7- Bipolar Disorder: Definition, Types and Diagnosis

Source: https://app.lecturio.com/#/lecture/c/7526/59632/33044

Correct answer: B. A mood disorder characterized by episodes of mania, hypomania, and major depression

Explanation:
Bipolar disorder is a mood disorder defined by episodic disturbances of mood, including mania, hypomania, and major depressive episodes. Psychotic symptoms may occur but are not required for diagnosis.

Definition

Which of the following best defines bipolar disorder?

A. A chronic psychotic disorder characterized by hallucinations and delusions
B. A mood disorder characterized by episodes of mania, hypomania, and major depression
C. A personality disorder marked by emotional instability
D. A disorder of circadian rhythm only

Correct answer: C. At least one manic episode

Explanation:
Bipolar I disorder is diagnosed based on the presence of at least one manic episode. Depressive episodes are common but not required.

Bipolar I

Which of the following is required for a diagnosis of bipolar I disorder?

A. At least one hypomanic episode
B. At least one major depressive episode
C. At least one manic episode
D. Rapid cycling over two years

Correct answer: B. It includes hypomania and major depression

Explanation:
Bipolar II disorder requires at least one hypomanic episode and at least one major depressive episode, with no history of manic episodes. It can be highly impairing, often due to severe depression.

Bipolar II

Which statement regarding bipolar II disorder is TRUE?

A. It includes manic episodes
B. It includes hypomania and major depression
C. It is less impairing than bipolar I
D. Psychosis is required for diagnosis

Correct answer: C. A full mood episode with ≥3 symptoms of the opposite pole

Explanation:
DSM-5 defines mixed features as a full manic, hypomanic, or depressive episode accompanied by at least three symptoms of the opposite mood polarity. Full criteria for both episodes simultaneously is not required.

Mixed Features

Which of the following best describes a mixed features specifier in bipolar disorder?

A. Simultaneous full manic and full depressive episodes
B. Rapid switching between mania and depression within hours
C. A full mood episode with ≥3 symptoms of the opposite pole
D. Mood fluctuations lasting less than one week

Correct answer: B. ≥4 mood episodes within 12 months

Explanation:
Rapid cycling is defined as four or more mood episodes (mania, hypomania, or major depression) within a 12-month period.
👉 The two-year criterion applies to cyclothymic disorder, not rapid cycling.

Rapid Cycling (CORRECTION)

Which of the following correctly defines rapid cycling bipolar disorder?

A. Alternating hypomania and depression over two years
B. ≥4 mood episodes within 12 months
C. Continuous mood symptoms without remission
D. Weekly mood changes

Correct answer: C. Subthreshold mood symptoms for ≥2 years

Explanation:
Cyclothymic disorder involves ≥2 years of fluctuating hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes.

Cyclothymic Disorder (Clarification)

Which feature distinguishes cyclothymic disorder from bipolar II disorder?

A. Presence of hypomania
B. Presence of major depressive episodes
C. Subthreshold mood symptoms for ≥2 years
D. Psychotic symptoms

Correct answer: D. 90%

Explanation:
Approximately 90% of patients with a prior manic episode will experience recurrence without treatment, highlighting the importance of maintenance therapy.

Recurrence Risk

What percentage of individuals with a history of one manic episode will experience another manic episode if untreated?

A. 30%
B. 50%
C. 70%
D. 90%

Correct answer: C. Circadian rhythm disruption

Explanation:
Sleep deprivation and circadian rhythm disruption (travel across time zones, night-shift work) are well-known triggers for mania and hypomania.

Sleep and Mania

Which of the following is most likely to trigger a manic episode in a vulnerable individual?

A. Increased carbohydrate intake
B. Hypothyroidism
C. Circadian rhythm disruption
D. Mild dehydration

Correct answer: B. Hyperthyroidism

Explanation:
Hyperthyroidism can mimic mania (insomnia, agitation, pressured speech).
Hypothyroidism is more commonly associated with depressive symptoms.

Medical Differential (CORRECTION)

Which medical condition is most classically associated with manic-like symptoms?

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

Correct answer: C. Antidepressants

Explanation:
Antidepressants, especially without mood stabilizers, can precipitate or unmask manic episodes in individuals with underlying bipolar disorder.

Medications

Which medication is MOST likely to unmask mania in a predisposed individual?

A. Benzodiazepines
B. Antipsychotics
C. Antidepressants
D. Beta blockers

Correct answer: C. Primary care or general medical settings

Explanation:
Patients with bipolar disorder often first present to primary care, usually during depressive episodes or with nonspecific complaints (fatigue, sleep disturbance), rather than directly to psychiatry.

First Point of Contact

Patients with bipolar disorder most commonly first present to which of the following settings?

A. Emergency psychiatry services
B. Inpatient psychiatric wards
C. Primary care or general medical settings
D. Neurology clinics

Correct answer: B. Schizophrenia

Explanation:
Bipolar disorder—especially when psychotic symptoms are present—may be misdiagnosed as schizophrenia, particularly in ethnic minority populations, contributing to delayed or inappropriate treatment.

Underdiagnosis and Misdiagnosis

Bipolar disorder is most commonly misdiagnosed as which of the following, particularly in ethnic minority populations?

A. Major depressive disorder
B. Schizophrenia
C. Borderline personality disorder
D. Generalized anxiety disorder

Correct answer: C. Equal prevalence among men and women

Explanation:
Bipolar disorder affects men and women equally (1:1 ratio). Lifetime prevalence is approximately 1–3%, and onset typically occurs in late adolescence or early adulthood.

Epidemiology

Which of the following best describes the epidemiology of bipolar disorder?

A. Lifetime prevalence <0.5%
B. Female predominance
C. Equal prevalence among men and women
D. Onset typically after age 40

Correct answer: B. 18 years

Explanation:
The mean age of onset for:

• Bipolar I ≈ 18 years

• Bipolar II ≈ 20 years

Early onset is a key distinguishing feature from unipolar depression.

Age of Onset

What is the approximate mean age of onset for bipolar I disorder?

A. 10 years
B. 18 years
C. 30 years
D. 45 years

Correct answer: C. Temporal lobe epilepsy

Explanation:
Temporal lobe epilepsy can present with episodic mood changes, irritability, and behavioral disturbances, making it an important differential diagnosis to rule out.

Neurological Differential Diagnosis

Which neurological condition is MOST associated with mood symptoms mimicking bipolar disorder?

A. Migraine
B. Parkinson disease
C. Temporal lobe epilepsy
D. Peripheral neuropathy

Correct answer: B. Corticosteroids

Explanation:
Corticosteroids are well known to cause mania, hypomania, and psychosis, even in individuals without prior psychiatric illness.

Substance-Induced Bipolar Symptoms

Which of the following medications is MOST likely to induce manic-like symptoms?

A. SSRIs
B. Corticosteroids
C. Benzodiazepines
D. Lithium

Correct answer: B. Levodopa

Explanation:
Levodopa increases dopamine levels and may induce mania or psychosis, particularly in vulnerable individuals.

Dopaminergic Agents

Which medication may mimic or precipitate manic symptoms due to increased dopamine activity?

A. Propranolol
B. Levodopa
C. Valproate
D. Gabapentin

Correct answer: B. B12 deficiency

Explanation:
Vitamin B12 deficiency can cause neuropsychiatric symptoms, including mood changes, irritability, and cognitive impairment, and must be ruled out.

Systemic Medical Conditions

Which systemic condition should be ruled out due to its association with mood disturbances resembling bipolar disorder?

A. Osteoporosis
B. B12 deficiency
C. Peptic ulcer disease
D. Chronic sinusitis