Bipolar and Related Disorders - Lesson 15 PDF

**[Lesson 15]** **[Bipolar and Related Disorders ]** **[Topic 70-76]** **[Topic 70: Bipolar Disorders]** **According to DSM 5, Bipolar disorders are a group of disorders that cause extreme fluctuation in a person's mood, energy, and ability to function. Such conditions feature extreme shifts in...

**[Lesson 15]** **[Bipolar and Related Disorders ]** **[Topic 70-76]** **[Topic 70: Bipolar Disorders]** **According to DSM 5, Bipolar disorders are a group of disorders that cause extreme fluctuation in a person's mood, energy, and ability to function. Such conditions feature extreme shifts in mood and fluctuations in energy and activity levels. Previously known as manic depressive disorder, it has been termed as Bipolar and Related Disorders in DSM 5.** **Bipolar disorder is a category that includes three different conditions:** 1. **Bipolar I disorder** 2. **Bipolar II disorder** 3. **Cyclothymic disorder** **If any of these disorders are left untreated, it can adversely affect relationships, undermine career prospects, and has serious effect on academic performance. Moreover, in some cases, it can lead to suicide. Diagnosis of these disorders most commonly occurs between the ages of 15 and 25 years, but it can happen at any age. It affects males and females equally.** In bipolar disorders, we have to know about three types of episodes: - Manic Episode - Hypomanic Episode - Depressive Episode **Manic Episode** As opposed to depression, mania is the other pole of mood. A manic episode is not a disorder in and of itself, but rather is diagnosed as a part of a condition called bipolar disorder. Individuals in a state of mania typically experience dramatic and inappropriate rises in mood. The symptoms of mania span the same areas of functioning i.e. emotional, motivational, behavioral, cognitive, and physical as those of depression, but mania affects those areas in an opposite way. A person experiencing a manic episode is usually engaged in significant goal-directed activity beyond their normal activities. **Distinctive Features** - The manic episode may have been preceded by and may be followed by hypomanic or major depressive episodes. - A distinct period of abnormally and persistently elevated, expansive, or irritable mood - Abnormally and persistently increased activity or energy **Duration**: Duration of the manic episode to be diagnosed must be 1 week and present most of the day, nearly every day. **[Topic 71: *Diagnostic Criteria* of Manic Episode]** According to DSM-5, it is necessary to meet the following criteria for a manic episode. A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary). B. During the period of mood disturbance and increased energy or activity, three (or more) of the following symptoms (four if the mood is only irritable) are present to a sig­nificant degree and represent a noticeable change from usual behavior: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation (i.e. purposeless non-goal-directed activity). 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). C. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. D. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment) or to another medical condition. **[Topic 72: Hypomanic Episode]** Hypo- comes from the Greek for "under"; hypomania is "under", less extreme than, mania. Although mania involves significant impairment, hypomania does not. Rather, hypomania involves a change in functioning that does not cause serious problems. The person with hypomania may feel more social, flirtatious, energized, and productive. It is a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy **Duration:** Duration of the manic episode to be diagnosed must at least 4 consecutive days and present most of the day, nearly every day. **Diagnostic Criteria** A. 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: 1. Inflated self-esteem or grandiosity. 2. Decreased need for sleep (e.g., feels rested after only 3 hours of sleep). 3. More talkative than usual or pressure to keep talking. 4. Flight of ideas or subjective experience that thoughts are racing. 5. Distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli), as reported or observed. 6. Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation. 7. Excessive involvement in activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments). B. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic. C. The disturbance in mood and the change in functioning are observable by others. D. 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. E. The episode is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication, other treatment). **[Topic 73: Bipolar I Disorder]** **Bipolar I disorder is a manic-depressive disorder that can exist both with and without psychotic episodes.** A person affected by bipolar I disorder has had at least one manic episode in his or her life. Most people with bipolar I disorder also suffer from episodes of depression. Often, there is a pattern of cycling between mania and depression. In between episodes of mania and depression, many people with bipolar I disorder can live normal lives. Following is the diagnostic criteria of Bipolar I disorder according to DSM-5: A. Criteria have been met for at least one manic episode B. The occurrence of the manic and major depressive episode(s) is not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional dis­ order, or other specified or unspecified schizophrenia spectrum and other psychotic **Severity:** We need to specify the current severity of the disorder on the following: - Mild - Moderate - Severe **Specify:** While diagnosing bipolar disorder we need to specify if it is: - Unspecified - with psychotic features - With anxious distress - With mixed features - With rapid cycling - With melancholic features - With mood-congruent psychotic features - With mood-incongruent psychotic features - With catatonia - With péri-partum onset - With seasonal pattern **[Topic 74: Bipolar II Disorder]** **Bipolar II disorder is characterized by cycles of depressive episodes followed by hypomanic periods. Bipolar II symptoms are very much similar with Bipolar I disorder but, in bipolar II, elevated moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania.** **Diagnostic Criteria:** **Following is the diagnostic criteria of Bipolar II disorder:** - Criteria have been met for at least one hypomanic episode and at least one major depressive episode - There has never been a manic episode. - The symptoms are not better explained by psychotic disorder or any other medical condition - The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. **Specify:** We need to specify current or most recent episode as per the following phases: - Hypomanic - Depressed It is also needed to be specified it is: - **With anxious distress** - **With mixed features** - **With rapid cycling** - **With mood-congruent psychotic features** - **With mood-incongruent psychotic features** - **With catatonia** - **With péri-partum onset** - **With seasonal pattern** **We also need to specify if the course if full criteria for a mood episode are not currently met:** - **In partial remission** - **In full remission** We need to specify the current severity of the disorder on the following: - Mild - Moderate - Severe **[Topic 75: Cyclothymic Disorder]** **Cyclothymic disorder is a cyclic disorder that causes brief episodes of hypomania and depression. It is diagnosed when symptoms are not sufficient to be a major depressive episode or a hypomanic episode.** **Following is the diagnostic criteria of Cyclothymic Disorder as per DSM 5:** A. **For at least 2 years (at least 1 year in children and adolescents) there have been numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode.** B. **During the above 2-year period (1 year in children and adolescents), the hypomanic and depressive periods have been present for at least half the time and the individual has not been without the symptoms for more than 2 months at a time.** C. **Criteria for a major depressive, manic, or hypomanic episode have never been met.** D. **The symptoms in Criterion A are not better explained by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified schizophrenia spectrum and other psychotic disorder.** E. **The symptoms are not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).** F. **The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.** **Specify:** **While diagnosing, it needs to be specified if it is:** - **With anxious distress** - **Substance/medication induced** **[Topic 76: Substance/Medication Induced Bipolar Disorder]** **These disorders are classified as** mania, hypomania or a major depressive episode directly caused by a substance/medication. The symptoms must start during or soon after the substance/medication was taken, or during withdrawal. **Following is the diagnostic criteria of Cyclothymic Disorder as per DSM 5:** A. **A prominent and persistent disturbance in mood that predominates in the clinical picture and is characterized by elevated, expansive, or irritable mood, with or without depressed mood, or markedly diminished interest or pleasure in all, or almost all, activities.** B. **There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):** 1. **The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication.** 2. **The involved substance/medication is capable of producing the symptoms in Criterion A.** C. **The disturbance is not better explained by a bipolar or related disorder that is not substance/medication-induced. Such evidence of an independent bipolar or related disor­der could include the following:** - **The symptoms precede the onset of the substance/medication use; the symptoms persist for a substantial period of time (e.g., about 1 month) after the cessation of acute withdrawal or severe intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced bipolar and related disorder (e.g., a history of recurrent non-substance/medication-related episodes).** D. **The disturbance does not occur exclusively during the course of a delirium.** E. **The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.** **Specify:** **We need to specify the current severity of the disorder on the following parameters:** - **With use disorder, mild** - **With use disorder, moderate** - **With use disorder, severe** **It also needs to be specified if:** - **With onset during intoxication** - **With onset during withdrawal**