Bipolar Disorder

An Overview of the Diagnosis An Overview of the Diagnosis including Symptoms and Diagnostic including Symptoms and Diagnostic

CriteriaCriteria

Bipolar Disorders Like other psychiatric diagnoses, this category is complex and has Like other psychiatric diagnoses, this category is complex and has

several subsets.several subsets. We will not specifically address all of the subsets, but I will list them We will not specifically address all of the subsets, but I will list them

for you here.for you here. Bipolar I DisorderBipolar I Disorder Single Manic EpisodeSingle Manic Episode Most Recent Episode HypomanicMost Recent Episode Hypomanic Most Recent Episode ManicMost Recent Episode Manic Most Recent Episode MixedMost Recent Episode Mixed Most Recent Episode DepressedMost Recent Episode Depressed Most Recent Episode UnspecifiedMost Recent Episode Unspecified Bipolar II DisorderBipolar II Disorder CyclothymiaCyclothymia Bipolar Disorder NOSBipolar Disorder NOS (not otherwise specified) (not otherwise specified)

Associated Features

Mortality rate due to suicide of 10%-15%Mortality rate due to suicide of 10%-15% Child abuse, spouse abuse, or other violent behavior may Child abuse, spouse abuse, or other violent behavior may

occur during severe Manic Episodesoccur during severe Manic Episodes School truancy, school failure, occupational failure, School truancy, school failure, occupational failure,

divorce, or episodic antisocial behavior. divorce, or episodic antisocial behavior. Rapid and/or persistent speech (hyper-verbal; rumination)Rapid and/or persistent speech (hyper-verbal; rumination) No racial differentiationNo racial differentiation No significant gender differences (unlike Maj. Dep. Dis.)No significant gender differences (unlike Maj. Dep. Dis.) Male first episode is likely to be a Manic EpisodeMale first episode is likely to be a Manic Episode Female first episode likely to be a Maj. Dep. Epi.Female first episode likely to be a Maj. Dep. Epi.

Criteria for a Manic Episode

A distinct period of A distinct period of abnormally and abnormally and persistently elevated, persistently elevated, expansive, or irritable expansive, or irritable mood, lasting at least mood, lasting at least 1 week (or any 1 week (or any duration if duration if hospitalization is hospitalization is necessary)necessary)

During the period of During the period of mood disturbance, mood disturbance, three (or more) of the three (or more) of the following symptoms following symptoms have persisted (four if have persisted (four if the mood is only the mood is only irritable) and have irritable) and have been present to a been present to a significant degree:significant degree:

Criteria cont’d

Inflated self-esteem or Inflated self-esteem or grandiositygrandiosity

Decreased need for sleep (e.g., Decreased need for sleep (e.g., feels rested after only 3 hours feels rested after only 3 hours of sleep)of sleep)

More talkative than usual or More talkative than usual or pressure to keep talkingpressure to keep talking

Flight of ideas or subjective Flight of ideas or subjective experience that thoughts are experience that thoughts are racingracing

Distractibility (i.e., attention too Distractibility (i.e., attention too easily drawn to unimportant or easily drawn to unimportant or irrelevant stimuli.irrelevant stimuli.

Increase in goal-directed Increase in goal-directed activity (either socially, at work activity (either socially, at work or school, or sexually) or or school, or sexually) or psychomotor agitationpsychomotor agitation

Excessive involvement in Excessive involvement in pleasurable activities that have pleasurable activities that have a high potential for painful a high potential for painful consequences (e.g., engaging in consequences (e.g., engaging in unrestrained buying sprees, unrestrained buying sprees, sexual indiscretions, or foolish sexual indiscretions, or foolish business investments)business investments)

Mood disturbance is Mood disturbance is sufficiently severe to cause sufficiently severe to cause marked impairments in life.marked impairments in life.

Course

Recurrent disorder ~ more than 90% of individuals who Recurrent disorder ~ more than 90% of individuals who have a single Manic Episode go on to have future episodes.have a single Manic Episode go on to have future episodes.

60% - 70% of Manic Episodes occur immediately before 60% - 70% of Manic Episodes occur immediately before or after a Major Depressive Episode.or after a Major Depressive Episode.

Majority of individuals return to fully functional state Majority of individuals return to fully functional state between episodes, 20%-30% continue to display mood between episodes, 20%-30% continue to display mood lability.lability.

Medically treated primarily with Lithium.Medically treated primarily with Lithium.