Coding
coding for BP II consist of
1. must have a hx of 1 hypomanic episode but can not have a FULL manic episode
2. I manic episode and 1 depressive episode
3. psychotic sx can only occur in depressive episode, NOT hypomania ( that would be BPI)
4. Severity is captured for severity of sx. NOT hypomania
5. specifiers can not be coded, current or most recent episode was hypomanic or depressed.
ex, Bipolar II disorder most recent episode hypomanic
6. if full criteria for mood episode are not currently met for 2 months use partial remission or full remission.
What are some diagnostic considerations with BP?
sx start before age 18 in 2/3 of pts
GOOD HX and collateral informants are key!
pt typically present during depressive phase and not during mania or hypomania if they are not accompanied by negative consequences
sx are constantly with 2 poles but BPI can be dx without a depression episode
70% of pts are misdiagnosed
Name the Disorder........
Mood changes: over minutes to hours
mood reactivity: depends on life even
Frequency: more common (6-10%
Tx: therapy. medication is NOT HELPFUL
Borderline Personality Disorder
Onset of BPI is _______ than MDD
onset ranges from ____ to ____
most cases _______ teens to ________ adulthood
earlier
5 to 50
late, early
True or False
BPII is more likely to have a seasonal pattern
True
1. pts may develop their own pattern
2. depression likely in the winter, mania in spring /summer
3. enc pts to learn their pattern
All of the following can be considered?
w/ anxious features
w/ mixed features
w/ rapid cycling
w/ melancholic fx
w/ atypical fx
w/catatonia
w/ peripartum onset
w/ seasonal pattern
Additional specifiers of BPI & BPII
poor or short lived ant depressant response despite trials of several antidepressants
multiple Antidepressant failures
rapid response to antidepressants ( mania)
consider reevaluating and changing strategies
Hypothyroidism is most ________ in BP pts and more likely in ________
More associates with BP _______
True or false
Range of TSH is 0.3 -5 and treat over 3
common, females
Bipolar II
True
Peak age for BPI is....
Average age for males? females
90 % will have __________ _______alf of the pts have __________ polarity
20-30
22,21.5 (DSM 4 24.3)
manic episodes
predominate
Name the co-occurring disorders with BP
Suicide risk is higher in those with affective disorder plus use of substance use and anxiety disorders
SUD(ETOH use in males)
Panic
OCD
Anxiety (females)
Eating (females)
can be assoc. or confused with ADHD
if mood changes in hours can be Borderline
Mixed Features were previously referred to as ________ __________
True or False
In Mixed Features, the pt has both manic &depressive sx nearly everyday for a week in rapid sequence or simultaneously.
Mixed State
True
ex. crying during euphoria or laughing while severely depressed.
impairment and fxn should not be d/t medical or drug use.
****** Mixed episodes can only occur in BPI or II
True or False
Bipolar sx are chromic and individuals will have more depression than mania
BPI disorder 32% asxmatic, 52% depressive 6% manic, and 9% mixed
BPII disorder 46% asxmatic, 5o% depressive 2% hypomanic, and 1% mixed
True
True
True
Which labs can be completed to suggest a alternate DX?
CBC-Anemia=fatigue confusion
Metabolic panel-abnormal NA levels=fatigue confusion
TSH levels- thyroid disease=change in mood
Pregnancy test-+HCG=change in mood/psychosis
UA-elevated specific gravity/hematuria= UTI/confusion
UDS-+ for Amphetamines, cocaine, MJ, benzos, PCP, opiates
EKG-prolong QTc, wide QRS. ST elevation or depression (MI)-agitation or confusion
CT of Brain- stroke, tumors, MS, intracranial hemorrhage
Environmental factors Assoc with BP
early emotional trauma
parental psychopathology
family conflict
SUD
Underlying pathology of BP is complexed assoc with ________ & ________ sxms along with _________ & __________ factors
emotional and behavioral
biological and environmental
Rapid cycling (RC) consist of _____ or more episodes of depression, hypomania, or mania in a year.
RC is more common in _________
RC does not respond to _________ and typically need ___________ does,
4 (no set requirement for # of episodes of depression vs mania)
Women
monotherapy, higher
side note 20% of ppl with BP have RC
Adolescent presentation has _______ psychotic features and maybe present with ____________ instead of euphoria during the manic stages
more
irritability
they may have psychotic features as well
Noted difference between Bipolar and ADHD
BP pts are more talkative with pressured speech and more impulsivity, decreased need for sleep opposed to a few hours in the beginning of the night
Which chromosomes are identified
The more _____ degree family members with BP the _______ the risk
AA with BPI are at a ________ risk for being misdiagnosed with schizophrenia
18,21q & 22q
first, higher
increased ( r/t underlying paranoia d/t hx)
Before the focus was on which NTs in regards to BPD?
Current focus is on
The other NTs are_____ ____& ___ are affected
5HT,DA,NE The Amines)
5HT & DA
Glutamate, ACh, GABA
Name the DSM 5 TR dx for with the following sx:
A. numerous periods with hypomanic or sx that do not meet the criteria for hypomanic or depression episode going on for 2 yrs in adults, 1 yr for children and teens
B. Above 2 yr period adults (1 yr for children and teens) Criterion A sx have been present at least 1/2 the time the individual has not been without sx more than 2 months
C. critera for major depression, hypomania, and mania have not been meet
D. SX n Criteraion A can not be better explained by schizoaffective disorder, schizophrenia, schizophreniform, delusional or any other schizophrenia , psychotic spectrum disorder
E. Not assoc. with medical or SUD
F. sx cause clinically significant impairment or distress in social, occupational, or any other important areas of fxning
Cyclothmia Disorder
Mood changes- weeks or months
Mood Activity-independent of live events
Frequency is rare
Treatment: primary medications & therapy
Bipolar
BP is_________ among males and females
Man are more _______ and females more ________ and __________
Marital status is usually ________ & __________ in ________ socioeconomic status
equal
manic, depressive & rapid cycling
Divorced and Single
Stressful life events typically _______ mania
Mania was thought to be an active _________ mechanism to depression
proceed
defense
(a way to handle developmental tragedy such as a death of a parent,
Glutamate & Bipolar describe role
Increased during mania in the DLPC
binds to the NMDA and lingers longer
once over returns to baseline