Bipolar disorders Lina Wardam, RN. PNS

Bipolar disorders  Bipolar disorders  Bipolar I disorder  Bipolar II disorder  Cyclothymic disorder  Other bipolar disorders:  Substance/Medication- induced bipolar and related disorders  Bipolar and related disorders related to another medical condition 2

Bipolar I Disorder  The following criteria to be met  Manic episode  Followed by or preceded by any of the following Hypomanic episode (are common in bipolar I but not required for the diagnosis of bipolar disorder) Depressive episode  Note: one manic episode in a life time is required for the diagnosis of bipolar I 11/16/20164

Mania Episode  A.  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) 5

Mania Episode  B.  B. During the period of mood disturbance and increased energy or activity, three or more of the following symptoms (four if the mood is irritable) are present to a significant degree and represent a change from usual behavior  Inflated self esteem or grandiosity.  Decreased need for sleep. Feels rested after only 3 hours of sleep. 11/16/20166

Mania Episode  More talkative than usual or pressure to keep talk.  Flight of ideas or subjective experience that thoughts are racing.  Distractibility, attention too easily drawn to unimportant or irrelevant external stimuli. 7

Mania Episode  Increase in goal directed activity (either socially, at work or school, or sexually) or psychomotor agitation.  Excessive involvement in pleasurable activities which have a high potential for painful consequences, the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments. 8

Mania Episode  C  C. The mood disturbance is severe to cause marked impairment in social and Occupational functioning or to necessitate hospitalization to prevent harm to self or others  D.  D. it is not attributed to the physiological effects of a substance (drugs of abuse, medication or other treatments) or another medical condition 11/16/20169

Hypomania Episodes  A.  A. distinct period of persistently elevated, expansive, or irritable mood, and persistently increased activity or energy, lasting through at least 4 consecutive days, and present most of the day, nearly every day.  B.  B. During mood disturbance, 3 or more of the following occurs (4 if mood irritable) to a significant degree:  Inflated self esteem or grandiosity  Decreased need for sleep 10

Hypomania Episodes  Talkative and pressured thoughts  Flight of ideas or subjective feeling of racing thoughts  Distractibility (attention is easily drawn to unimportant external stimuli) as reported by observer 11/16/201611

Hypomania Episodes  Increase in goal directed activity (either socially, at work or school or sexually) or psychomotor agitation  Excessive involvement in pleasurable activities that have painful consequences (buying sprees, sexual indiscretions, or foolish business investments) 11/16/201612

Hypomania Episodes  C.  C. Episode associated with unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.  D.  D. The disturbance in mood and changes in functioning is observable by others 13

Hypomania Episodes  E.  E. Episode not severe to cause marked impairment in occupational functioning, no need for hospitalization. If there are psychotic features, the episode is mania by definition  F.  F. Exclude physiological changes due to substances (drug abuse, medication or other treatment) 11/16/201614

Major depressive episode  Go back to the previous lecture on major depressive disorder 11/16/201615

Bipolar Disorder  Bipolar I – Combinations of major depression and full manic episode  Bipolar II – Combination of major depression and hypomania (less severe form of mania) 11/16/201616

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Cyclothymia  Alternate periods of hypomania and depressed mood (not major depression ) that persists for at least two years (children 1 year).  The person has not been without the symptoms in criteria A for more than 2 moths during the 2 years  No Major depressive episodes or Manic episodes during the first 2 years  Symptoms in criteria A not accounted for other psychiatric disorders  Exclude substance abuse, medications, or other treatments  Clinically significant impairment in social functioning, occupation, or school 18

Further Classification of mood disorders  Single episode or recurrent of either, mania, depression or hypomania  Mild, moderate, or severe  Partial or full remission 11/16/201619

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