1. By the end of session students would be able
to:
⦿Describe Bipolar affective disorders and its
various types as given in DSM-V classification.
⦿Describe prevalence; etiology/risk factors for
Bipolar affective disorder and D/D.
2. ⦿Mood disorder: disorders that have a disturbance
in mood as their prominent feature
⦿Affect: a person’s present emotional
responsiveness
⦿Mood: Pervasive and sustained emotion that
colors the person’s perception of the world
4. Diagnostic Criteria (DSM-V):
⦿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.
5. ⦿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).
⦿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:
6. 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 (i.e., attention too easily drawn to
unimportant or irrelevant external stimuli).
6.Increase in goal-directed activity (either socially, at
work or school, or sexually) or psychomotor agitation
(i.e., purposeless non-goal-directed activity).
7.Excessive involvement in activities that have a high
potential for painful consequences (e.g., overspending,
sexual indiscretions, or foolish business investments).
7. ⦿C. The mood disturbance is sufficiently
severe to cause marked impairment in social
or occupational functioning or to require
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.
8. ⦿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.
⦿Similar to manic episode but less severe
in symptoms.
9. ⦿The episode is not severe enough to cause
marked impairment in social or occupational
functioning or to require hospitalization. If
there are psychotic features, the episode is,
by definition, manic.
10. ⦿Unipolar:
◾ Major depressive disorder
◾ Dysthymic disorder
⦿Bipolar:
◾ Bipolar I disorder: Manic & depressive episodes
◾ Bipolar II disorder: Hypomanic & depressive episodes
◾ Cyclothymic disorder
⦿Mood disorder due to GMC
⦿Substance induced mood disorder
11. ⦿Race & ethnic group: Roughly similar prevalence
but different symptomatic presentation.
⦿Lifetime prevalence 0.3-1.5% (0.8% bipolar I;
0.5% bipolar II).
⦿The lifetime male-to-female prevalence ratio is
approximately 1.1:1.
12. ⦿Mean age at onset of the first manic,
hypomanic, or major depressive episode is
approximately 18 years for bipolar I disorder.
⦿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.
⦿Approximately 60% of manic episodes occur
immediately before a major depressive episode.
⦿Bipolar I disorder with multiple (four or more)
mood episodes (major depressive, manic, or
hypomanic) within 1 year = “rapid cycling”.
13. ⦿ 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, schizophreniform disorder,
delusional disorder, or other psychotic
disorder.
⦿D. The symptoms causes clinically significant
distress or impairment in social, occupational,
or other important areas of functioning.
14. ⦿Although bipolar II disorder can begin in late
adolescence and throughout adulthood,
average age at onset is the mid-20s.
⦿The illness most often begins with a
depressive episode and is not recognized as
bipolar II disorder until a hypomanic episode
occurs.
15. ⦿A. For at least 2 years 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, 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.
16. ⦿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 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.
17. ⦿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.
⦿The symptoms developed during or soon after
substance intoxication or withdrawal or after
exposure to a medication.
⦿ The involved substance/medication is capable
of producing the symptoms.
18. ⦿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.
⦿C. The disturbance is not better explained by
another mental disorder.
⦿D. The disturbance does not occur exclusively
during the course of a delirium.
21. Biological
•Neurotransmitter:
(NA, DA, 5HT, and
glutamine)
•Endocrine system
(HPA axis)
•Genetics: 1st-
degree relatives are 7x
more likely to develop
the condition than the
general population.
•Sleep dysfunction
Psychological
•Stressful life events
•Behavioral factors
•Cognitive factors
•Psychodynamic
Bipolar
Disorder
Social
•Stressful life events
•Support system
23. Low Vulnerability High Vulnerability
Stress
Vulnerability
Threshold for mood disorder
Threshold model
24. ⦿Course:
◾ Recurrent episodes
◾ Manic/hypomanic episodes often occur immediately
before or after a major depressive episode.
◾ Intervals between episodes tend to decrease with
age.
◾ 5-15% rapid cycling (4+ episodes/year)
◾ For woman there is an increased risk of a mood
episode occurring after childbirth.
25. ⦿Associated features:
◾ Suicide: up to 15% of sufferers kill themselves
◾ Often occurs together with substance abuse, anxiety,
eating disorders.
◾ School truancy and failure, occupational difficulties
and divorce.
◾ Bipolar I: Violent and antisocial behaviour during
manic episodes.
