___________________________________________________________________________
DEMOGRAPHIC DETAILS:
Name: xyz
Age: xx
gender :male
address: xyz
Occupation: Unemployed
DIAGNOSIS: BIPOLAR AFFECTIVE DISORDER
There are two types of bipolar disorder: bipolar I characterized by the occurrence of manic
episodes with or without a major depressive episode and bipolar II characterized by at least
one depressive episode with or without a hypomanic episode.
Signs and symptoms of major depressive episode
1. A depressed mood and a loss of interest or pleasure
2. Feeling blue, hopeless, in the dumps, or worthless
3. Trouble sleeping, especially early morning awakening or hypersomnia
4. Decreased appetite and weight loss, or increased appetite and weight gain
5. Inability to concentrate and impairments in thinking
6. Depressed mood most of the day, and nearly every day
7. Psychomotor agitation or retardation
8. Fatigue and decreased energy
9. Feeling worthless with guilt
10. Suicidal and recurrent morbid thoughts
Signs and symptoms of manic episode
1. An elevated, expansive, or irritable mood
2. Increased self-esteem or grandiosity
3. Less need for sleep (2–3 hours)
4. Very talkative and desire to keep talking
5. Racing thoughts
6. Easily distracted and unable to focus
7. Excessive spending and engaging in pleasurable activities (sex and gambling)
8. Severe impairment in occupational and social functioning
Signs and symptoms of hypomanic episode
1. An expansive, elevated, or irritable mood, but of lesser duration than mania
2. Increased self-esteem or grandiosity
3. Less need for sleep
4. Very talkative and desire to keep talking
5. Racing thoughts
6. Easily distracted and unable to focus
7. Excessive spending and engaging in pleasurable activities (sex and gambling)
8. Less severe than mania and with no significant change in daily functioning.
, Epidemiology:
A. Incidence and prevalence. Mood disorders are common. In the most recent surveys,
major depressive disorder has the highest lifetime prevalence (almost 17%) of any psychiatric
disorder. The annual incidence (number of new cases) of a major depressive episode is 1.59%
(women, 1.89%; men, 1.10%). The annual incidence of bipolar illness is less than 1%, but it
is difficult to estimate because milder forms of bipolar disorder are often missed (Tables 11-1
and 11-2).
B. Sex. Major depression is more common in women; bipolar I disorder is equal in women
and men. Manic episodes are more common in women, and depressive episodes are more
common in men.
C. Age. The age of onset for bipolar I disorder is usually about age 30. However, the disorder
also occurs in young children as well as older adults.
D. Sociocultural. Depressive disorders are more common among single and divorced
persons compared to married persons. No correlation with socioeconomic status. No
difference between races or religious groups.
ETIOLOGY
A. Neurotransmitters
1. Serotonin. Serotonin depletion occurs in depression; thus, serotonergic agents are effective
treatments.
2. Norepinephrine. Abnormal levels (usually low) of norepinephrine metabolites (3-
methoxy-4-hydroxyphenylglycol [MHPG]) are found in blood, urine, and CSF of depressed
patients
3. Dopamine. Dopamine activity may be reduced in depression and increased in mania.
B. Psychosocial
1. Psychoanalytic.
2. Psychodynamics.
3. Cognitive.
4. Learned helplessness.
5. Stressful life events.
Laboratory, Brain Imaging, and Psychological Tests
A. Dexamethasone suppression test.
B. Brain imaging.
C. Psychological tests
1. Rating scales. Can be used to assist in diagnosis and assessment of treatment efficacy.
The Beck Depression Inventory (BDI) and Zung Self-rating Scale are scored by patients. The
Hamilton Rating Scale for Depression (HAM-D), Montgomery Asberg
Depression Rating Scale (MADRS), and Young Manic Rating Scale are scored by the
examiner.
2. Rorschach test. Standardized set of 10 inkblots scored by examiner—few associations,
slow response time in depression.
3. Thematic apperception test (TAT). Series of 30 pictures depicting ambiguous situations
and interpersonal events. Patient creates a story about each scene.
Depressives will create depressed stories, maniacs more grandiose and dramatic ones.
DEMOGRAPHIC DETAILS:
Name: xyz
Age: xx
gender :male
address: xyz
Occupation: Unemployed
DIAGNOSIS: BIPOLAR AFFECTIVE DISORDER
There are two types of bipolar disorder: bipolar I characterized by the occurrence of manic
episodes with or without a major depressive episode and bipolar II characterized by at least
one depressive episode with or without a hypomanic episode.
Signs and symptoms of major depressive episode
1. A depressed mood and a loss of interest or pleasure
2. Feeling blue, hopeless, in the dumps, or worthless
3. Trouble sleeping, especially early morning awakening or hypersomnia
4. Decreased appetite and weight loss, or increased appetite and weight gain
5. Inability to concentrate and impairments in thinking
6. Depressed mood most of the day, and nearly every day
7. Psychomotor agitation or retardation
8. Fatigue and decreased energy
9. Feeling worthless with guilt
10. Suicidal and recurrent morbid thoughts
Signs and symptoms of manic episode
1. An elevated, expansive, or irritable mood
2. Increased self-esteem or grandiosity
3. Less need for sleep (2–3 hours)
4. Very talkative and desire to keep talking
5. Racing thoughts
6. Easily distracted and unable to focus
7. Excessive spending and engaging in pleasurable activities (sex and gambling)
8. Severe impairment in occupational and social functioning
Signs and symptoms of hypomanic episode
1. An expansive, elevated, or irritable mood, but of lesser duration than mania
2. Increased self-esteem or grandiosity
3. Less need for sleep
4. Very talkative and desire to keep talking
5. Racing thoughts
6. Easily distracted and unable to focus
7. Excessive spending and engaging in pleasurable activities (sex and gambling)
8. Less severe than mania and with no significant change in daily functioning.
, Epidemiology:
A. Incidence and prevalence. Mood disorders are common. In the most recent surveys,
major depressive disorder has the highest lifetime prevalence (almost 17%) of any psychiatric
disorder. The annual incidence (number of new cases) of a major depressive episode is 1.59%
(women, 1.89%; men, 1.10%). The annual incidence of bipolar illness is less than 1%, but it
is difficult to estimate because milder forms of bipolar disorder are often missed (Tables 11-1
and 11-2).
B. Sex. Major depression is more common in women; bipolar I disorder is equal in women
and men. Manic episodes are more common in women, and depressive episodes are more
common in men.
C. Age. The age of onset for bipolar I disorder is usually about age 30. However, the disorder
also occurs in young children as well as older adults.
D. Sociocultural. Depressive disorders are more common among single and divorced
persons compared to married persons. No correlation with socioeconomic status. No
difference between races or religious groups.
ETIOLOGY
A. Neurotransmitters
1. Serotonin. Serotonin depletion occurs in depression; thus, serotonergic agents are effective
treatments.
2. Norepinephrine. Abnormal levels (usually low) of norepinephrine metabolites (3-
methoxy-4-hydroxyphenylglycol [MHPG]) are found in blood, urine, and CSF of depressed
patients
3. Dopamine. Dopamine activity may be reduced in depression and increased in mania.
B. Psychosocial
1. Psychoanalytic.
2. Psychodynamics.
3. Cognitive.
4. Learned helplessness.
5. Stressful life events.
Laboratory, Brain Imaging, and Psychological Tests
A. Dexamethasone suppression test.
B. Brain imaging.
C. Psychological tests
1. Rating scales. Can be used to assist in diagnosis and assessment of treatment efficacy.
The Beck Depression Inventory (BDI) and Zung Self-rating Scale are scored by patients. The
Hamilton Rating Scale for Depression (HAM-D), Montgomery Asberg
Depression Rating Scale (MADRS), and Young Manic Rating Scale are scored by the
examiner.
2. Rorschach test. Standardized set of 10 inkblots scored by examiner—few associations,
slow response time in depression.
3. Thematic apperception test (TAT). Series of 30 pictures depicting ambiguous situations
and interpersonal events. Patient creates a story about each scene.
Depressives will create depressed stories, maniacs more grandiose and dramatic ones.
