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Revision as of 16:03, 22 March 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

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

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.