what is the difference between bi-polar and MDD?
history of manic or hypomanic episodes
what are risk factors for bipolar?
a strong family history for bipolar disorder (up to ten times higher risk), come from wealthier nations than poorer ones, and often seen in association with relationship events or problems
when does bi-polar typically appear?
20s
how does bi-polar present in men?
often presents as mania
how does bi-polar present in women?
after a depressive episode
what are common conditions associated with bi-polar?
migraines, hypothyroidism,, some sti’s
what is mania?
The DSM-5 defines mania as the presence of persistently elevated, expansive, or irritable mood with increased activity for more than 1 week. In addition, at least 3 of the following features must be present, with impaired functioning (4 features are required if mood is only irritable)8:
Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech
Racing thoughts
Distractibility
Excessive involvement in pleasurable, high-risk activities.
what is hypomania?
Hypomania is a less severe condition, in which the abnormally elevated mood is of shorter duration (4–7 days) and meets the other criteria for mania but without significant functional impairment. People may, in fact, be very functional and productive during hypomanic episodes.
what is the most severe form of bipolar?
Bi-polar 1 : is marked by major depression and manic episodes.
what are some medicatiosn that can induce mania?
- antidepressants
- stimulants
- steroids
- Antiparkinsonian or dopaminergic drugs: carbidopa, levodopa, pramipexole
Levothyroxine
Cyclosporine
Antibiotics: ciprofloxacin, gentamicin
Chloroquine
Cancer drugs: fluorouracil, ifosfamide
how to screen for bi-polar?
s specific for bipolar disorder, and like the PHQ-9, it is a patient-reported, short questionnaire that is available free online. The Mood Disorder Questionnaire asks about the symptoms of mania in a yes-no format. The result is positive if all of the following are present:
A “yes” response to 7 of the 13 features
Several features occur simultaneously
The features are a moderate or serious problem.
Unlike most screening instruments, the Mood Disorder Questionnaire is more specific than sensitive. It is 93% specific for bipolar disorder in patients treated for depression in a primary care setting, but only 58% sensitive
when do you refer someone to psychiatry?
Patients suspected of having bipolar disorder or who have been previously diagnosed with it should be referred to a psychiatrist if they have certain features, including:
Bipolar I disorder
Psychotic symptoms
Suicide risk or in danger of harming others
Significantly impaired functioning
Unclear diagnosis.
what is DIGFAST associated with?
Mnemonic: DIGFAST
D = distractibility,
I = impulsivity, irresponsibility,
G = grandiose thoughts,
F = family history positive for bipolar,
A = appetite changes (weight loss) and activity level increases,
S = sleep disturbances, T = talkative.
Diagnostic Criteria for Mania – DSM-5
- A distinct period of abnormally and persistent elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization becomes necessary).
- During the period of mood disturbance and increased energy or activity three or more of the following symptoms must be significantly present and be significantly different from the individual’s normal behaviour:
Inflated self-esteem or grandiosity
Decreased need for sleep (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
Increase in goal-directed activity either socially, at work or sexually or with psychomotor agitation (purposeless non-goal-directed activity)
Excessive involvement in potentially destructive activities like buying sprees, foolish investments, excessive sexual promiscuity, driving recklessly, risk taking, etc. - The mood disturbance is sufficiently severe to cause marked impairment in functioning in most domains OR the impairment is severe enough to require hospitalization to prevent self-harm or harm to others.
- The manic episode is not due to a substance or medication. Treatment of depression in a person with bipolar disorder can cause mania.
At least ONE LIFETIME manic episode is required for a diagnosis of bipolar disorder.
what medications can cause mania?
amphetamines, medication for ADHD in normal individuals, anabolic steroids and levodopa. Antidepressants, especially the tricyclics and MAO inhibitors, can cause/exacerbate a manic episode in those with bipolar disorder or who are predisposed to bipolar disorder.
Diagnostic Criteria for Hypomania – DSM-5
Hypomania criteria are the same as for mania with the following differences:
- must be at least four days in duration.
The symptoms cause much less dysfunction but are still different from the baseline energy level and level of functioning normally present. The changes are evident to others.
There are no psychotic features and hospitalization is never necessary.
what is cyclothymia?
Cyclothymia is another bipolar mood disorder wherein individuals experience episodes of both hypomania and low mood but are NOT severe enough to fit the diagnostic criteria for MDD or mania. The pattern, or cycling, is the important distinguishing feature as well as the effect on function. Cyclothymia has a tendency to run in families.
Diagnostic Criteria for Cyclothymia – DSM-5
- Recurrent episodes of low-level hypomania that do not meet the criteria for hypomania AND recurrent periods of mild depression that do not meet the criteria for MDD AND must occur over a period of two years.
- The low-level hypomania and mild depression must be present for at least half the time and the individual has not been without the symptoms for more than two months at a time.
- MMD, mania, or hypomania criteria have never been met.
- Criteria 1. is not better explained by a schizophrenic or other delusional disorder.
- The symptoms are not attributable to substance use/abuse or medications or another physical condition like hyperthyroidism.
- The symptoms cause significant distress and impairment in functioning in any/all domain(s).
what are features to watch for with cyclothymia?
a positive family history, cycling pattern of over at least two years, and distress and functional impairment.
Cyclothymia can improve over time on its own, become chronic, or worsen into bipolar disorder.
what are key diagnostic points for bipolar 1?
- consists of at least one episode of mania and an episode of MDD or hypomania.
- The manic episode may have been preceded by and may be followed by hypomania or MDD
- The presence of any psychotic features automatically qualifies as Bipolar I, if all other criteria is met, and all physical or substance causes are excluded.
what are key diagnostic points for bipolar 2?
- requires an episode of hypomania and an episode(s) of MDD.
- Bipolar II have significantly higher rates of suicide completion
- Bipolar II individuals are more likely to have anxiety disorders (75%), substance use disorders (37%) and may have up to three different mental health diagnoses (APA, 2013, p.139). The concomitant issues most often exacerbate or exhibit themselves during the hypomanic phases.
A current or preceding hypomanic episode must occur, as well as a past or current depressive episode. Hypomania, and MDD diagnostic criteria are as above.
True or False:
Familial history strongly associated with cyclothymia.
true
One episode of mania followed by hypomania or depression is characteristic of:
Bipolar I Disorder
One hypomanic episode and at least one episode of MDD is characterized by:
Bipolar II Disorder
