been a Manic Episode or a Mixed Episode.
The mood episodes in Criteria A and B are not better accounted for by Schizoaffective Disorder and is not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
not due to substamce or GM
DSM criteria for cyclothymia
For at least 2 years, the presence of numerous periods with hypomanic symptoms and numerous periods with depressive symptoms that do not meet criteria for a Major Depressive Episode.
During the above 2-year period (1 year in children and adolescents), the person has not been without the symptoms in Criterion A for more than 2 months at a time.
No Major Depressive Episode, Manic Episode, or Mixed Episode has been present during the first 2 years of the disturbance.
The symptoms in Criterion A are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
not substance or GMC
clinically sig distress or impairment
Note: In children and adolescents, the duration must be at least 1 year.
differential diagnosis with BP
MDD – carefull assessment for manic symptoms (collateral information, second opinion)
Substance-related mood d/o
mood d/o due to GMC
sz/szaffective d/o (chronic vs. episodic)
personality d/o (chronic vs. episodic)
ADHD (chronic vs. episodic; AAO, ADHD is typically earlier than BP)
variations of BP D/o
Bipolar I Disorder: 1 or more manic/mixed episode
- Single Manic Episode
- Most Recent Episode: Hypomanic, Manic, Mixed, Depressed, Unspecified
Bipolar II Disorder: 1 or more MDE, 1 or more hypomanic, no mania/mixed episodes
-Most Recent Episode: Hypomanic, Depressed
Cyclothymia: 2 or more years, periods of hypomanic & depressive sxs, no full criteria for MDE, Manic, Mixed episode
lifetime prev rates for BP I
.4-1.6%
difference in prev rates based on race?
no
difference in prev rates based on gender?
no
though onset and course for women is characteried by more MDEs than men
what proportion of Px’s with BP commit suicide?
10-15%
can aggressive and violent bx occur during a manic or mixed episode?
yes
what percentage of Px’s with BP experience more than one manic episode?
90%
if untreated, on average, how many manic episodes does an individual have in 10 yer?
4
regarding relapse, for Px’s who comply with med tx…
1/3 relapse within 3 years
regarding relapse, in naturlistic studies with varying levels of tx compliance…
2/3 relapse within 2 years
BP is the ____ leading cause of disability (both physical and psych)
6th
in 1999, estimated fiscal cost for americans with BP
45 million
where does the info on the last four cards come from?
Johnson et al., 2000
describe the etiology of BP
Evidence for genetic component from adoption and twin studies – 50 to 80%
Neurotransmitter dysfunction
- Dopamine dysregulation (and serotonin)
- Don’t fully understand the mechanisms here
Brain regions
- Elevated activity in amygdala
- Diminished activity in prefrontal cortex
Milkowitz and Johnson, 2006
Broadly, what does the research say about LE’s and BP
Research has found that stressful life events play a role in the onset of and recovery from episodes of depression and mania
Hlastala, et al., 2000
What are some findings from cross section research on LE’s (gen) and BP; what are the limitations
LE’s more common before bipolar episodes than they are in general population
–56% of px’s with BP report a major role loss before a major episode
LE’s more likely to occur before a bipolar relapse (i.e., new episode) than after
Severe LE’s 4X as common in the month before relapse and 2X as common in the 2 months before relapse compared with control periods
Limitations: causal inferences (temporal precedence); self-report (longterm/emotional recall, emotionally laden material, social desirability)
