Bipolar disorders Lina Wardam RN PNS 2 Bipolar

Bipolar disorders Lina Wardam, RN. PNS

2 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

4 9/10/2020 Bipolar I Disorder The following criteria to be met Manic episode Followed by or preceded by any of the following ü 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

5 Mania 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)

6 9/10/2020 Mania Episode 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 Ø Inflated self esteem or grandiosity. Ø Decreased need for sleep. Feels rested after only 3 hours of sleep.

7 Mania Episode Ø Ø Ø 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.

8 Mania Episode Ø Ø 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.

9 9/10/2020 Mania Episode 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. it is not attributed to the physiological effects of a substance (drugs of abuse, medication or other treatments) or another medical condition

10 Hypomania Episodes 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. 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

11 9/10/2020 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

12 9/10/2020 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)

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

14 9/10/2020 Hypomania Episodes 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. Exclude physiological changes due to substances (drug abuse, medication or other treatment)

15 9/10/2020 Major depressive episode Go back to the previous lecture on major depressive disorder

16 9/10/2020 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)

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18 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

19 9/10/2020 Further Classification of mood disorders Single episode or recurrent of either, mania, depression or hypomania Mild, moderate, or severe Partial or full remission

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