Week 4: Bipolar and Related Disorders

What are the The DSM-5 Bipolar and related disorders?

Bipolar I Disorder 296.4X (F31.9), Bipolar II Disorder 293.89 (F31.81), Cyclothymic Disorder 301.13 (F34.0), Substance/Medication-Induced Bipolar and Related Disorder 292.XX (FXX.XX), Bipolar and Related Disorder Due to Another Medical Condition 293.83 (F06.3X), Other Specified Bipolar and Related Disorder 296.89 (F31.89), Unspecified Bipolar and Related Disorder.

What are Bipolar Disorders?

Begin more acutely than MDD. The presence of mania or hypomania is the key defining feature. The individual tends to experience mania episodes alternating with depressive episodes. At times, the moods alternate so quickly that both the highs and lows can be experienced on the same day. The mood tends to be ‘elevated,’ ‘expansive,’ or ‘irritable.’ We may see initial signs of (Inflated self-esteem, A decreased need for sleep, Pressured speech, Racing thoughts, Distractibility, Hyperactivity or agitation, Excessive involvement in potentially dangerous activity)

What is Mania?

the mood disturbance is severe and causes marked impairment. If we see psychotic features (i.e., delusions, hallucinations, and disorganization) the episode is this

What is hypomania?

We often see the same disturbance, but less severe.

Major Depressive Disorder vs. Bipolar Disorder?

MDD (More women than men, Onset can be at any age and first late-life onset is not uncommon, Can be very influenced by environment. Although we see a genetic risk, it is less strong a predictor than in bipolar). Bipolar (No gender differences, Ave age of onset for bipolar I is 18 and bipolar II is mid-20s, Less affected by environmental factors and more common in high-income countries, Greater genetic risk).

What would we see in bipolar disorder?

The signs and symptoms can develop within just a few hours, but typically emerge over a period of time. In a manic episode a person can go without sleep for several days. An inflated self-esteem (grandiosity), which can also look delusional. Pressured, urgent, rapid speech. Children may seem “goofy.” Racing thoughts and distractibility (Unable to focus). Seems to have boundless energy. Judgment tends to be poor and impulsive (Expensive buying sprees, Promiscuous, Pugnacious)

What is the Familial pattern of bipolar disorder?

We think that bipolar is predominantly biological. A specific part of the brain is affected. The Dopamine – responsible for mood – may have increased transmission of synapses during the manic phase. The increase in dopamine results in a down regulation resulting in decreased dopamine, which leads to depression.Between 30% to 50% of adults with bipolar report traumatic and abusive experiences in childhood.

What is the Prevalence of Bipolar disorder?

Bipolar I: 0.6%. Bipolar II: 0.8%. There is some evidence that bipolar in general has a poorer prognosis than major depressive disorder. 16% of individuals with bipolar disorder recover in contrast to 52% of people who experience multiple relapses and 8 percent commit suicide. Up until the 1980s, the term bipolar II was little known (An important distinction between the two is the degree of impairment and discomfort in intrapersonal and interpersonal (especially occupational) functioning).

What are Variations of Bipolar Disorder?

A first episode may be either depressive or manic. The presenting pattern of bipolar is unpredictable and subsequent episodes remain variable. We should consider bipolar disorders as a spectrum. Individuals can present with a range of symptoms from mild (cyclothymic) to moderate (bipolar II) to more severe (bipolar I)

What is Bipolar I 296.4X (F31.9)?

more severe! Manic and depression

What is mania in bipolar 1 characterized by?

Severe manic episodes accompanied by one or more periods of major depression (with or without psychotic features). The person must show at least 3 symptoms of mania that last for more than 1 week (from the list of 7 symptoms): (Inflated self-esteem, Decreased need for sleep, More talkative than usual/pressured speech, Flight of ideas, Distractibility, Increased goal-directed activity, Excessive involvement in activities that can be risky)

What is depression in bipolar 1 characterized by?

Depressed mood. Loss of interest/anhedonia. Five symptoms are required: (Changes in appetite or sleep, Significantly decreased energy levels, Feelings of worthlessness, Poor concentration, Suicidal thoughts)

What is Bipolar II 293.89 (F31.81)?

Less severe mania and depression

What is mania in bipolar II characterized by?

At least one hypomanic episode lasting approximately 4 days. Also requires 3 of 7 symptoms. We would typically see one hypomanic episode

What is depression in bipolar II characterized by?

One or more depressive episodes. Typically does not lead to psychotic behavior or require hospitalization. We would likely see one or more depressive episodes.

What are Bipolar specifiers: Anxious distress?

Symptoms of anxiety that are not part of the bipolar criteria. The person shows anxiety symptoms that are beyond the diagnostic criteria for bipolar (Feeling wound up, Restlessness, Unable to concentrate due to worry, Feeling a sense of dread, Fear of losing control). Severity is rated as (mild (2 symptoms), moderate (3 symptoms), severe (for or five symptoms with motor agitation)).

What are Bipolar specifiers: Mixed features?

The symptoms of the opposite pole are present. Depression in the manic phase. Increased activity despite depressed mood. Mania/Hypomania in the depressed phase. Retail therapy or promiscuity after a breakup

What are Bipolar specifiers: Rapid cycling?

The person experiences at least four mood episodes (in any combination) within a 1-year period. The person may experience a major depressive episode and then switch to the opposite pole or mania or hypomania, or the person may experience a full remission between episodes.

What are Bipolar specifiers: Melancholic features?

Nearly a complete loss of pleasure in all or almost all activities. Three or more of the following: (Depressed mood – profound despondency, Depression that is worse in the morning, Marked psychomotor agitation or retardation, Significant anorexia or weight loss, Excessively inappropriate guilt feelings). Note that this feels very different from basic depression. We will likely see psychomotor activity and the overall pervasive FEELING of depression.

What are Bipolar specifiers: Atypical features?

The person’s mood seems to brighten during the most recent major depressive episode and two or more of the following are seen: (Weight gain or an increase in appetite, Hypersomnia, Heavy or leaden feeling in the arms or legs, Sensitivity to rejection leading to social or occupational impairment).

What are Bipolar specifiers: Psychotic features?

The person experiences delusions or hallucinations that may be mood-congruent, (Themes of suspiciousness or paranoia, Typical delusions and hallucinations, Grandiosity, Invulnerability). or mood-incongruent (The content of the person’s hallucinations and delusions is inconsistent or a mixture of mood-congruent and mood-incongruent).

What are Bipolar specifiers: Catatonia?

Same as we would see in schizophrenia - marked inflexibility in body position. They can sit there for hours and not be uncomfortable.

What are Bipolar specifiers: Peripartum onset?

Occurrence is during the pregnancy or 4-weeks following delivery

What are Bipolar specifiers: Seasonal pattern?

A pattern that follows changes in seasons for a 2-year period. Seasonal manias but the depression does not occur during a specific time of year (e.g., spring). With this in mind, we may see remission during certain times of the year.

What is the course in bipolar disorder?

Partial remission and remission

What is partial remission?

The symptoms are currently present but do not fully meet criteria, or the person has gone for at least 2 months without any significant symptoms.

What is full remission?

There are no significant signs or symptoms for the past two months.

What is mild severity?

Few symptoms in excess of those required for the diagnosis

What is moderate severity?

The number of symptoms is between mild to severe

What is severe?

Symptoms present are in excess of those needed for a diagnosis, and marked interference in social or other important areas of functioning.

What is Cyclothymic Disorder 301.13 (F34.0)?

Chronic or cyclic mood disturbance that has some of the same features found in major depressive disorder and usually begins in early life. People with this will be in one mood state or the other for years with relatively few periods of neutral mood. The pattern must last for a 2-year period (1 year for children and adolescents), and the individual is not free of symptoms for more than 2 months. Some consider this to be a milder version of bipolar II.

Differential assessment of bipolar?

The symptoms tend to alternate in an irregular fashion lasting for days to weeks. During manic periods, an individual may be enthusiastic and cheerful or at times irritable. During depressive periods, the person may be described as ill humored, peevish, or overly sensitive to slight criticisms.

What is Substance/Medication-Induced Bipolar and Related Disorder 292.XX (FXX.XX)?

This disorder may be or may not be evidence of a depressive mood episode. The disorder is considered when it is clear that the symptoms have occurred during or soon after substance intoxication or withdrawal, or after exposure to a medication. The substance ingested would be listed along with a specifier indicating whether the onset was during intoxication or during withdrawal.

What is Bipolar and Related Disorders Due to Another Medical Condition 293.83 (F06.3X)?

This diagnosis would be used in the manic, hypomanic, or mixed symptoms as a direct pathophysiological result of another medical condition. Typical conditions would be (Cushing’s disease, Hyperthyroidism, Lupus, Multiple Sclerosis, Stroke, Traumatic Brain Injury)

What is Other Specified Bipolar and Related Disorder 296.89 (F31.89)?

Can be used when the symptom picture causes significant distress in social, occupational, or other important areas in a person’s life. But, the person does not meet the full criteria for any of the bipolar and related disorders. The social worker can indicate the reasons why the individual does not meet criteria (Short-duration, Insufficient symptoms, Only one pole appears to have ever been present, Short-duration cyclothymia)

What is Unspecified Bipolar and Related Disorder 296.80 (F31.9)?

This diagnosis refers to the presentation of symptoms of a bipolar disorder that does not meet the full criteria, but distress in social, occupational, or other areas of functioning are present.

What was bipolar formerly known as?

Manic-depressive illness

What are the sxs of the manic type?

hyperactivity, euphoria, distractibility, pressured speech, and grandiosity.

What are the sxs of the depressive type?

deep sadness, apathy, sleep disturbance, poor appetite, lose self-esteem, and slowed thinking.

Why does the DSM provide specifiers?

to better distinguish among the bipolar and related disorders.