Problem 3: Bipolar Disorder Pt.1
Vignette 1
● Remember that it's one of the most biological disorder= Heritability is high in BP
● Cyclothymia
● Basic facts of prevalence; Etiology risk factors; Treatment & time course
Bipolar and Related Disorders (DSM-V)
General Bipolar Disorder: recurrent chronic disorder characterised by fluctuations in mood state & energy
Knowledge Bipolar can be classified as a mix btw depressive disorder & psychotic disorders (symptomatology, family history &
genetics)
Several types of Bipolar Disorders
1. Unipolar
2. Bipolar I
3. Bipolar II
4. Cyclothymic Disorder
Prevalence: affects more than 1% of the population regardless of ethnicity etc
Bipolar I affects both genders equally; Bipolar II most common in women
Diagnostic BIPOLAR I
Criteria The manic episode may have been preceded by and may be followed by hypomanic/major depressive episodes.
At LEAST 1 lifetime manic episode is required for the diagnosis. Hypomanic episode & MDD common, but not
required for a diagnosis.
● Criteria have been met for at least one manic episode
● Not better explained by other illness (ie schizoaffective)
Mean age of onset:18y; More prevalent in high-income countries
Separated, widowed, divorced have higher rates of Bipolar I
Family history of Bipolar I most consistent risk factor (likely share a genetic origin w/ scz)
Females + likely to experience rapid cycling, dep states, comorbidity w/ eating disorders & alcohol use disorder
● Suicide risk high
MANIC EPISODE
(a) Distinct period of abnormally & persistently elevated, expansive/irritable mood, & abnormally & persistently
increased activity, energy, lasting AT LEAST 1w & present most of the day, nearly everyday.
(b) During the period of mood disturbance & increased energy/activity, 3+ of the following symptoms (4 if the
mood is only irritable) are present to a sig. degree & represent a noticeable change from usual behavior.
I. Inflated Self-Esteem/grandiosity
II. Decreased need for sleep (feels rested after 3h of sleep)
III. More talkative than usual/pressure to keep talking
, IV. Flights of ideas/subjective experiences that thoughts are racing
V. Distractibility
VI. Increased in Goal-Directed Activity (socially, work, sexually) OR Psychomotor Agitation
(purposeless non-goal-directed activity)
VII. Excessive involvement in activities that have a high potential for painful consequences
(unrestrained buying sprees, sexual indiscretions, 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/psychotic features.
(d) The episode is not attributable to the physiological effects of a substance or another medical condition.
*NOTE: Full manic episodes that emerge during antidepressant treatment but persists at a fully syndromal lvl
beyond physiological effects of treatment is sufficient to diagnose BP I.
HYPOMANIC EPISODE
(a) Distinct period of abnormally & persistently elevated, expansive mood & abnormally persistent increased
activity/energy, lasting AT LEAST 4 consecutive days & present most of the day, nearly every day.
(b) During period of mood disturbance & increased energy/activity, 3+ of the following sympts have persisted
I. Inflated Self-Esteem/grandiosity
II. Decreased need for sleep (feels rested after 3h of sleep)
III. More talkative than usual/pressure to keep talking
IV. Flights of ideas/subjective experiences that thoughts are racing
V. Distractibility
VI. Increased in Goal-Directed Activity (socially, work, sexually) OR Psychomotor Agitation
(purposeless non-goal-directed activity)
VII. Excessive involvement in activities that have a high potential for painful consequences
(unrestrained buying sprees, sexual indiscretions, foolish business investments)
(c) Episode assoc w/ unequivocal change in functioning uncharacteristic of the id when not symptomatic.
(d) Disturbance in mood observable to others
(e) Episode is not severe enough to cause marked impairment in social/occupational functioning or to
necessitate hospitalization
* If psychotic features→ Manic
(f) Episode not attributable to physiological effects of a substance
MAJOR DEPRESSIVE EPISODE
(a) 5+ of the following symptoms have been present during the same 2-week period and represent a change
from previous functioning: at least 1 of the symptoms is either depressed mood OR loss of interest/pleasure
I. Depressed mood most of the day, nearly everyday, as indicated by subjective reports (feels sad,
empty) or observation made by others
II. Markedly diminished interest or pleasure in all/almost all activities of the day, nearly everyday
III. Significant weight loss when not dieting or weight gain
, IV. Insomnia or hypersomnia or retardation nearly everyday (observable by others)
V. Psychomotor agitation or retardation nearly everyday (observable by others)
VI. Fatigue
VII. Feelings of worthlessness/excessive inappropriate guilt nearly everyday
VIII. Diminished ability to think/concentrate
IX. Recurrent thoughts of death, suicide attemps
(b) Symptoms cause clinically significant distress of impairment in social, occupation or other areas of
functioning
(c) Episode not attributable to physiological effects of a substance/medical condition
BIPOLAR II
For diagnosis it is necessary to meet the following criteria for a current or past hypomanic episode AND the follow
criteria for a current or past major depressive episode
● Criteria have been met for AT LEAST 1 hypomanic episode AND 1 major depressive episode
● There have never been a manic episode
● Not better explained by schizoaffective disorder, etc
● Causes clinically significant impairments in functioning
Age of onset: mis 20s (slightly later than BP.I)
Most often begins with depressive episode and wait until hypomanic episode comes along
Higher prevalence for lifetime episodes
Rapid cycling pattern leads to poorer prognosis
More common in women
HYPOMANIC EPISODE & MAJOR DEPRESSIVE EPISODE
(Mentioned before)
Cyclothymic Disorder (???)
= Characterized by recurring depressive & hypomanic states, lasting for at least 2 years, that don’t meet diagnostic
threshold for a major affective episode (from carvalho article).
Bipolar disorder (Carvalho, Firth, & Vieta, 2020).
Introduction Main thing separating BP from other affective dis= recurring manic or hypomanic epi alternating w/ dep episodes.
Onset
● Usually around age 20
● Earlier onset: poorer prognosis, longer treatment delays, more severe dep episodes & higher prevalences
of concurrent anxiety & SUD.
Vignette 1
● Remember that it's one of the most biological disorder= Heritability is high in BP
● Cyclothymia
● Basic facts of prevalence; Etiology risk factors; Treatment & time course
Bipolar and Related Disorders (DSM-V)
General Bipolar Disorder: recurrent chronic disorder characterised by fluctuations in mood state & energy
Knowledge Bipolar can be classified as a mix btw depressive disorder & psychotic disorders (symptomatology, family history &
genetics)
Several types of Bipolar Disorders
1. Unipolar
2. Bipolar I
3. Bipolar II
4. Cyclothymic Disorder
Prevalence: affects more than 1% of the population regardless of ethnicity etc
Bipolar I affects both genders equally; Bipolar II most common in women
Diagnostic BIPOLAR I
Criteria The manic episode may have been preceded by and may be followed by hypomanic/major depressive episodes.
At LEAST 1 lifetime manic episode is required for the diagnosis. Hypomanic episode & MDD common, but not
required for a diagnosis.
● Criteria have been met for at least one manic episode
● Not better explained by other illness (ie schizoaffective)
Mean age of onset:18y; More prevalent in high-income countries
Separated, widowed, divorced have higher rates of Bipolar I
Family history of Bipolar I most consistent risk factor (likely share a genetic origin w/ scz)
Females + likely to experience rapid cycling, dep states, comorbidity w/ eating disorders & alcohol use disorder
● Suicide risk high
MANIC EPISODE
(a) Distinct period of abnormally & persistently elevated, expansive/irritable mood, & abnormally & persistently
increased activity, energy, lasting AT LEAST 1w & present most of the day, nearly everyday.
(b) During the period of mood disturbance & increased energy/activity, 3+ of the following symptoms (4 if the
mood is only irritable) are present to a sig. degree & represent a noticeable change from usual behavior.
I. Inflated Self-Esteem/grandiosity
II. Decreased need for sleep (feels rested after 3h of sleep)
III. More talkative than usual/pressure to keep talking
, IV. Flights of ideas/subjective experiences that thoughts are racing
V. Distractibility
VI. Increased in Goal-Directed Activity (socially, work, sexually) OR Psychomotor Agitation
(purposeless non-goal-directed activity)
VII. Excessive involvement in activities that have a high potential for painful consequences
(unrestrained buying sprees, sexual indiscretions, 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/psychotic features.
(d) The episode is not attributable to the physiological effects of a substance or another medical condition.
*NOTE: Full manic episodes that emerge during antidepressant treatment but persists at a fully syndromal lvl
beyond physiological effects of treatment is sufficient to diagnose BP I.
HYPOMANIC EPISODE
(a) Distinct period of abnormally & persistently elevated, expansive mood & abnormally persistent increased
activity/energy, lasting AT LEAST 4 consecutive days & present most of the day, nearly every day.
(b) During period of mood disturbance & increased energy/activity, 3+ of the following sympts have persisted
I. Inflated Self-Esteem/grandiosity
II. Decreased need for sleep (feels rested after 3h of sleep)
III. More talkative than usual/pressure to keep talking
IV. Flights of ideas/subjective experiences that thoughts are racing
V. Distractibility
VI. Increased in Goal-Directed Activity (socially, work, sexually) OR Psychomotor Agitation
(purposeless non-goal-directed activity)
VII. Excessive involvement in activities that have a high potential for painful consequences
(unrestrained buying sprees, sexual indiscretions, foolish business investments)
(c) Episode assoc w/ unequivocal change in functioning uncharacteristic of the id when not symptomatic.
(d) Disturbance in mood observable to others
(e) Episode is not severe enough to cause marked impairment in social/occupational functioning or to
necessitate hospitalization
* If psychotic features→ Manic
(f) Episode not attributable to physiological effects of a substance
MAJOR DEPRESSIVE EPISODE
(a) 5+ of the following symptoms have been present during the same 2-week period and represent a change
from previous functioning: at least 1 of the symptoms is either depressed mood OR loss of interest/pleasure
I. Depressed mood most of the day, nearly everyday, as indicated by subjective reports (feels sad,
empty) or observation made by others
II. Markedly diminished interest or pleasure in all/almost all activities of the day, nearly everyday
III. Significant weight loss when not dieting or weight gain
, IV. Insomnia or hypersomnia or retardation nearly everyday (observable by others)
V. Psychomotor agitation or retardation nearly everyday (observable by others)
VI. Fatigue
VII. Feelings of worthlessness/excessive inappropriate guilt nearly everyday
VIII. Diminished ability to think/concentrate
IX. Recurrent thoughts of death, suicide attemps
(b) Symptoms cause clinically significant distress of impairment in social, occupation or other areas of
functioning
(c) Episode not attributable to physiological effects of a substance/medical condition
BIPOLAR II
For diagnosis it is necessary to meet the following criteria for a current or past hypomanic episode AND the follow
criteria for a current or past major depressive episode
● Criteria have been met for AT LEAST 1 hypomanic episode AND 1 major depressive episode
● There have never been a manic episode
● Not better explained by schizoaffective disorder, etc
● Causes clinically significant impairments in functioning
Age of onset: mis 20s (slightly later than BP.I)
Most often begins with depressive episode and wait until hypomanic episode comes along
Higher prevalence for lifetime episodes
Rapid cycling pattern leads to poorer prognosis
More common in women
HYPOMANIC EPISODE & MAJOR DEPRESSIVE EPISODE
(Mentioned before)
Cyclothymic Disorder (???)
= Characterized by recurring depressive & hypomanic states, lasting for at least 2 years, that don’t meet diagnostic
threshold for a major affective episode (from carvalho article).
Bipolar disorder (Carvalho, Firth, & Vieta, 2020).
Introduction Main thing separating BP from other affective dis= recurring manic or hypomanic epi alternating w/ dep episodes.
Onset
● Usually around age 20
● Earlier onset: poorer prognosis, longer treatment delays, more severe dep episodes & higher prevalences
of concurrent anxiety & SUD.
