5- Bipolar Disorder: criteria, types, symptoms, and treatment

Source: https://www.youtube.com/watch?v=-TOs6cceTlA

Correct answer: C. Symptoms characteristic of manic and hypomanic episodes

Explanation:
DIG FAST (Distractibility, Impulsivity, Grandiosity, Flight of ideas, Activity, Sleep ↓ need, Talkativeness) describes manic-spectrum symptoms, which occur in mania and hypomania, not depression and not exclusively bipolar I.

Which of the following best describes the DIG FAST mnemonic used to identify manic symptoms?

A. Core symptoms of major depressive disorder
B. Symptoms specific to hypomania only
C. Symptoms characteristic of manic and hypomanic episodes
D. Symptoms exclusive to bipolar I disorder

Correct answer: B. At least 3

Explanation:
DSM-5 requires ≥3 symptoms (or ≥4 if mood is only irritable).
Many teaching resources simplify this to “4 of 7,” but the DSM distinction is important.

According to DSM-5 criteria, how many manic symptoms are required for a manic episode if the mood is elevated or expansive?

A. At least 2
B. At least 3
C. At least 4
D. All 7

Correct answer: D. Bipolar I disorder

Explanation:
This is a manic episode (≥1 week with sufficient symptoms).
Any manic episode = Bipolar I, regardless of depression history.

A patient presents with elevated mood, decreased need for sleep, pressured speech, and grandiosity for 9 days. What is the most accurate diagnosis?

A. Bipolar II disorder
B. Cyclothymic disorder
C. Major depressive disorder
D. Bipolar I disorder

Correct answer: C. Hospitalization for mood symptoms

Explanation:
Hospitalization or psychotic features automatically qualify as mania, fulfilling criteria for bipolar I disorder, regardless of duration.

Which of the following automatically qualifies an episode as a manic episode, even if symptom duration is less than one week?

A. Family history of bipolar disorder
B. Presence of distractibility alone
C. Hospitalization for mood symptoms
D. Symptoms lasting four days

Correct answer: C. Psychotic features

Explanation:
Hypomania never includes psychosis or hospitalization.
If psychosis occurs → diagnosis becomes bipolar I (mania) or schizoaffective disorder.

Which feature distinguishes hypomania from mania?

A. Presence of increased goal-directed activity
B. Elevated mood
C. Psychotic features
D. Decreased need for sleep

Correct answer: B. ≥3 DIG FAST symptoms for ≥4 days

Explanation:
Hypomania = ≥3 DIG FAST symptoms lasting ≥4 days, without psychosis or hospitalization.

What are the diagnostic criteria for a hypomanic episode?

A. ≥4 DIG FAST symptoms for ≥7 days
B. ≥3 DIG FAST symptoms for ≥4 days
C. ≥2 DIG FAST symptoms for ≥2 weeks
D. ≥5 SIGECAPS symptoms for ≥2 weeks

Correct answer: C. Hypomanic episodes with major depressive episodes

Explanation:
Bipolar II requires hypomania + major depressive episodes.
No mania is present.

Which of the following best describes bipolar II disorder?

A. Manic episodes with or without depression
B. Hypomanic episodes without depression
C. Hypomanic episodes with major depressive episodes
D. Alternating hypomania and dysthymia for ≥2 years

Correct answer: C. It involves hypomanic symptoms and depressive symptoms not meeting MDD criteria for ≥2 years

Explanation:
Cyclothymia = ≥2 years of:

• Hypomanic symptoms (not full hypomania)

• Depressive symptoms not meeting MDD criteria

DSM does not strictly define symptom counts, only that MDD criteria are not met.

Which statement about cyclothymic disorder is MOST accurate?

A. It requires at least one manic episode
B. It consists of alternating hypomania and major depression
C. It involves hypomanic symptoms and depressive symptoms not meeting MDD criteria for ≥2 years
D. It lasts at least 6 months

Correct answer: D. SSRIs can precipitate mania

Explanation:
SSRIs alone can overcorrect depression and trigger mania.
They should only be used with a mood stabilizer, if at all.

Why should SSRI monotherapy be avoided in patients with bipolar disorder?

A. SSRIs worsen depressive symptoms
B. SSRIs cause psychosis directly
C. SSRIs can induce rapid cycling only
D. SSRIs can precipitate mania

Correct answer: C. Hyperthyroidism

Explanation:
Hyperthyroidism is a classic cause of secondary mania.
Others include steroids, stimulants, SLE, HIV, neurosyphilis, B12 deficiency, Wilson disease, and Lyme disease.

Which of the following conditions is a known cause of secondary mania?

A. Hypothyroidism
B. Iron deficiency anemia
C. Hyperthyroidism
D. Parkinson disease

Correct answer: C. Major depressive disorder

Explanation:
Depression causes trouble sleeping with fatigue.
Mania causes decreased need for sleep without fatigue—a critical distinction.

A patient sleeps only 2 hours per night and feels exhausted the next day. This sleep pattern most strongly suggests:

A. Mania
B. Hypomania
C. Major depressive disorder
D. Cyclothymia

Correct answer: B. Lamotrigine

Explanation:
Lamotrigine is a mood stabilizer effective for bipolar depression.
SSRIs must never be used alone in bipolar disorder.

Which medication is appropriate for treating bipolar depression?

A. SSRI monotherapy
B. Lamotrigine
C. Amphetamine
D. Benzodiazepine monotherapy

Correct answer: B. 4

Explanation:
When mood is only irritable (not elevated/expansive), DSM-5 requires ≥4 symptoms (instead of ≥3). This is a common exam trick.

Irritable mood nuance (DSM detail)

A patient presents with only irritable mood, decreased need for sleep, distractibility, pressured speech, and increased goal-directed activity for 8 days. How many total symptoms are required to meet criteria for mania?

A. 3
B. 4
C. 5
D. 7

Correct answer: C. Marked functional impairment

Explanation:
Hypomania does not cause marked functional impairment and does not require hospitalization. Mania does.

Hypomania functional impairment

Which feature must be ABSENT in hypomania but may be present in mania?

A. Increased energy
B. Decreased need for sleep
C. Marked functional impairment
D. Increased goal-directed activity

Correct answer: D. Bipolar II disorder

Explanation:
One hypomanic episode + major depression = bipolar II, even if depression dominates the clinical picture.

Bipolar diagnosis despite depression prominence

A patient has multiple severe major depressive episodes and one past episode of hypomania lasting 4 days. What is the correct diagnosis?

A. Major depressive disorder
B. Cyclothymic disorder
C. Bipolar I disorder
D. Bipolar II disorder

Correct answer: C. Duration of symptoms ≥2 years

Explanation:
Cyclothymia requires ≥2 years of fluctuating symptoms that never meet full criteria for hypomania or major depression.

Cyclothymia vs bipolar II time course

Which feature distinguishes cyclothymic disorder from bipolar II disorder?

A. Presence of hypomanic symptoms
B. Alternation between mood states
C. Duration of symptoms ≥2 years
D. Presence of depressive symptoms

Correct answer: C. Bipolar I disorder

Explanation:
Antidepressant-induced mania counts as a manic episode → diagnosis is bipolar I disorder.

Antidepressant-induced mania diagnosis

A patient develops a full manic episode shortly after starting an SSRI, with no prior psychiatric history. How is this episode classified?

A. Substance-induced mood disorder only
B. Major depressive disorder with mixed features
C. Bipolar I disorder
D. Adjustment disorder

Correct answer: D. History of antidepressant-induced mania

Explanation:
A history of antidepressant-induced mania is a classic clue for underlying bipolar disorder.

Bipolar vs unipolar depression clue

Which clinical feature most strongly suggests bipolar depression rather than unipolar depression?

A. Early morning awakening
B. Psychomotor retardation
C. Hypersomnia with normal energy
D. History of antidepressant-induced mania

Correct answer: C. Major depressive disorder with mixed features

Explanation:
Mixed features = depressive episode with manic symptoms, without meeting full criteria for mania or hypomania.

Mixed features (often tested subtly)

A patient meets full criteria for a major depressive episode but also has pressured speech and decreased need for sleep. This presentation is best described as:

A. Hypomania
B. Bipolar II disorder
C. Major depressive disorder with mixed features
D. Cyclothymia

Correct answer: C. Mood stabilizers

Explanation:
Mood stabilizers (lithium, anticonvulsants, atypical antipsychotics) are the backbone of acute and maintenance treatment.

Mood stabilizers vs antidepressants

Which medication class is most appropriate as first-line maintenance therapy across bipolar spectrum disorders?

A. SSRIs
B. Benzodiazepines
C. Mood stabilizers
D. Stimulants