Bipolar and Related Disorders

Manic Episode

A distinct period of abnormaly and persistently elevated, expansive, or irritable mood and abnormaly and persistently increased activity or energy

at least 1 week and present most of the day, nearly every day

How long should a manic episode last?

At least one lifetime

At least how many manic episode is required for the diagnosis of bipolar I disorder

at least 4 consecutive days and present most of the day, nearly every day.

How long should a hypomanic episode last?

Schizoaffective Disorder

• Manic and/or major depressive episodes occur alongside active-phase symptoms of schizophrenia, and

• Delusions or hallucinations persist for at least 2 weeks without mood symptoms.

Bipolar I Disorder with Psychotic Features

• Psychotic symptoms only occur during manic or depressive episodes, and never on their own.

Bipolar II Disorder

• At least one hypomanic episode (a less severe form of mania), and

• At least one major depressive episode

• No history of a full manic episode (if mania occurs, the diagnosis changes to Bipolar I)

With Rapid Cycling

The person experiences four or more mood episodes (manic, hypomanic, or depressive) within a 12-month period.

With Seasonal Pattern

Mood episodes (typically depressive) follow a seasonal pattern, often beginning and ending at the same time each year, usually in fall/winter.

In Partial Remission

Some symptoms are still present, but the person no longer meets full diagnostic criteria. There has been improvement.

In Full Remission

No significant symptoms remain. The disorder is not currently active, but the diagnosis is still recorded because there is a history of the disorder.

Cyclothymic Disorder

For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode

2 months

In cyclothymic disorder, Criterion A symptoms have been present for at least half the time and the individual has not been without the symptoms for more than __________ at a time

substance/medication-induced bipolar and related disorder

is a prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy, these symptoms are judged to be attributable to the effects of a substance

DURING, SOON AFTER

To meet criteria for the diagnosis of substance/medication-induced bipolar and related disorder, the abnormally elevated, expansive, or irritable mood and increased activity or energy must have developed ____ or ______ substance intoxication or withdrawal or after exposure to or withdrawal from a medication

mixed episode

characterized by symptoms of both full-blown manic and major depressive episodes for at least 1 week, either intermixed or alternating rapidly every few days

women

Bipolar disorder occurs equally in males and females (although depressive episodes are more common in_____) and usually starts in adolescence and young adulthood, with an average age of onset of 18 to 22 years

monoamine oxidase inhibitors (MAOIs

inhibit the action of monoamine oxidase, the enzyme responsible for the break down of norepinephrine and serotonin once released, can be as effective in treating depression as other categories of medications

tricyclic antidepressants

For most patients who are moderately to seriously depressed, including those with persistent depressive dis order, the drug treatment of choice from the 1960s to the early 1990s was

selective serotonin reup take inhibitors (SSRIs)

are used not only to treat severe depression but also to treat people with mild depressive symptoms

Lithium

mood stabilizer in the treatment of both depressive and manic episodes of bipolar disorder. has been more widely studied as a treatment of manic episodes than of depressive episode

electroconvulsive therapy (ECT)

often used with patients who are severely depressed (especially among the elderly) and who may present an immediate and serious suicidal risk, including those with psychotic or melancholic features

cognitive-behavioral therapy (CBT)

best-known psychotherapies for unipolar depression with documented effectiveness. It is a relatively brief form of treatment (usually 10 to 20 sessions) that focuses on here-and-now problems rather than on the more remote causal issues that psychodynamic psychotherapy often addresses. consists of highly structured, sys tematic attempts to teach people with unipolar depression to evaluate systematically their dysfunctional beliefs and negative automatic thoughts. They are also taught to iden tify and correct their biases or distortions in information processing and to uncover and challenge their underlying depressogenic assumptions and beliefs

mindfulness-based cognitive therapy

This group treatment involves train ing in mindfulness meditation techniques aimed at devel oping patients’ awareness of their unwanted thoughts, feelings, and sensations so that they no longer automati cally try to avoid them but rather learn to accept them for what they are—simply thoughts occurring in the moment rather than a reflection of reality.

behavioral activation treatment

treatment for unipolar depression. This treatment approach focuses intensively on getting patients to become more active and engaged with their environment and with their interpersonal relationships. These techniques include scheduling daily activities and rating pleasure and mastery while engaging in them, exploring alternative behaviors to reach goals, and role-playing to address specific deficits.

interpersonal therapy (IPT)

focuses on current relationship issues, trying to help the person understand and change maladaptive interaction patterns

nonsuicidal self-injury (NSSI)

deliberate destruction of body tissue (often taking the form of cutting or burning one’s own skin) in the absence of any intent to die

depression

the disorder most strongly predictive of which people develop suicidal thoughts