Difference between revisions of "Bipolar disorder"

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(Added General ED Psychiatric Management template)
 
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==Background==
 
==Background==
*mental disorder characterized by periods of elevated moods and periods of depression
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*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
+
*Spectrum of disorders including Bipolar Type I, Bipolar Type II, and Bipolar NOS
  
 
==Clinical Features==
 
==Clinical Features==
===Manic Episode===
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===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
+
*Abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week
*at least 3 of the following symptoms (4 if only irritable)
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*At least 3 of the following symptoms (4 if only irritable)
**inflated self esteem or grandiosity
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**Inflated self esteem or grandiosity
**decreased need for sleep
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**Decreased need for sleep
**more talkative/pressured speech
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**More talkative/pressured speech
**flight of ideas/racing thoughts
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**Flight of ideas/racing thoughts
**easily distractible
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**Easily distracted
**increase in goal-directed activity or psychomotor agitation
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**Increase in goal-directed activity or psychomotor agitation
**involvement in high pleasure, high risk activities  
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**Involvement in high pleasure, high risk activities  
***gambling, shopping sprees, sexual indiscretions
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***Gambling, shopping sprees, sexual indiscretions
*sufficient to cause impairment in functioning, relationships, or hospitalization
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*Sufficient to cause impairment in functioning, relationships, or hospitalization
*not as a result of substance abuse or medical condition (e.g. hyperthyroid)
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*Not as a result of substance abuse or medical condition (e.g. hyperthyroid)
  
===Hypomanic Episode===
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===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''
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''Must have 5 symptoms in a 2 week period including depressed mood and loss of interest''<ref name="DSM5"/>
  
===Mixed Episode===
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===Mixed Episode<ref name="DSM5"/>===
*fulfill features of both manic and major depressive episode
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*Fulfill features of both manic and major depressive episode
*must last at least 1 week
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*Must last at least 1 week
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
 
{{Psych DDX}}
 
{{Psych DDX}}
  
==Diagnosis==
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==Evaluation==
*usually will not be diagnosed in the emergency department
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*Usually will not be diagnosed in the emergency department
*needs evaluation by a psychiatrist
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*Needs evaluation by a psychiatrist
  
 
===Bipolar I===
 
===Bipolar I===
*meets criteria for one manic or mixed episode
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*Meets criteria for one manic or mixed episode
*symptoms cause social/occupational distress or impairment
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*Symptoms cause social/occupational distress or impairment
  
 
===Bipolar II===
 
===Bipolar II===
*meets criteria for at least one major depressive episode
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*Meets criteria for at least one major depressive episode
*meets criteria for at least one hypomanic episode
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*Meets criteria for at least one hypomanic episode
*does not meet criteria for manic or mixed episode
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*Does not meet criteria for manic or mixed episode
*symptoms cause social/occupational distress or imairment
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*Symptoms cause social/occupational distress or imairment
  
 
===Bipolar NOS===
 
===Bipolar NOS===
*disorder with bipolar features that don't meet criteria for specific bipolar disorder
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*Disorder with bipolar features that do not meet criteria for specific bipolar disorder
  
 
==Management==
 
==Management==
*medically clear
+
*Medically clear
*determine whether patient meets 5150 criteria
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*Place patient on legal hold if meets local criteria
*arrange psychiatry evaluation (psych ED, PET team, outpatient depending on clinical severity)
+
*Arrange psychiatry evaluation (inpatient vs outpatient depending on clinical severity)
 +
 
 +
{{General ED Psychiatric Management}}
  
 
==Disposition==
 
==Disposition==
 +
*May need psych eval after medical clearance
  
 
==See Also==
 
==See Also==
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<references/>
 
<references/>
  
[[Category:Psych]]
+
[[Category:Psychiatry]]

Latest revision as of 22:36, 10 November 2016

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

Evaluation

  • 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 do not meet criteria for specific bipolar disorder

Management

  • Medically clear
  • Place patient on legal hold if meets local criteria
  • Arrange psychiatry evaluation (inpatient vs outpatient depending on clinical severity)

General ED Psychiatric Management

Disposition

  • May need psych eval after medical clearance

See Also

External Links

References

  1. 1.0 1.1 1.2 1.3 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Publishing.