BP overview
The DSM 5 TR bipolar and related disorders are......
Bipolar I/ II & Cyclothymic Disorder (most common)
Substance/Medication induced Bipolar
Bipolar and related disorder d/t another medical condition
other specified bipolar and related disorders
unspecified bipolar and related disorders
Hypomanic (partial) episode last at least ______ consecutive days sxms present most of the day, nearly every day.
Sxms ARE or ARE NOT severe enough to cause impairment in social or occupation settings.
4
ARE NOT
Name the Dx......
hx of 1 or more FULL manic episodes and perhaps a major depressive disorder
Bipolar I
**** do not need to have a hx of a major depressive episode
manic sxm are a direct consequences from a medical condition
Give examples
Bipolar related Disorder d/t medical Condition
-Graves Disease-Hyperthyroidism
Cushing's Disease- too much cortisol in body
MS
Stroke
TBI
anti NMDA receptor encephalitis
BPI dx requires
meeting at least one of the manic episodes
which is not better explained by schizoaffective or superimposed by on schizophrenia, schizophrenia disorder, delusional disorder or unspecified schizophrenia spectrum or other psychotic disorder
How is Unipolar Depression is different from bipolar
Bipolar was previously called
If you teat someone with bipolar antidepressants may send them into
hx of mania or hypomania (2 ples
Manic Depression
Mania
True or False:
Psychotic feature ARE NOT present with hypomania
True
Name the Dx......
Hx of one or more episodes of hypomania and at least one major depressive disorder
BP II
Name the DX.......
Sx characteristics of BP noted, but full criteria is not met
***** do not cause an impairment in the important areas of fxning
other Specified BP related Disorders
BPII DX per DSM 5 TRM must meet criteria for current or past episode of hypomanic episode and following criteria for major depressive episode
Hypomania
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least four consecutive days and present most of the day, nearly every day.
B, During the period of mood disturbance and increased energy and activity, three (or more) of the following symptoms (four if the mood is only irritable) have persisted, represent a noticeable change from usual behavior, and have been present to a significant degree:
Inflated self-esteem or grandiosity.
Decreased need for sleep (eg, feels rested after only three hours of sleep).
More talkative than usual or pressure to keep talking.
Flight of ideas or subjective experience that thoughts are racing.
Distractibility (ie, attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed.
Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation.
Excessive involvement in activities that have high potential for painful consequences (eg, engaging in unrestrained buying sprees, sexual indiscretions, or foolish business i investments).
C. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic.
D. The disturbance in mood and the change in functioning are observable by others.
E. The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.
F. The episode is not attributable to the physiological effects of a substance (eg, a drug of abuse, a medication, or other treatment).
NOTE: A full hypomanic episode that emerges during antidepressant treatment (eg, medication, electroconvulsive therapy) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a hypomanic episode diagnosis. However, caution is indicated so that one or two symptoms (particularly increased irritability, edginess, or agitation following antidepressant use) are not taken as sufficient for a diagnosis of a hypomanic episode, nor necessarily indicative of a bipolar diathesis.
Cyclothymia is dx in individual who have hx of depression & mania for at least _____ years and children________ year
but sxms have been insufficient to meet the diagnostic criteria for mania, hypomania, or depression
2, 1
Hospitalization or psychotic sxms unless depressed equals _______ _________
manic episode
The difference between BP I & II is.....
BP II they NEED to have a major depressive episode
Name the Dx.......
similar to other specified dx clinician elects NOT TO specify reason for criteria is not met for specific BP disorder or in situations of insufficient information
What type setting would this DX be appropriate for?
Unspecified BP and related Disorders
Emergency room or Unit Consultation
When determining severity, the decision is based on ________ or most recent sxm episode
current
________ is described as an abnormally, persistently elevated expansive or irritable mood which can be a full or partial episode
Mania
Individuals with BPI may have a manic or hypomanic episodes, as long as they meet the criteria at least _________
once
Name the Dx......
Hx of at least 2 yrs of frequent occurring hypomanic episodes PLUS depressive sxms that are not severe enough to meet the criteria for a full episode of mania, hypomania, or major depression disorder
Cyclothymia
A major Depressive episode is?
Criterion A 1-9 characteristics
2 or more the the sxms have to be present in the same 2 week period and represent a change from previous fxn
& at least one or more sx Depressed mood or loss of interest or pleasure (PHQ)
A. 1 depressed mod most of the day nearly every day(subjective sad, empty ,hopeless) objective: tearful *** teens or children may be irritable
2. decreased pleasure or interest all most all day nearly every day(subjective or observed)
3. wt. loss/ gain 5% or more of body mass in a month. increase or decreed in appetite nearly everyday*** children unable to make wt
4. insomnia or hypersomnia nearly everyday
5 Psychomotor agitation or retardation nearly everyday (Objective-seen by others not subjective of moving slow or feeling restlessness
6 fatigue or loss of energy everyday
7 feeling of worthlessness, excessive inappropriate guilt (could be delusional) everyday
8 decreased ability to think, concentrate, indecisiveness nearly everyday (subjective or objective
9 recent thoughts of death (nit fear of dying) suicidal ideations with out a plan, or an attempt or specific plan
_______ & ________ are only used when pt is symptomatic not when in remission
Severity & Psychosis
Manic episode lasts ______ week with sxms present most of the day, nearly everyday unless sx require hospitalization
one week
Sms shared by mania nd hypomania are
inflated self esteem-grandiose
decreased need for sleep
more talkative than usual
flight of ideas
Distractibility
increased goal directed behavior
over involvement in activities with a high potential for painful consequences
disturbance in mood that predominates the clinical picture with characteristics of abnormal elevated, expansive or irritable mood and abnormal energy.
these sxms started with intoxication or withdrawal from a substances that can cause these sxms
Substance/Medication induced Bipolar
A major Depressive episode is?
Criterion B and C characteristics
B. sx cause clinically distress or impairment of social, occupational, or other important areas of functioning
C. Episode is not attributed to SUD or medical condition
Describe severity of BP I
Mild: minimum manic/depressed sx, in excess to make a dx . sx are manageable
Moderate: Increase in activity or impaired judgement. the number of sx and their intensity are between mild and severe.
Severe: continual supervision is required to prevent physical harm to self or others. the # of sxms are in excess of what is required to make the dx and are distressing & unmanageable. functionality is impaired.
w/ psychotic features: delusions or hallucinations are present during the manic or depressed mood.
Congruent: context of psychotic sx are consistent with manic or depressed mood
incongruent: context of psychotic sx does not involve the themes present in the sx