Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Schizophrenia Spectrum & Other Psychotic Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
Schizophrenia is a mental disorder that usually appears in late adolescence or early adulthood. Characterized by delusions, hallucinations, and other cognitive difficulties, schizophrenia can often be a lifelong struggle. In this article, we will cover the causes, symptoms, and treatment of schizophrenia
Schizophrenia Spectrum & Other Psychotic Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
Will talk about the severe psychological disorders-- The familiar name for all might be -"Schizophrenia" - it is not just one category but has multiple categories combined under -"Schizophrenia spectrum"
My forensic psychiatric research done in Indian jails shows most convicts under murder cases belong to schizophrenia spectrum (98% schizophrenia and 2% paranoid & schizoid personality disorders), and most have murdered their spouses, family members, friends or colleagues and surrendered themselves on the spot.
This presentation on the "Schizophrenia spectrum" has been particularly shared with you all to extend my message to help these affected people at the right time and maintaining their condition to prevent them from committing such crimes as there is no proper mental health care--Clinical, Legal or authoritative help available for convicts suffering from mental disorder.
Trauma & Stressor Related Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation. NCMHCE, mental disorders, treatments
Case study CC26-year-old white female. Individual is AO x3.MaximaSheffield592
Case study
CC
26-year-old white female. Individual is A/O x3. Individual reports she was placed on medication during recent inpatient admission to psychiatric facility. Individual reports “it works a little too well. It makes me sleepy.” She reports originally going to the psychiatric facility because she could not sleep. Individual reports being diagnosed with Bipolar disorder. She reports losing 14 pounds within one week. Individual reports taking Gabapentin 600 mg in the morning, 600 mg at noon, and 1200 mg at night, and Abilify 5 mg at night. Individual complains of sleeping too much at night. Individual rates life 8/10 with 10 being total happiness. She denies S/I, H/I. individual reports that she has highs and lows. She reports she tried Lithium during inpatient admission “I had a really bad reaction. I had diarrhea.” DX; Bipolar I disorder (mixed); Mild depression. Plan; Gabapentin 600 mg tablet, 1.5 tablet nightly, Gabapentin 600 mg one tablet twice daily, Aripiprazole 5 mg one tablet nightly.
Mental function
PHQ-9 total core: 4, GAD-7 total score: 6
Vitals
Ht: 5’11”
Wt: 169 lbs
BMI: 23.57
Pain: 0/10
HPI
“Everything hit me like a freight train in January. I could not sleep.” Individual denies childhood trauma.
PMHx
Bipolar disorder
Hallucinations, delusions – Reports hallucinations and delusions when medications were adjusted.
Hyperlipidemia
PSHx
Comments: teeth pulled; cyst cut in back
FHx
Comments: Mother (living) Father (living), skin cancer (mets to brain)
Soc Hx
Alcohol: do not drink
Drug Abuse: No illicit drugs
Tobacco: Never smoker
Ob Preg Hx
Age of menses: 12
Allergies
No known medication allergies
ROS
Psychiatric: (+) change in mood, (-) depression, (-) sadness interfering with function, (+) anxiety, (+) nervousness, (-) sleep disturbance, (-) suicidal/homicidal ideations, (-) hopelessness, (+) worthlessness, (-) delusions, (-) hallucinations
Bipolar and Related Disorders
Bipolar and related disorders are separated from the depressive disorders in DSM-5 and placed between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders in recognition of their place as a bridge between the two diagnostic classes in terms of symptomatology, family history, and genetics. The diagnoses included in this chapter are bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder.
The bipolar I disorder criteria represent the modern understanding of the classic manic-depressive disorder or affective psychosis described in the nineteenth century, differing from that classic description only to the extent that neither psychosis nor the lifetime experience of a major depressive episode is a requirement. However, the vast majority of individuals whose symptoms meet the criteria for a ful ...
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
Will talk about the severe psychological disorders-- The familiar name for all might be -"Schizophrenia" - it is not just one category but has multiple categories combined under -"Schizophrenia spectrum"
My forensic psychiatric research done in Indian jails shows most convicts under murder cases belong to schizophrenia spectrum (98% schizophrenia and 2% paranoid & schizoid personality disorders), and most have murdered their spouses, family members, friends or colleagues and surrendered themselves on the spot.
This presentation on the "Schizophrenia spectrum" has been particularly shared with you all to extend my message to help these affected people at the right time and maintaining their condition to prevent them from committing such crimes as there is no proper mental health care--Clinical, Legal or authoritative help available for convicts suffering from mental disorder.
Trauma & Stressor Related Disorders for NCMHCE StudyJohn R. Williams
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation. NCMHCE, mental disorders, treatments
Case study CC26-year-old white female. Individual is AO x3.MaximaSheffield592
Case study
CC
26-year-old white female. Individual is A/O x3. Individual reports she was placed on medication during recent inpatient admission to psychiatric facility. Individual reports “it works a little too well. It makes me sleepy.” She reports originally going to the psychiatric facility because she could not sleep. Individual reports being diagnosed with Bipolar disorder. She reports losing 14 pounds within one week. Individual reports taking Gabapentin 600 mg in the morning, 600 mg at noon, and 1200 mg at night, and Abilify 5 mg at night. Individual complains of sleeping too much at night. Individual rates life 8/10 with 10 being total happiness. She denies S/I, H/I. individual reports that she has highs and lows. She reports she tried Lithium during inpatient admission “I had a really bad reaction. I had diarrhea.” DX; Bipolar I disorder (mixed); Mild depression. Plan; Gabapentin 600 mg tablet, 1.5 tablet nightly, Gabapentin 600 mg one tablet twice daily, Aripiprazole 5 mg one tablet nightly.
Mental function
PHQ-9 total core: 4, GAD-7 total score: 6
Vitals
Ht: 5’11”
Wt: 169 lbs
BMI: 23.57
Pain: 0/10
HPI
“Everything hit me like a freight train in January. I could not sleep.” Individual denies childhood trauma.
PMHx
Bipolar disorder
Hallucinations, delusions – Reports hallucinations and delusions when medications were adjusted.
Hyperlipidemia
PSHx
Comments: teeth pulled; cyst cut in back
FHx
Comments: Mother (living) Father (living), skin cancer (mets to brain)
Soc Hx
Alcohol: do not drink
Drug Abuse: No illicit drugs
Tobacco: Never smoker
Ob Preg Hx
Age of menses: 12
Allergies
No known medication allergies
ROS
Psychiatric: (+) change in mood, (-) depression, (-) sadness interfering with function, (+) anxiety, (+) nervousness, (-) sleep disturbance, (-) suicidal/homicidal ideations, (-) hopelessness, (+) worthlessness, (-) delusions, (-) hallucinations
Bipolar and Related Disorders
Bipolar and related disorders are separated from the depressive disorders in DSM-5 and placed between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders in recognition of their place as a bridge between the two diagnostic classes in terms of symptomatology, family history, and genetics. The diagnoses included in this chapter are bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorder, and unspecified bipolar and related disorder.
The bipolar I disorder criteria represent the modern understanding of the classic manic-depressive disorder or affective psychosis described in the nineteenth century, differing from that classic description only to the extent that neither psychosis nor the lifetime experience of a major depressive episode is a requirement. However, the vast majority of individuals whose symptoms meet the criteria for a ful ...
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
2. CHANGES FROM DSM IV TR TO DSM 5
Bipolar Disorders
Criterion A for manic and hypomanic
episodes now includes an emphasis on
changes in activity and energy as well as
mood to enhance accuracy of diagnosis
Bipolar I disorder, mixed episode= Removed
A new specifier, “with mixed features,” has
been added
It can be applied to episodes of mania or
hypomania when depressive features are
present.
3. CHANGES CONT.
Other Specified Bipolar and Related Disorder
Particular conditions: categorization for
individuals with a past history of a major
depressive disorder who meet all criteria
for hypomania except the duration criterion
(i.e., at least 4 consecutive days)
second condition: too few symptoms of
hypomania are present to meet criteria for
the full bipolar II syndrome
Although Duration sufficient at 4 or more
days.
4. CHANGES CONT.
Anxious Distress Specifier
This specifier is intended to identify patients
with anxiety symptoms that are not part of
the bipolar diagnostic criteria.
5. Bipolar I Disorder
Diagnostic Criteria
For a diagnosis of bipolar I disorder, it
is necessary to meet the following
criteria for a manic episode. The manic
episode may have been preceded by
and may be followed by hypomanic or
major depressive episodes.
6. MANIC 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).
7. MANIC 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 only irritable)
are present to a significant degree and represent a
noticeable change from usual behavior:
1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after
only 3 hours of sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas
5. Distractibility as reported or observed.
6. Increase in goal-directed activity or psychomotor
agitation
7. Excessive involvement in activities that have a high
potential for painful consequences
8. MANIC EPISODE
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, or there are psychotic
features.
D. The episode is not attributable to the
physiological effects of a substance (e.g., a
drug of abuse, a medication, other
treatment) or to another medical condition.
9. Note: A full manic episode that emerges
during antidepressant treatment (e.g.,
medication, electroconvulsive therapy)
but persists at a fully syndromal level
beyond the physiological effect of that
treatment is sufficient evidence for a
manic episode and, therefore, a bipolar I
diagnosis.
Note: Criteria A-D constitute a manic
episode. At least one lifetime manic
episode is required for the diagnosis of
bipolar I disorder.
10. HYPOMANIC EPISODE
A. A distinct period of abnormally and
persistently elevated, expansive, or irritable
mood and abnormally and persistently
increased activity or energy, lasting at least
4 consecutive days and present most of the
day, nearly every day.
11. HYPOMANIC EPISODE
B. During the period of mood disturbance and
increased energy and activity, three (or more) of the
following symptoms (four if the mood is only irritable)
have persisted, represent a noticeable change from
usual behavior, and have been present to a significant
degree:
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
12. HYPOMANIC EPISODE
C. The episode is associated with an unequivocal
change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in
functioning are observable by others.
E. The episode is not severe enough to cause
marked impairment in social or occupational
functioning or to necessitate hospitalization. If there
are psychotic features, the episode is, by definition,
manic.
F. The episode is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a
medication, other treatment).
13. Note: A full hypomanic episode that emerges
during antidepressant treatment (e.g., medication,
electroconvulsive therapy) but persists at a fully
syndromal level beyond the physiological effect of
that treatment is sufficient evidence for a
hypomanic episode diagnosis. However, caution is
indicated so that one or two symptoms
(particularly increased irritability, edginess, or
agitation following antidepressant use) are not
taken as sufficient for diagnosis of a hypomanic
episode, nor necessarily indicative of a bipolar
diathesis.
Note: Criteria A-'F constitute a hypomanic
episode. Hypomanic episodes are common in
bipolar I disorder but are not required for the
diagnosis of bipolar I disorder.
14. MAJOR DEPRESSIVE EPISODE
A. Five (or more) of the following
symptoms have been present during the
same 2-week period and represent a
change from previous functioning; at least
one of the symptoms is either (1)
depressed mood or (2) loss of interest or
pleasure.
Note: Do not include symptoms that are
clearly attributable to another medical
condition.
15. MAJOR DEPRESSIVE EPISODE
1. Depressed mood most of the day, nearly every
day (e.g., feels sad, empty, or hopeless appears
tearful). (Note: In children and adolescents, can
be irritable mood.)
2. Markedly diminished interest or pleasure in all,
or almost all, activities most of the day, nearly
every day
3. Significant weight loss when not dieting or
weight gain, or decrease or increase in appetite
nearly every day. (Note: In children, consider
failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
16. 5. Psychomotor agitation or retardation
nearly every day
6. Fatigue or loss of energy nearly
every day.
7. Feelings of worthlessness or
excessive or inappropriate guilt (which
may be delusional) nearly every day
8. Diminished ability to
think/concentrate, or indecisiveness,
nearly every day.
9. Recurrent thoughts of death,
recurrent suicidal ideation without a
specific plan, or a suicide attempt or a
specific plan for committing suicide.
17. B. The symptoms cause clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning.
C. The episode is not attributable to
the physiological effects of a
substance or another medical
condition.
18. Note: Criteria A-C constitute a major
depressive episode. Major depressive
episodes are common in bipolar I disorder
but are not required for the diagnosis of
bipolar I disorder.
Note: Responses to a significant loss (e.g.,
bereavement, financial ruin, losses from a
natural disaster, a serious medical illness or
disability) may include the feelings of
intense sadness, rumination about the loss,
insomnia, poor appetite, and weight loss
noted in Criterion A, which may resemble a
depressive episode. Normal responses.
Clinical judgment is required
19. Bipolar I Disorder
A. Criteria have been met for at least one
manic episode (Criteria A-D under “Manic
Episode” above).
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.
20. Specify.
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
21. Prevalence
The 12-month prevalence estimate in the
continental United States was 0.6% for
bipolar I disorder as defined in DSM-IV.
Twelve-month prevalence of bipolar I
disorder across 11 countries ranged from
0.0% to 0.6%. The lifetime male-to-female
prevalence ratio is approximately 1.1:1.
22. DEVELOPMENT AND COURSE
Mean age of onset is 18 years
Children should be judged according
to their baseline
Onset occurs throughout the life cycle
23. RISK AND PROGNOSTIC FACTORS
Environmental.
More in high income countries
More in Separated, divorced, or widowed
individuals but the direction of the
association is unclear.
Genetics.
Family history is a strong predictor
Course modifiers. After an individual has a
manic episode with psychotic features,
subsequent manic episodes are more likely
to include psychotic features.
25. DIFFERENTIAL DIAGNOSIS
Major depressive disorder
Similarity: MDD has associated
symptoms of mania and hypomania
and symptoms of irritability
Difference: The associated symptoms
are few or of shorter duration than
required for mania/ hypomania
26. DIFFERENTIAL DIAGNOSIS
Other bipolar disorders
Bipolar I and Bipolar II: Past episodes
of mania in Bipolar I
Unspecified and Other specified
Bipolar disorders: fail to meet the
criteria fully
Another Medical Condition: Causal
factor is medical
28. DIFFERENTIAL DIAGNOSIS
Substance
induced bipolar
disorder
Response to mood
stabilizers during a
substance/medicat
ion induced mania
may not
necessarily be
diagnostic for
bipolar disorder
Bipolar I
May overuse
substance during an
episode
Symptoms remain
when substance isn’t
used
32. Bipolar II Disorder
Diagnostic Criteria
For a diagnosis of bipolar II disorder, it
is necessary to meet the following
criteria for a current or past
hypomanic episode and the following
criteria for a current or past major
depressive episode
33. A. Criteria have been met for at least one
hypomanic episode and at least one major
depressive episode
B. There has never been a manic episode.
C. The occurrence of the hypomanic episode(s)
and major depressive episode(s) is not better
explained by schizoaffective disorder,
schizophrenia, and other psychotic disorder.
D. The symptoms of depression or the
unpredictability caused by frequent alternation
between periods of depression and hypomania
causes clinically significant distress or impairment
in social, occupational, or other important areas of
functioning.
BIPOLAR II DISORDER
34. SPECIFY CURRENT OR MOST RECENT EPISODE:
HYPOMANIC
DEPRESSED
SPECIFY COURSE IF FULL CRITERIA FOR A MOOD EPISODE
ARE NOT CURRENTLY MET:
IN PARTIAL REMISSION
IN FULL REMISSION
SPECIFY SEVERITY IF FULL CRITERIA FOR A MOOD
EPISODE ARE CURRENTLY MET:
MILD
MODERATE
SEVERE
35. Specify.
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 (For Depressive
episode)
36. • 0.3% international
• 12 month prevalence
Prevalence
• High in relatives
• Educated; married and few
years of illness= Recovery
Risk and
Prognostic
Factors
• Anxiety, Substance use,
• Eating disorder
Comorbidity
37. DIFFERENTIAL DIAGNOSIS
Major depressive disorder
Similarity: MDD has associated
symptoms of hypomania and
symptoms of irritability
Difference: The associated symptoms
are few or of shorter duration than
required for hypomania
42. CYCLOTHYMIC DISORDER
Diagnostic Criteria
A. For at least 2 years (at least 1 year in children
and adolescents) there have been numerous
periods with hypomanic symptoms that do not meet
criteria for a hypomanic episode and numerous
periods with depressive symptoms that do not meet
criteria for a major depressive episode.
B. During the above 2-year period (1 year in
children and adolescents), the hypomanic and
depressive periods have been present for at least
half the time and the individual has not been without
the symptoms for more than 2 months at a time.
43. C. Criteria for a major depressive, manic, or
hypomanic episode have never been met.
D. The symptoms in Criterion A are not better
explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or
unspecified schizophrenia spectrum and other
psychotic disorder.
E. The symptoms are not attributable to the
physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition
(e.g., hyperthyroidism).
F. The symptoms cause clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
45. PREVALENCE
The lifetime prevalence is
approximately 0.4%-l%.
In the general population, equally
common in males and females.
In clinical settings, females with
cyclothymic disorder may be more
likely to present for treatment than
males.
46. RISK FACTORS
More common in first degree biological
relatives
Comorbidity
Substance-related disorders, sleep
disorders, ADHD
47. DIFFERENTIAL DIAGNOSIS
Bipolar and related
disorder due to another
medical condition and
depressive disorder due
to another medical
condition
Mood disturbance is
attributable to
physiological effect
of chronic medical
condition
Cyclothymia
Mood disturbance is
not only
attributable to
physiological effect
of chronic medical
condition
48. DIFFERENTIAL DIAGNOSIS
Substance/medication-
induced bipolar and
related disorder and
substance/medication-
induced depressive
disorder
Cause= Substance
Symptoms end with
cessation of
substance/
medication
Cyclothymia
Symptoms do not
end with
cessation of
substance/
medication
49. DIFFERENTIAL DIAGNOSIS
Bipolar I and bipolar II
disorder, with rapid
cycling.
Similarity= Marked
Frequent shifts in
mood
Diff= Criteria met for
depressive, manic
and hypomanic
episodes
Cyclothymia
Criteria never
met for
depressive,
manic and
hypomanic
episodes
50. SUBSTANCE/MEDICATION-INDUCED BIPOLAR
AND RELATED DISORDER
Diagnostic Criteria
A. A prominent and persistent
disturbance in mood that
predominates in the clinical picture
and is characterized by elevated,
expansive, or irritable mood, with or
without depressed mood, or markedly
diminished interest or pleasure in all,
or almost all, activities.
51. B. There is evidence from the history, physical
examination, or laboratory findings of both
(1) and (2):
1. The symptoms in Criterion A developed
during or soon after substance intoxication or
withdrawal or after exposure to a medication.
2. The involved substance/medication is capable
of producing the symptoms in Criterion A.
C. The disturbance is not better explained by
a bipolar or related disorder that is not
substance/ medication-induced.
52. D. The disturbance does not occur exclusively
during the course of a delirium.
E. The disturbance causes clinically significant
distress or impairment in social, occupational, or
other important areas of functioning.
Specify if
With onset during intoxication: If the criteria are
met for intoxication with the substance and the
symptoms develop during intoxication.
With onset during withdrawal: If criteria are met
for withdrawal from the substance and the
symptoms develop during, or shortly after,
withdrawal.
53. BIPOLAR AND RELATED DISORDER DUE TO
ANOTHER MEDICAL CONDITION
Diagnostic Criteria
A. A prominent and persistent period of
abnormally elevated, expansive, or irritable
mood and abnormally increased activity or
energy that predominates in the clinical
picture.
B. There is evidence from the history,
physical examination, or laboratory findings
that the disturbance is the direct
pathophysiological consequence of another
medical condition.
54. C. The disturbance is not better explained
by another mental disorder.
D. The disturbance does not occur
exclusively during the course of a delirium.
E. The disturbance causes clinically
significant distress or impairment in social,
occupational,
or other important areas of functioning, or
necessitates hospitalization to prevent harm
to self or others, or there are psychotic
features.
55. Specify if:
With manic features: Full criteria are
not met for a manic or hypomanic
episode.
With manic- or hypomanic-like
episode: Full criteria are met except
Criterion D for a manic episode or
except Criterion F for a hypomanic
episode.
With mixed features: Symptoms of
depression are also present but do not
predominate in the clinical picture.
56. OTHER SPECIFIED BIPOLAR AND RELATED
DISORDER
When presentation does not meet the full
criteria of any disorder and clinician chooses
to report the reason.
Short-duration hypomanic episodes (2-3 days)
and major depressive episodes
Hypomanic episodes with insufficient
symptoms and major depressive episodes
Hypomanic episode without prior major
depressive episode
Short-duration cyclothymia (less than 24
months)
57. UNSPECIFIED BIPOLAR AND RELATED DISORDER
When presentation does not meet the
full criteria of any disorder and clinician
chooses not to report the reason.
Insufficient information e.g., in
Emergency room settings
58. SPECIFIERS FOR BIPOLAR AND RELATED DISORDERS
With anxious distress: The presence of at least two
of the following symptoms during the majority of days
of the current or most recent episode of mania,
hypomania, or depression:
1. Feeling keyed up or tense.
2. Feeling unusually restless.
3. Difficulty concentrating because of worry.
4. Fear that something awful may happen.
5. Feeling that the individual might lose control of
himself or herself.
Specify current severity:
Mild: Two symptoms. Moderate: Three
symptoms.
Moderate-severe: Four or five symptoms.
Severe: Four or five symptoms with motor agitation.
59. With rapid cycling (can be applied
to bipolar I or bipolar II disorder):
Presence of at least four mood
episodes in the previous 12 months
that meet the criteria for manic,
hypomanic, or major depressive
episode.
60. With melancholic features:
A. One of the following is present during the most
severe period of the current episode;
1. Loss of pleasure in all, or almost all, activities.
2. Lack of reactivity to usually pleasurable stimuli
B. Three (or more) of the following:
1. A distinct quality of depressed mood
characterized by profound despair, by so-called
empty mood.
2. Early-morning awakening (i.e., at least 2 hours
before usual awakening).
3. Marked psychomotor agitation or retardation.
4. Significant anorexia or weight loss.
5. Excessive or inappropriate guilt.
61. With psychotic features: Delusions or
hallucinations are present at any time in the
episode. If psychotic features are present,
specify if mood-congruent or mood-
incongruent
With catatonia: This specifier can apply to
an episode of mania or depression if
catatonic features are present during most
of the episode.
62. With peripartum onset: This specifier
can be applied to the current or, if the
full criteria are not currently met for a
mood episode, most recent episode of
mania, hypomania, or major
depression in bipolar I or bipolar II
disorder if onset of mood symptoms
occurs during pregnancy or in the 4
weeks following delivery.
63. With seasonal pattern: This specifier
applies to the lifetime pattern of mood
episodes.
The essential feature is a regular
seasonal pattern of at least one type of
episode (i.e., mania, hypomania, or
depression). The other types of
episodes may not follow this pattern.
For example, an individual may have
seasonal manias, but his or her
depressions do not regularly occur at a
specific time of year.
64. With atypical features: This specifier can be applied when
these features predominate during the majority of days of the
current or most recent major depressive episode.
A. Mood reactivity (i.e., mood brightens in response to actual
or potential positive events).
B. Two (or more) of the following features:
1. Significant weight gain or increase in appetite.
2. Hypersomnia.
3. Leaden paralysis (i.e., heavy, leaden feelings in arms or
legs).
4. A long-standing pattern of interpersonal rejection
sensitivity that results in significant social or occupational
impairment.
C. Criteria are not met for “with melancholic features” or
“with catatonia” during the same episode.
65. ETIOLOGY
Genetics
Family Studies: There is a 4.5%
prevalence of bipolar disorder among
relatives of bipolar patients, and a
1.5% prevalence among relatives of
depressed patients.
Adoption Studies: Compared with a
control group, the biological parents of
bipolar adoptees had an increase
prevalence of bipolar disorder, but the
adoptive parents of bipolar adoptees did
not.
66. Neuroanatomical differences
Small abnormal areas in the white matter of
the brain (especially in the frontal lobe).
Smaller amygdala: Involvement of the
amygdala in BD is consistent with its central
role in emotional and social behavior
(assigning emotional valence to stimuli and
memories, facilitating encoding). The
amygdala plays a key role in emotions and
forming emotional memories.
67. Decreased hippocampal volume: The
hippocampus is a horseshoe-shaped brain
structure involved in memory, learning, and
emotion. It forms new memories and organizes
them with related memories and emotions.
Social rhythm stability hypothesis: Life events
can act as zeitstorers, which disrupt established
social and circadian rhythms For example,
previously unemployed patient who gets a job
with constantly shifting work hours is forced to
adopt a new pattern of daily routines, which may
include changes in sleep-wake habits. Major
events can also result in loss of social zeitgebers,
people or events that help maintain the stability of
the rhythms.
68. ASSESSMENT
Clinical Interview
Mental Status Examination (MSE): It
occupies the information related to
appearance, hygiene, eye contact,
perception, thinking, mood, speech, volume,
orientation, memory etc of the client.
Daily Mood Chart
Behavioral Checklist
Subjective Ratings of the problems
69. Other Assessment Tools
Goldberg Bipolar Spectrum Screening
Questionnaire
Minnesota Multiphasic Personality
Inventory (D-scale for depression and
Ma-scale for hypomania)
The Mood Disorder Questionnaire
MDS
The Child Bipolar Questionnaire
71. Lithium: For classic, euphoric mania; for mixed
manic episode
Selective serotonin reuptake inhibitors : For
Bipolar Depression
An antipsychotic agent: For mania with psychosis
or psychotic depression.
Valproic acid (Depakene): For classic, euphoric
mania; for mixed manic episode; for mania with rapid
cycling
Benzodiazepine: Sleep and sedation in mania or
hypomania; insomnia in depression
DRUG THERAPY
72. COGNITIVE BEHAVIOR THERAPY
Identifying Thoughts, Emotions &
Behaviors
Understanding the Links between
Thoughts, Feelings & Behaviors
Making Changes – Behaviors
Making Changes - Thoughts
Challenging Thoughts
Distancing or Defusing from Thoughts
Imagery
74. INTERPERSONAL SOCIAL RHYTHM THERAPY (IPSRT)
The reciprocal relationships between life
stress and the onset of mood disorder
symptoms.
The importance of maintaining regular
daily rhythms and sleep–wake cycles.
The identification and management of
potential precipitants of rhythm
dysregulation, with special attention to
interpersonal triggers.
76. References
American Psychiatric Association (2000). Diagnostic
and statistical manual of mental disorders-text
revised (4th ed.). Washington, DC: American
Psychiatric Association.
American Psychiatric Association (2013). Diagnostic
and statistical manual of mental disorders (5th ed.).
Arlington, VA: American Psychiatric Publishing.
Basco, M.R., Rush, A.J. (1996). Cognitive-Behavioral
Therapy For Bipolar Disorder. New York: Guilford
Press.
Baldessarini, R.J., Tondo, L., Hennen, J. (1999).
Effects of lithium treatment and its discontinuation on
suicidal behavior in bipolar manic-depressive
disorders. Journal of Clinical Psychiatry, 60(2), 77–84.
Beck, J.S. (1995). Cognitive Therapy: Basics and
Beyond. New York: Guilford Press.