Bipolar disorder: Difference between revisions
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==Background== | ==Background== | ||
* | *Mental disorder characterized by periods of elevated moods and periods of depression | ||
* | *Spectrum of disorders including Bipolar Type I, Bipolar Type II, and Bipolar NOS | ||
==Clinical Features== | ==Clinical Features== | ||
===Manic Episode=== | ===Manic Episode<ref name="DSM5">American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Publishing.</ref>=== | ||
* | *Abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week | ||
* | *At least 3 of the following symptoms (4 if only irritable) | ||
** | **Inflated self esteem or grandiosity | ||
** | **Decreased need for sleep | ||
** | **More talkative/pressured speech | ||
** | **Flight of ideas/racing thoughts | ||
** | **Easily distracted | ||
** | **Increase in goal-directed activity or psychomotor agitation | ||
** | **Involvement in high pleasure, high risk activities | ||
*** | ***Gambling, shopping sprees, sexual indiscretions | ||
* | *Sufficient to cause impairment in functioning, relationships, or hospitalization | ||
* | *Not as a result of substance abuse or medical condition (e.g. hyperthyroid) | ||
===Hypomanic Episode=== | ===Hypomanic Episode<ref name="DSM5"/>=== | ||
*Same features as manic episode however less intense | *Same features as manic episode however less intense | ||
*Symptoms only need to persist for 4 days | *Symptoms only need to persist for 4 days | ||
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*'''<big>S</big>'''uicidal ideation | *'''<big>S</big>'''uicidal ideation | ||
''Must have 5 symptoms in a 2 week period including depressed mood and loss of interest'' | ''Must have 5 symptoms in a 2 week period including depressed mood and loss of interest''<ref name="DSM5"/> | ||
===Mixed Episode=== | ===Mixed Episode<ref name="DSM5"/>=== | ||
* | *Fulfill features of both manic and major depressive episode | ||
* | *Must last at least 1 week | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Diagnosis== | ==Diagnosis== | ||
* | *Usually will not be diagnosed in the emergency department | ||
* | *Needs evaluation by a psychiatrist | ||
===Bipolar I=== | ===Bipolar I=== | ||
* | *Meets criteria for one manic or mixed episode | ||
* | *Symptoms cause social/occupational distress or impairment | ||
===Bipolar II=== | ===Bipolar II=== | ||
* | *Meets criteria for at least one major depressive episode | ||
* | *Meets criteria for at least one hypomanic episode | ||
* | *Does not meet criteria for manic or mixed episode | ||
* | *Symptoms cause social/occupational distress or imairment | ||
===Bipolar NOS=== | ===Bipolar NOS=== | ||
* | *Disorder with bipolar features that don't meet criteria for specific bipolar disorder | ||
==Management== | ==Management== | ||
* | *Medically clear | ||
* | *Determine whether patient meets 5150 criteria | ||
* | *Arrange psychiatry evaluation (psych ED, PET team, outpatient depending on clinical severity) | ||
==Disposition== | ==Disposition== | ||
*May need psych eval after medical clearance | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Psych]] | [[Category:Psych]] | ||
Revision as of 20:56, 4 September 2015
Background
- Mental disorder characterized by periods of elevated moods and periods of depression
- Spectrum of disorders including Bipolar Type I, Bipolar Type II, and Bipolar NOS
Clinical Features
Manic Episode[1]
- Abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week
- At least 3 of the following symptoms (4 if only irritable)
- Inflated self esteem or grandiosity
- Decreased need for sleep
- More talkative/pressured speech
- Flight of ideas/racing thoughts
- Easily distracted
- Increase in goal-directed activity or psychomotor agitation
- Involvement in high pleasure, high risk activities
- Gambling, shopping sprees, sexual indiscretions
- Sufficient to cause impairment in functioning, relationships, or hospitalization
- Not as a result of substance abuse or medical condition (e.g. hyperthyroid)
Hypomanic Episode[1]
- Same features as manic episode however less intense
- Symptoms only need to persist for 4 days
Major Depressive Episode
- Sleep - increased or decreased
- Interest - losing interest or pleasure in activities
- Guilt - excessive guilt
- Energy - feels of fatigue, low energy
- Concentration - cognitive decine, indecisiveness
- Appetite - weight loss/gain
- Psychomotor agitation or depression
- Suicidal ideation
Must have 5 symptoms in a 2 week period including depressed mood and loss of interest[1]
Mixed Episode[1]
- Fulfill features of both manic and major depressive episode
- Must last at least 1 week
Differential Diagnosis
General Psychiatric
- Organic causes
- Psychiatric causes
Diagnosis
- Usually will not be diagnosed in the emergency department
- Needs evaluation by a psychiatrist
Bipolar I
- Meets criteria for one manic or mixed episode
- Symptoms cause social/occupational distress or impairment
Bipolar II
- Meets criteria for at least one major depressive episode
- Meets criteria for at least one hypomanic episode
- Does not meet criteria for manic or mixed episode
- Symptoms cause social/occupational distress or imairment
Bipolar NOS
- Disorder with bipolar features that don't meet criteria for specific bipolar disorder
Management
- Medically clear
- Determine whether patient meets 5150 criteria
- Arrange psychiatry evaluation (psych ED, PET team, outpatient depending on clinical severity)
Disposition
- May need psych eval after medical clearance