CMN 552
Final Exam
Comprehensive Guide
University of South Alabama
, CMN 552 - Comprehensive Final Exam Guide
Module 1 – Mood Disorders
1. Identify symptoms, characteristics, and potential complications of Bipolar Postpartum.
(Page 486- 487??)
“Postpartum psychosis” typically resembles a manic or mixed mood episode with psychotic
symptoms and is strongly associated with bipolar I disorder.
With peripartum onset: This specifier is applied to the current manic, hypomanic, or major
depressive episode in bipolar I disorder (or the most recent manic, hypomanic, or major
depressive episode if bipolar I disorder is currently in partial or full remission) or to the current
hypomanic or major depressive episode in bipolar II disorder (or the most recent hypomanic or
major depressive episode if bipolar II disorder is currently in partial or full remission) if onset of
mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
Note: Mood episodes can have their onset either during pregnancy or postpartum. About 50% of
postpartum major depressive episodes begin prior to delivery. Thus, these episodes are referred
to collectively as peripartum episodes.
Between conception and birth, about 9% of women will experience a major depressive episode.
The best estimate for prevalence of a major depressive episode between birth and 12 months
postpartum is just below 7%.
Peripartum-onset mood episodes can present either with or without psychotic features.
Infanticide (a rare occurrence) is most often associated with postpartum psychotic episodes that
are characterized by command hallucinations to kill the infant or delusions that the infant is
possessed, but psychotic symptoms can also occur in severe postpartum mood episodes without
such specific delusions or hallucinations.
Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur
in from 1 in 500 to 1 in 1,000 deliveries and may be more common in primiparous women. The
risk of postpartum episodes with psychotic features is particularly increased for women with prior
postpartum psychotic mood episodes but is also elevated for those with a prior history of a
depressive or bipolar disorder (especially bipolar I disorder) and those with a family history of
bipolar disorders.
Once a woman has had a postpartum episode with psychotic features, the risk of recurrence
with each subsequent delivery is between 30% and 50%. Postpartum episodes must be
differentiated from delirium occurring in the postpartum period, which is distinguished by a
fluctuating level of awareness or attention.
Peripartum-onset depressive disorders must be distinguished from the much more common
“maternity blues,” or what is known in lay terms as “baby blues.” Maternity blues is not
considered to be a mental disorder and is characterized by sudden changes in mood (e.g., the
sudden onset of tearfulness in the absence of depression) that do not cause functional
impairment and that are likely caused by physiological changes occurring after delivery. It is
temporary and self-limited, typically improving quickly (within a week) without the need for
treatment. Other symptoms of maternity blues include sleep disturbance and even confusion that
can occur shortly after delivery.
Perinatal women may be at higher risk for depressive disorders due to thyroid abnormalities as
well as other medical conditions that can cause depressive symptoms. If the depressive
symptoms are judged to be due to another medical condition related to the perinatal period,
depressive disorder due to another medical condition should be diagnosed instead of a major
depressive episode, with peripartum onset.
,2. What are risk factors for the development of bipolar disorder? (Page 175 purple book)
Genetic loading
Family history of first-order relative having MDD or BP disorder
24% increased risk if relative has BP disorder Type I (see below)
5% increased risk if relative has BP disorder Type II (see below)
25% increased risk if relative has MDD
For BP disorder Type II, similar to MDD
3. Identify common differential diagnosis for bipolar disorder. (Pg 179 purple book)
If first onset of manic symptoms occurs after age 40, most likely symptoms are caused by
another medical condition.
Many medical conditions mimic manic symptoms:
-Endocrine disorders
-Hyperthyroidism
-Intoxication or withdrawal from illicit drug use:
Amphetamines
Cocaine
Hallucinogens
Opiates
Medications:
Captopril
Cimetidine
Corticosteroids
Cyclosporine
Disulfiram
Hydralazine
Isoniazid
Mania can be precipitated by treatment of MDD or other unipolar mood disorders in susceptible
persons.
Antidepressants
ECT
Light therapy
4. Differentiate depressive episodes in bipolar I disorder vs bipolar II disorder. (Pg 177
purple book)
Type I
- Clinical history characterized by occurrence of one or more manic or mixed episodes
Type II
- Clinical history characterized by occurrence of one or more major depressive episodes
accompanied by at least one manic or hypomanic episode
- In a small subset of people with BP disorder, the recurrent shifts in polarity can occur more
frequently—rapid cycling.
~ Occurrence of 4 or more mood episodes during the previous 12 months
~ Mood episodes are either major depressive or manic
~ Other than occurring more frequently, mood episodes are same as nonrapid-cycling
episodes
, ~ 20% of people with BP disorder have rapid cycling.
~ Most rapid cyclers are women (90%).
- Identifying rapid cycling is important.
- Antidepressants may accelerate the cycling.
- Persons with rapid cycling have a poorer prognosis.
5. What are the diagnostic criteria and characteristics of cyclothymia in adolescents. (Pg
468 –69 combined readings exam 1)
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), Criterion A symptoms
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 if: With anxious distress (see pp. 169–170)
The essential feature of cyclothymic disorder is a chronic, fluctuating mood disturbance involving
numerous periods of hypomanic symptoms and periods of depressive symptoms (Criterion A).
The hypomanic symptoms are of insufficient number, severity, pervasiveness, and/or duration to
meet full criteria for a hypomanic episode, and the depressive symptoms are of insufficient
number, severity, pervasiveness, and/or duration to meet full criteria for a major depressive
episode. During the initial 2-year period (1 year for children or adolescents), the symptoms must
be persistent (present more days than not), and any symptom-free intervals last no longer than 2
months (Criterion B). The diagnosis of cyclothymic disorder is made only if the criteria for a major
depressive, manic, or hypomanic episode have never been met (Criterion C).
If an individual with cyclothymic disorder subsequently (i.e., after the initial 2 years in adults or 1
year in children or adolescents) experiences a major depressive, manic, or hypomanic episode,
the diagnosis changes to major depressive disorder, bipolar I disorder, or other specified or
unspecified bipolar and related disorder (subclassified as hypomanic episode without prior major
depressive episode), respectively, and the cyclothymic disorder diagnosis is dropped.
The cyclothymic disorder diagnosis is not made if the pattern of mood swings is better explained
by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or
other specified and unspecified schizophrenia spectrum and other psychotic disorders (Criterion
D), in which case the mood symptoms are considered associated features of the psychotic
disorder. The mood disturbance must also not be attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism) (Criterion E). Although some individuals may function particularly well during
some of the periods of hypomania, over the prolonged course of the disorder, there must be
clinically significant distress or impairment in social, occupational, or other important areas of
Final Exam
Comprehensive Guide
University of South Alabama
, CMN 552 - Comprehensive Final Exam Guide
Module 1 – Mood Disorders
1. Identify symptoms, characteristics, and potential complications of Bipolar Postpartum.
(Page 486- 487??)
“Postpartum psychosis” typically resembles a manic or mixed mood episode with psychotic
symptoms and is strongly associated with bipolar I disorder.
With peripartum onset: This specifier is applied to the current manic, hypomanic, or major
depressive episode in bipolar I disorder (or the most recent manic, hypomanic, or major
depressive episode if bipolar I disorder is currently in partial or full remission) or to the current
hypomanic or major depressive episode in bipolar II disorder (or the most recent hypomanic or
major depressive episode if bipolar II disorder is currently in partial or full remission) if onset of
mood symptoms occurs during pregnancy or in the 4 weeks following delivery.
Note: Mood episodes can have their onset either during pregnancy or postpartum. About 50% of
postpartum major depressive episodes begin prior to delivery. Thus, these episodes are referred
to collectively as peripartum episodes.
Between conception and birth, about 9% of women will experience a major depressive episode.
The best estimate for prevalence of a major depressive episode between birth and 12 months
postpartum is just below 7%.
Peripartum-onset mood episodes can present either with or without psychotic features.
Infanticide (a rare occurrence) is most often associated with postpartum psychotic episodes that
are characterized by command hallucinations to kill the infant or delusions that the infant is
possessed, but psychotic symptoms can also occur in severe postpartum mood episodes without
such specific delusions or hallucinations.
Postpartum mood (major depressive or manic) episodes with psychotic features appear to occur
in from 1 in 500 to 1 in 1,000 deliveries and may be more common in primiparous women. The
risk of postpartum episodes with psychotic features is particularly increased for women with prior
postpartum psychotic mood episodes but is also elevated for those with a prior history of a
depressive or bipolar disorder (especially bipolar I disorder) and those with a family history of
bipolar disorders.
Once a woman has had a postpartum episode with psychotic features, the risk of recurrence
with each subsequent delivery is between 30% and 50%. Postpartum episodes must be
differentiated from delirium occurring in the postpartum period, which is distinguished by a
fluctuating level of awareness or attention.
Peripartum-onset depressive disorders must be distinguished from the much more common
“maternity blues,” or what is known in lay terms as “baby blues.” Maternity blues is not
considered to be a mental disorder and is characterized by sudden changes in mood (e.g., the
sudden onset of tearfulness in the absence of depression) that do not cause functional
impairment and that are likely caused by physiological changes occurring after delivery. It is
temporary and self-limited, typically improving quickly (within a week) without the need for
treatment. Other symptoms of maternity blues include sleep disturbance and even confusion that
can occur shortly after delivery.
Perinatal women may be at higher risk for depressive disorders due to thyroid abnormalities as
well as other medical conditions that can cause depressive symptoms. If the depressive
symptoms are judged to be due to another medical condition related to the perinatal period,
depressive disorder due to another medical condition should be diagnosed instead of a major
depressive episode, with peripartum onset.
,2. What are risk factors for the development of bipolar disorder? (Page 175 purple book)
Genetic loading
Family history of first-order relative having MDD or BP disorder
24% increased risk if relative has BP disorder Type I (see below)
5% increased risk if relative has BP disorder Type II (see below)
25% increased risk if relative has MDD
For BP disorder Type II, similar to MDD
3. Identify common differential diagnosis for bipolar disorder. (Pg 179 purple book)
If first onset of manic symptoms occurs after age 40, most likely symptoms are caused by
another medical condition.
Many medical conditions mimic manic symptoms:
-Endocrine disorders
-Hyperthyroidism
-Intoxication or withdrawal from illicit drug use:
Amphetamines
Cocaine
Hallucinogens
Opiates
Medications:
Captopril
Cimetidine
Corticosteroids
Cyclosporine
Disulfiram
Hydralazine
Isoniazid
Mania can be precipitated by treatment of MDD or other unipolar mood disorders in susceptible
persons.
Antidepressants
ECT
Light therapy
4. Differentiate depressive episodes in bipolar I disorder vs bipolar II disorder. (Pg 177
purple book)
Type I
- Clinical history characterized by occurrence of one or more manic or mixed episodes
Type II
- Clinical history characterized by occurrence of one or more major depressive episodes
accompanied by at least one manic or hypomanic episode
- In a small subset of people with BP disorder, the recurrent shifts in polarity can occur more
frequently—rapid cycling.
~ Occurrence of 4 or more mood episodes during the previous 12 months
~ Mood episodes are either major depressive or manic
~ Other than occurring more frequently, mood episodes are same as nonrapid-cycling
episodes
, ~ 20% of people with BP disorder have rapid cycling.
~ Most rapid cyclers are women (90%).
- Identifying rapid cycling is important.
- Antidepressants may accelerate the cycling.
- Persons with rapid cycling have a poorer prognosis.
5. What are the diagnostic criteria and characteristics of cyclothymia in adolescents. (Pg
468 –69 combined readings exam 1)
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), Criterion A symptoms
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 if: With anxious distress (see pp. 169–170)
The essential feature of cyclothymic disorder is a chronic, fluctuating mood disturbance involving
numerous periods of hypomanic symptoms and periods of depressive symptoms (Criterion A).
The hypomanic symptoms are of insufficient number, severity, pervasiveness, and/or duration to
meet full criteria for a hypomanic episode, and the depressive symptoms are of insufficient
number, severity, pervasiveness, and/or duration to meet full criteria for a major depressive
episode. During the initial 2-year period (1 year for children or adolescents), the symptoms must
be persistent (present more days than not), and any symptom-free intervals last no longer than 2
months (Criterion B). The diagnosis of cyclothymic disorder is made only if the criteria for a major
depressive, manic, or hypomanic episode have never been met (Criterion C).
If an individual with cyclothymic disorder subsequently (i.e., after the initial 2 years in adults or 1
year in children or adolescents) experiences a major depressive, manic, or hypomanic episode,
the diagnosis changes to major depressive disorder, bipolar I disorder, or other specified or
unspecified bipolar and related disorder (subclassified as hypomanic episode without prior major
depressive episode), respectively, and the cyclothymic disorder diagnosis is dropped.
The cyclothymic disorder diagnosis is not made if the pattern of mood swings is better explained
by schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or
other specified and unspecified schizophrenia spectrum and other psychotic disorders (Criterion
D), in which case the mood symptoms are considered associated features of the psychotic
disorder. The mood disturbance must also not be attributable to the physiological effects of a
substance (e.g., a drug of abuse, a medication) or another medical condition (e.g.,
hyperthyroidism) (Criterion E). Although some individuals may function particularly well during
some of the periods of hypomania, over the prolonged course of the disorder, there must be
clinically significant distress or impairment in social, occupational, or other important areas of
