Bipolar

Question 1

Define bipolar one disorder

Answer 1

At least one episode mania. Major depressive or hypomanic episodes usually also occur.

Question 2

Define bipolar 2

Answer 2

At least 1 episode hypomania and one depressive episode. No previous mania!

Question 3

Define cyclothymic disorder and conditions for diagnosis (4)

Answer 3

Chronic, fluctuating mood disturbance involving numerous episodes hypomanic episodes and periods MINOR depressive symptoms . “Mild” bp 2. For 2 or more years (1 in children), where the hypomanic and depressive periods present for at least half the time. Individual not without symptoms for more than 2 months.
Don’t meet full criteria for hypomania and mde

Question 4

Define rapid cycling

Answer 4

More than or equal to four depressive/manic episodes in 1 year.

Question 5

Mean age onset of bipolar disorders?

Answer 5

1: 18
2: 20

Question 6

Which 3 hormones are theorised to play a part in bipolar?

Answer 6

1. NorAdrenalin and serotonin mostly (decreased ) esp depression
2. Also dopamine. Increased in mania, decreased in depression.

Question 7

What are the 2 key differences between mania and hypomania?

Answer 7

1 mania for at least 1 week or any duration if hospitalisation required • hypo-mania at least 4 consecutive days but less than week
2. Mania marked impairment, hypomania not as much.

Question 8

Name 7 symptoms of mania. How many need to make diagnosis?

Answer 8

DIG FAST
Distractibility
Impulsivity and indiscretion
Grandiosity
Flight of ideas
Activity increased: sexually/at work/socially. Or psychomotor agitation
Sleep deficit
Talkativeness
Need 3 or more to diagnose.

Question 9

Define manic episode length

Answer 9

1 week

Question 10

Define hypomanic episode length

Answer 10

4 consecutive days to 6 days ( from 1 week-mania)

Question 11

Mania vs hypomania? (4)

Answer 11

• Extreme symptoms (eg psychosis) vs less extreme
• 1 week vs 4 consecutive days
• symptom of bipolar 1 vs 2
• marked impairment in socio - occupational function, often require hospitalisation vs not severe

Question 12

Name 4 presentations that fall under other specified bipolar and related disorder

Answer 12

• Short duration hypomanic episodes (2-3 days) and major depressive episodes
• hypomanic episodes with insufficient symptoms and major depressive episodes
• hypomanic episode without prior major depressive episode
• short duration cyclothymia (<2 years)

Question 13

Define full remission for bipolar

Answer 13

Symptomless > 2 months

Question 14

Name 18 specifiers bipolar

Answer 14

• With anxious distress
• with mixed features
• with rapid cycling
• with melancholic features (NOT bipolar 2)
• with atypical features (NOT bipolar 2)
• with mood-congruent psychotic features
• with mood-incongruent psychotic features
• with Catatonia
• with peripartum onset
• with seasonal pattern
• mild
• moderate
• severe
• in partial remission
• in full remission
• unspecified

Bipolar 2: specify current / most recent episode as hypomanic/ depressed

Question 15

When use specifier “with anxious distress” for bipolar / depression (5)

Answer 15

At least 2:

• feel keyed up or tense
• unusually restless
• difficulty concentrating due to worry
• fear something awful might happen
• feel might lose control

Mild: 2
Moderate: 3
Moderate - severe: 4-5
Severe: 4-5 + motor agitation

Question 16

When use specifier “manic or hypomanic episode, with mixed features “ for bipolar (6)

Answer 16

At least 3:

• dysphoria/depressed
• anhedonia
• psychomotor retardation
• fatigue / energy loss
• feel worthless/guilt
• recent thoughts of death/suicide/ attempt/plan

If symptoms meet full episode criteria for both mania + depression at same time, make this diagnosis,

Question 17

When use specifier “ depressive episode, with mixed features “ for bipolar (6)

Answer 17

Full criteria met for depressive episode and 3 manic/hypomanic symptoms

If meet all criteria mania, diagnose as manic episode with mixed features

Question 18

When use specifier “with melancholic features “ for bipolar /depression (8)

Answer 18

A.at least 1:

• anhedonic,
• lack reactivity to usually pleasurable stimuli

B.at least 3:

• depressed mood: profound despondency, despair, moroseness, empty mood
• depression regularly worse in morning
• early morning awakening
• psychomotor agitation/retardation
• anorexia / weight loss
• guilt

Question 19

When use specifier “with atypical features “ for bipolar depressive episode /depression (6)

Answer 19

A. Mood reactivity: mood brightens in response to positive event
B. 2 or more
- weight gain/appetite increase
- hypersomnia
- leaden paralysis
- long-standing pattern of interpersonal rejection sensitivity

C. Criteria not met for melancholic features or Catatonia

Question 20

Name 7 bipolar and related disorders

Answer 20

• Bipolar 1 disorder
• bipolar 2
• cyclothymic (2 years adult, 1 children)
• ” substance/medication “ induced bipolar and related disorder
• bipolar and related disorder due to “another medical condition “
• other specified bipolar and related disorder, reason
• unspecified bipolar and related disorder

Question 21

Name 8 depressive disorders

Answer 21

• Disruptive mood dysregulation disorder (age 6-10, 3 or more outbursts/ week for 1 year)
• major depressive ( 2 weeks)
• persistent depressive (2 years)
• premenstrual dysphoric disorder (1 - year)
• “substance/medication” induced depressive disorder
• depressive disorder due to “ AMC”
• other specified depressive disorder, reason
• unspecified depressive disorder

Question 22

Name 11 anxiety disorders

Answer 22

• Separation anxiety disorder (children 4 weeks, adults 6 months)
• specific phobia (6 mo)
• selective mutism (1 mo)
• agoraphobia (6 mo)
• social anxiety disorder ( 6 mo)
• panic disorder (1 mo)
• generalised anxiety disorder ( 6 mo)
• ”s/m -I” anxiety disorder
• anxiety disorder due to “AMC”
• other specified anxiety disorder, reason
• unspecified anxiety disorder