Difference between revisions of "Bipolar disorder"
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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 | ||
| Line 39: | Line 39: | ||
*'''<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== | ||
| Line 78: | Line 79: | ||
==References== | ==References== | ||
| − | |||
<references/> | <references/> | ||
[[Category:Psych]] | [[Category:Psych]] | ||
Revision as of 20:56, 4 September 2015
Contents
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