BIPOLAR DISORDER P1
1. How do we diagnose bipolar disease, what are the subtypes and what are the general
characteristics of this disease?
a. How can we distinguish between Bipolar Disorder 1 and 2 and Cyclothymia?
b. What is the prevalence of bipolar disorder in comparison to major depressive disorder?
c. What do we know about the prevalence of bipolar disorder in males vs. females?
d. What are risk factors for bipolar disease?
Pointers: lecture by Amati de jong is important,
DSM-5 DIAGNOSTIC CRITERIA
● BIPOLAR I DISORDER
For the diagnosis of bipolar I disorder, the following criteria for a manic episode should be met.
NOTE: the manic episode may have been preceded by and may be followed by hypomanic or
major depressive episodes.
,Here, the manic episode is often described by patients as euphoric, excessively cheerful, high,
or ‘’feeling on the top of the world’’ — individuals often do not perceive that they are ill or in need
of treatment, failing to perceive that there can be catastrophic consequences to manic episodes
resulting from poor judgement, loss of insight, and hyperactivity.
Note that instead of elevated mood - it can be irritable (in that cause criterion B at least 4 should
be present)
Rapid shifts in mood over brief periods of time may occur and referred to as lability – i.e. the
alternation among euphoria, dysphoria, and irritability) - could be specified as ‘with rapid cycling’
NOTE: decreased need for sleep vs insomnia
Do not feel tired or have desire to sleep wanting to sleep but unable
NOTE2: speech of individuals with bipolar can be disorganized, incherent, rapid, pressured
loud, which is also distressful to the individual.
The manic episode could be followed by [but doesn’t have to be]
,Or by a major depressive episode (diagnostic criteria already mentioned in the previous
problem)
SO, for diagnosis of Bipolar I disorder:
A. Criteria have been met for at least one manic episode
B. The occurrence is not better explained by schizoaffective disorder, schizophrenia,
delusional disorder etc.
Prevalence: around 0.6%, with the lifetime male-to-female prevalence ratio is approximately
1.1:1.
Development and course, & risk factors
- First manic, hypomanic, or depressive episode mostly around 18 years of age, & special
considerations are necessary to detect the diagnosis in children
- Onset of manic symptoms in late midlife or late-life should prompt consideration of
medical conditions e.g. frontotemporal neurocognitive disorder.
- 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
(so it is mostly followed by it)
- Individuals with bipolar I who have multiple (four or more) mood episodes (any) within 1
year receive the specifier ‘with rapid cycling’
- More common in high-income countries
Environmental:
- Separated, divorced, or widowed individuals have higher rates of bipolar I (the direction
of this association is unclear)
Genetic:
, - A family history of bipolar disorder is one of the strongest and most consistent risk
factors for bipolar disorders
Other info
- Females are more likely to experience rapid cycling and mixed states, and to have
patterns of comorbidity that differ from those of melaes, including higher rates of lifetime
earring disorder, and to experience depressive symptoms.
- Notably surprising: females with bipolar I also have a higher lifetime risk of alcohol use
disorder than males with bipolar
Suicide
- At least 15 (some sources state 20-30) times that of the general population – it has been
suggested that one-quarter (¼) of all completed suicides are due bipolar.
Note: misdiagnosis of ADHD - many symptoms overlap, however misdiagnosis can be avoided
if the clinician clarifies whether the symptom(s) represents a distinct episode
Comorbidity: high comorbidity with anxiety disorders, ADHD, any disruptive impulse-control, or
construct disorder, and any substance use disorder
As well as metabolic syndrome and migraine, and alcohol use disorder with higher risk for
suicide attempts.
