Detailed info about bipolar 1 disorder, from DSM-5

1. Bipolar-I
Disorder

2. Story of Caroline
Caroline age 32 is a staff nurse working at Govt.
Medical college, amidst of the pandemic everyone
was having hectic work schedules. She has been
assigned for night duty for weeks. Since the whole
situation was getting worse, the Govt. cant make to
pay the salaries for the nurses on time, poor Caroline
was working too hard to get the salary and to pay her
bills. That incident pushed her through lot of stress.
After few days its been noticed by her husband that
she was waking up so early and doing some religious
rituals which was not so common.

3. Story of Caroline
Not doing the household works she runs to the
hospital early. Her colleagues noticed that she was
talking in very fast manner and taking extra shifts.
She was offering some money and telling to the
patients that she have the contact with god and she
will be treating all patients as she was assigned. She
was jumping from one patient from another when
ever she hears something from them and forgetting
the case which she was on to.”

4. “We’re not crazy or
insane.
We’re just people living
with a condition”

5. Bipolar Disorder
Mood disorder affecting
Thought
Energy level
Behavior
(Manic – Depressive illness)
Person feels extreme mood swings
Mania to Depression
Bipolar – I
Bipolar – II
cyclothymic disorder
Bipolar N O S

7. Diagnostic
Critieria
Manic Episode
A. Distinct period of abnormalities
Elevated, Expansive or Irritable mood
Increased goal directed activity/energy
Lasting at least 1 week
C. Marked impairment in social or occupational
functioning
Necessitate hospitalization to prevent harm to
self or others, or there are psychotic features.
D. Not attributable to physiological effects of a
substance - DSM-5

8. Manic Episode cntd.
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility
6. Increase in goal-directed activity or psychomotor agitation
7. Excessive involvement in activities that have a high potential for
painful consequences
B. Period of mood disturbance and increased energy or activity,
Three (or more) symptoms ,Four if the mood is only irritable
In a significant degree and represent a noticeable change than usual
- DSM-5

9. Diagnostic
Critieria
Hypo Manic Episode
A. Distinct period of abnormalities /mood
disturbance for 4 consecutive days
B. Same criterion as Manic episode
C. Episode associated with an unequivocal
change in functioning
D. Disturbance in mood
E. No marked impairment
F. Not attributable to physiological effects of
substance.
- DSM-5

10. Major Depressive Episode
1. Depressed mood most of the day
2. Diminished interest or pleasure in all, or almost all, activities
3. Significant weight loss or weight gain/decrease or increase in appetite.
4. Insomnia or hypersomnia nearly every day
5. Psychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive or inappropriate guilt
8. Diminished ability to think or concentrate, or indecisiveness
9. Recurrent suicidal ideation, attempt, plan or thoughts.
A. Five (or more) of the following symptoms - 2-week period
At least one of the symptoms is either (1) depressed mood or (2) loss
of interest or pleasure.
- DSM-5

11. Diagnostic Critieria
Major Depressive Episode cntd
B. Distress or impairment in social
functioning
C. Not attributable to physiological
effects of substance
- DSM-5

12. Diagnostic
Criteria
A. Criteria have been met for at least one manic
episode (Criteria A–D under “Manic Episode”)
B. The occurrence of the manic and major
depressive episode(s) is not better explained
by schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional
disorder, or other specified or unspecified
schizophrenia spectrum and other psychotic
disorder.
- DSM-5
Bipolar – I Disorder

13. DIAGNOSTIC FEATURES
• Distinct period of abnormalities or mood disturbance
• Inflated self-esteem
• Grandiose delusion
• Decreased need for sleep
• Speech problems
• Psychomotor agitation
• Mood is euphoric

14. ASSOCIATED FEATURES SUPPORTING DIAGNOSIS
• Denial of treatment
• Anti-social behaviour
• Rapid mood changes
• Harm oneself and others

15. PREVALENCE
12-month prevalence estimate in U.S was 0.6%
Across 11 countries ranged from 0.0% to 0.6%.
Lifetime male-to-female prevalence ratio is approximately 1.1:1
In one U.S. study, 12-month prevalence of bipolar I
disorder was significantly lower for Afro-Caribbeans
than for African Americans or whites.
CULTURE RELATED DIAGNOSTIC ISSUES

16. RISK AND PROGNOSTIC FACTORS
Environmental
• More common in high-income than in low-income countries
(1.4 vs. 0.7%)
• Separated, divorced, or widowed individuals have higher rates
than to individuals who are married or have never been married.
Genetic and physiological
• Family history is one of the strongest and most consistent risk
factors
• Average 10-fold increased risk among adult relatives
• Risk increases with degree of kinship

17. • Onset: 18 years
• Special considerations are necessary to detect the diagnosis in
children
• Onset occurs throughout the life cycle, including first onsets in
the 60s or 70s
• More than 90% of individuals who have a single manic episode
go on to have recurrent mood episodes
• 60% of manic episodes occur immediately before a major
depressive episode
• Specifier “with rapid cycling”- multiple (four or more) mood
episodes (major depressive, manic, or hypomanic) within 1
year
DEVELOPMENT AND COURSE

18. • Women more often have seasonal pattern of mood
disturbance than men
• Women also tend to experience more depressive and
mixed states episodes then do men.
• Higher risk of attempting suicide ,have an eating
disorder or phobia.
• Higher risk of comorbidity
GENDER RELATED DIAGNOSTIC

19. SUICIDE RISK
• The risk of suicide in individuals with bipolar I is
estimated to be at least 15 times
• Past history of suicide attempts
• The rates of attempted suicide in bipolar 2 and bipolar 1
disorder appear to be similar
• The lethality of attempts is lower in individuals with
bipolar 1 disorder compared with bipolar 2 disorder

20. FUNCTIONAL CONSEQUENCE
• Return To fully functional level
• 30% severe impairment work role function
• Lower socio- economic status
• Individuals Perform very poor in cognitive tests
• Cognitive impairments
• Vocational & interpersonal difficulties during euthymic
periods

21. DIFFERENTIAL DIAGNOSIS
• Major depressive disorder
• Other bipolar disorders
• Generalized anxiety disorder, panic disorder,
posttraumatic stress disorder, or other anxiety disorders
• Substance/medication-induced bipolar disorder
• Attention-deficit/hyperactivity disorder
• Personality disorders
• Disorders with prominent irritability

22. COMORBIDITY
• Co-occurring mental disorders
• Frequent anxiety disorders
• ADHD ,disruptive, impulse control ,conduct disorders,
substance use disorder
• High rates of serious or untreated co-occurring medical
conditions
• Metabolic syndrome & migraine
• More than half of individuals have alcohol use disorder
• Those with both disorders are greater risk
for suicide attempt

23. Check on sarah againCheck on Caroline again.

24. CREDITS: This presentation template was created by Slidesgo, including
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THANKS
Do you have any
questions?
Rahul M , MSW, Amrita University