Mood disorders, Bipolar disorder 1 & 2, DSM -5, APA -2013, development & course, Diagnostic criteria, features, Prevelance, interventions, medications,

1. BIPOLAR
DISORDERS I
& II
Vinutha Suresh
University of madras
2nd year M.SC Psychology
May 24, 2021

2. OBJECTIVE
• To understand bipolar disorders, I & II (DSM – 5)
• diagnostic criteria
• diagnostic features
• development & course
• prevalence
• interventions

3. INTRODUCTION TO BIPOLAR
• manic/ hypomanic episodes preceded or followed by
periods of depression
• manic – elevated, euphoric, expansive mood/ outbursts
of irritability/ violence
• moods persists for more than a week
• 2 or 3 additional symptoms in the same period
• significant impairment of occupational and social
functioning/ hospitalization

4. BIPOLAR I DIAGNOSTIC
CRITERIA
• criteria has been met for at least one lifetime
manic episode (fully blown)
• manic episode must be preceded or followed by
hypomanic or major depressive episode
• criteria for hypomanic/ major depressive mood
must be met
• specific criteria must be met for a current/past
hypomanic episode and current/past major
depressive episode
• the occurrence of manic/ major depressive
episodes not better explained by schizoaffective
disorder, schizophrenia, schizophreniform
disorder, delusional disorder,..

5. MANIC EPISODE (CRITERIA A)
• distinct period of abnormally and persistently elevated,
expansive, or irritable mood •
• increased energy or activity •
• lasting at least 1 week and present most of the day,
• nearly every day

6. CRITERIA B
• 3 or more of the following (4 if mood is only irritable):
• • inflated self-esteem or grandiosity
• • decreased need for sleep
• • more talkative than usual
• • flight of ideas, racing thoughts
• • distractibility
• • increase in goal-directed activity
• • excessive involvement in risk taking activities
• • spending sprees • sexual indiscretions of the following

7. CRITERIA C & D
• mood disturbance is severe to cause marked impairment
in social/occupational functioning or requires
hospitalization to prevent harm to self or others
• the episode is not attributable to the physiological
effects of a substance or another medical condition

8. HYPOMANIC EPISODE
CRITERIA A
• a distinct period of abnormally and
persistently elevated, expansive, or
irritable mood
• abnormally and persistently
increased activity or energy
• lasting at least 4 consecutive days
and present most of the day, nearly
every day

9. CRITERIA B
• 3 or more of the following (4 if mood is only irritable):
• inflated self-esteem or grandiosity
• decreased need for sleep
• more talkative than usual • flight of ideas & racing
thoughts
• distractibility
• increase in goal-directed activity
• excessive involvement in risk taking activities
• spending sprees • sexual indiscretions

10. • episode associated with change in functioning •
• disturbance in mood/change in functioning observed
by others
• not severe enough to cause impairment in
social/occupational functioning
• not requiring hospitalization
• not attributable to the physiological effects of a
substance
CRITERIA C, D, E & F

11. MAJOR DEPRESSIVE DISORDER
CRITERIA A
• 5 or more of the following symptoms
during the same 2- week period and
represent change from prior functioning: •
at least 1 symptom must be
(1) depressed mood or (2) loss of
interest/pleasure
• depressed mood most of the day, nearly
every day per subjective report or
observation
• diminished interest, pleasure in all, or
most, activities

12. CRITERIA A - CONTD.
• insomnia or hypersomnia
• psychomotor agitation
• fatigue or loss of energy
• feelings of worthlessness or excessive/
inappropriate guilt (may be delusional)
nearly everyday
• diminished ability to think/concentrate
or indecisiveness
• recurrent thoughts of death, suicidal
ideation

13. CRITERIA B, C
• symptoms cause clinically significant distress/impairment in
social, occupational functioning
• not attributable to the physiological effects of a substance or
another medication
Criteria A to C constitute major depressive disorder those are
common in bipolar I but not required for diagnosis

14. DIAGNOSTIC FEATURES
manic episode:
• euphoric: “feeling on top of the world”
• increased activity • irritable
• grandiose delusions
• decreased need for sleep
• rapid, pressured speech
• racing thoughts
• distractibility
• marked impairment in social/occupational
function
• rapidly shifting mood to anger or depression
specifiers:
• with anxious distress
• with mixed features
• with rapid cycling
• with melancholic features
• with atypical features
• with mood-congruent psychotic features
• with mood-incongruent psychotic
features
• with catatonia
• with peripartum onset • with seasonal
pattern

15. DEVELOPMENT & COURSE
• mean age of onset: 18 years (first manic, hypomanic, major depressive episode)
• onset may occur throughout the life cycle (even in 60s 70s)
• manic symptoms later in life may indicate medical conditions (substance)
• > 90% of individuals who have 1 episode experience recurrent
• approx. 60% of manic episodes occur immediately before a major depressive
episode
• “rapid cycling” occurs when individuals experience 4 or more mood episodes in
1 year

16. BIPOLAR II DIAGNOSTIC CRITERIA
• one hypomanic and at least one major depressive episode
• never experienced a fully blown manic (or mixed)
episodes
• Experienced clear-cut hypomanic and major depressive
episodes
• the occurrence of hypomanic/ major depressive episodes
not better explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder, delusional
disorder,..

17. HYPOMANIC EPISODE
CRITERIA A
• a distinct period of abnormally and
persistently elevated, expansive, or
irritable mood
• abnormally and persistently increased
activity or energy
• lasting at least 4 consecutive days
and present most of the day, nearly
every day

18. CRITERIA B
• 3 or more of the following (4 if mood is only irritable):
• inflated self-esteem or grandiosity
• decreased need for sleep (usually feel rested after 3 hours of
sleep)
• more talkative than usual / pressure to talk
• flight of ideas/ racing thoughts
• distractibility
• increase in goal-directed activity (@ social, work, school,
sexual)
• excessive involvement in risk taking activities

19. CRITERIA C, D, E & F
C - episode associated with change in functioning
uncharacteristic when asymptomatic
D - disturbance in mood and change in functioning
observed by others
E - not severe enough to cause impairment in
social/occupational functioning
not requiring hospitalization
F - not attributable to the physiological effects of a
substance

20. MAJOR DEPRESSIVE DISORDER
CRITERIA A
• 5 or more of the following symptoms during the same 2- week
period and represent change from prior functioning: at least 1 of
the symptoms must be
• (1) depressed mood or (2) loss of interest/pleasure
• depressed mood most of the day, nearly every day per
subjective report or observation
• diminished interest, pleasure in all, or most, activities
• significant weight-loss or weight-gain
• insomnia or hypersomnia
• psychomotor agitation
• fatigue or loss of energy

21. CRITERIA A – CONTD.
• feelings of worthlessness
• diminished ability to think/concentrate
• recurrent thoughts of death, suicidal ideation
B • symptoms cause clinically significant distress/impairment in social,
occupational functioning
C • the episode not attributable to the physiological effects of a substance or
another medication
Criteria A-C above constitute a major depressive episode

22. DEVELOPMENT & COURSE
• can begin in late adolescence
• average age of onset in mid-20s
• slightly later than bipolar I
• most often begins with depressive episode and not recognized until
hypomanic episode occurs
• may be preceded by anxiety, substance use, or eating disorders
• lifetime episodes of hypomanic and depressive episodes greater than
in bipolar I

23. DIAGNOSTIC FEATURES
• • recurring mood episodes:
• • 1 or more major depressive episodes
• • episode lasting at least 2 weeks
• • at least 1 hypomanic episode
• • episode lasting at least 4 days
• • during episode(s), required number of
symptoms must be present most of the day,
nearly every day
• • a manic episode precludes the diagnosis
of bipolar II
• • individuals typically present for treatment
during major depressive episode
• specify current or most recent episode:
• • hypomanic
• • depressed
• • with anxious distress
• • with mixed features
• • with rapid cycling
• • with mood-congruent psychotic
features
• • with mood-incongruent psychotic
features
• • with catatonia
• • with peripartum onset • with
seasonal pattern
SPECIFIERS AND SEVERITY

24. FUNCTIONAL CONSEQUENCES
BIPOLAR I
• approx. 30% of individuals experience severe impairment in work role function
• functional recovery may be slow • cognitive impairments may occur
• BIPOLAR II
most individuals return to fully functional state between episodes • 15% may
continue to have some inter-episode dysfunction • 20% transition directly into
another mood episode without inter-episode recovery • functional recovery may
be slow • cognitive impairments may occur

25. RISK & PROGNOSTIC FEATURES
• environmental – high income
countries, separated, divorced or
windowed (than married or never
married)
• genetic/ physiological – family
history
• course modifiers – psychotic
features

26. PREVALENCE
• occur equally in men & women
• depressive episodes are more common in
women than men
• average onset of 18-22 years – bipolar II is
approx. 5 years later than bipolar I
• both are typically recurrent – experiencing
only one episode is very rare
• periods of remission – relatively symptom
free (50% of days)

28. INTERVENTIONS
aim – to prevent relapse, improve social
functioning, promote coping, reduce mood
fluctuations & treat acute episodes
psychological therapies
• cognitive behavioral therapy (CBT)
• psychoeducation
• family-focussed therapy
• interpersonal and social rhythm therapy

29. PHARMACOTHERAPY
• lithium (lithium carbonate, lithium citrate – liquid form)
• stabilize moods (treat acute mania)
• weeks to months to start working
• to be taken everyday
• dosage 600 – 1800 mg lithium carbonate daily
• anticonvulsant medications
• antipsychotic medications
• antidepressant medications

30. CHECK YOUR UNDERSTANDING
1. what are the chances the children or other family members can
inherit bipolar disorder?
2. what’s the difference between bipolar I and bipolar II disorder?
3. how to decide on treating for my condition?
4. Therapy or medications?
5. How long should medications be taken?
6. Considerable depression due to spouse sudden death, is it bipolar?
7. A person recovering from heart surgery, loss of appetite and weight
loss, is it bipolar?
8. what are the major warning signs that i could be developing mania
or hypomania?
9. If family support needed to treat patient with bipolar therapy?

31. REFERENCES
• https://www.healthline.com/health/bipolar-disorder/bipolar-1-
vs-bipolar-2
• https://www.slideshare.net/donnapetko/petko-bipolar-
disordersiii?from_action=save
• https://www.franceshaxtonmd.com/psychiatry-services-syracuse-
ny/what-is-pharmacotherapy/
• http://www.ideunom.ac.in
• https://www.psychiatry.org/psychiatrists/practice/dsm

32. THANK YOU!