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26 Cards in this Set

  • Front
  • Back

Bipolar I Disorder

1(+) manic episode


(1+ major depressive episode)

Bipolar II Disorder

1(+) hypomanic episode


1(+) major depresive episode

Cyclothymic Disorder

Hypomanic symptoms


Depressive symptoms


Full criteria for MDD and hypomania not met

DSM-5 Criteria: Manic Episode

A. Distinct period of bad mood and persistent goal-directed activity/energy lasting 1 week for most of the day, every day


B. 3+: infalted self-esteem/grandiosity; decreased sleep; talkative; flighty ideas; distractibility; goal-direct activity; excessive involvement in painful consequence activities


C. impairs social/occupational functioning

DSM-5 Criteria: Hypomanic Episode

A. distinct period of abnormally elevated, expansive mood + increased energy, lasting 4 consecutive days, most days, all day


B. 3+: grandiosity; decreased sleep; talkative; flighty ideas; distractibility; goal-direct activity; excessive involvement in painful conseqactivities


C. change from when indiv is not symptomatic


D. disturbances are observable by others

DSM-5 Criteria: Cyclothymic Disorder

A. 2 years there have been numerous periods with hypomanic+depressive nonqual symptoms


B. the period haves been present for @ 1/2 time and not w/o symp for more than 2 months(1yrb)


C. Can't be dx'd w/ major depressive, manic, hypomanic or other disorder


D. symptoms cause clinically significant distress or impairment in social/occupational functioning

What's the difference between Bipolar I and Bipolar II? and cyclothymia

BI - Mania (clinically significant distress), at least 1 week


BII - Hypomania at least 4 days + MDE


Cyclothymia - Hypomanic symptoms, depressive symptoms, clinically signficant distress

BD - Manic Symptoms

Frequency, Intensity, Number, Duration


Elated Mood:


Normal: very excited to go to disneyland


Mania: 7 year old repeatedly taken to the principal for giggling when no one else was


Grandiose Behaviors:


Normal - 7yro pretended to be a fireman


Mania- 7yro thought police wanted to play

What's the difference between ADHD and BD?

ADHD- show a CONSTANT pattern of overactivity/distractibility


Bipolar Disorder - shows a CHANGE from usual behavior to overactivity or distractibility

What's the difference between CD/ODD and Bipolar Disorder?

CD/ODD - irritability and dyregulation but also vindictibe, intentional and without guilt


Bipolar Disorder - irritability and dysregulation with impulsivity and sense of omnipotence

Prevalence: Bipolar Disorder

Lifetime prevalence 1.8% (for I and II combined)


Girls = Boys

Comorbidities: Bipolar Disorder

Anxiety Disorder (about 75%), during depression


ADHD


ODD/CD


Substance Use Disorders (during manic states)


Eating disorders


- particularly BED


- during depressive states

Course: Bipolar Disorder

20% of all patients have their first episode in late adolescence; onset before 10 is rare - childhood/adol onset is a more severe course, worse prognosis


- youths with BDs typically recover from episode1, in 5 years 60% relapse/never recover


- median duration of manic episodes is 10.8 mo


- duration of mood disturbance is 80.2 mo





Causes: Bipolar Disorder

Strong genetic component (5-10x greater)


Reduced brain volume


Hyperactivation of the amygdala, hypoactivation of prefrontal cortex (see more threats)


Lower frustration tolerance


Perpetuating: high expressed emotion


- critical, hostile, over-involved

Treatment: Bipolar Disorder

Atypical antipsychotic are often the first-line treatment now


Mood stabilizers: lithium


Antidepressants may create mania


Psychotherapy may increase compliance with medication and prevent recurrence of symptoms

Psychotherapy for Bipolar Disorder

Psychoeducation, improving emotion-regulation and communication

Lithium

Low effectiveness, high drop-out rate, high side effects

Atypical antipsychotics

Approved in those 10-17


Affect dopamine, serotonin, and norepinephrine


Bind more strongly to dopamine receptors, causing fewer side effects


~50% see reduction in manic symptoms (~25%)


Response Rates ~2x as high as to lithium

New Diagnosis in the DSM-5

40-fold increase in kids from 1994-2003


Biological relatives of kids with chronic irritability often have problems with anxiety and depression, not BD


May lead to inappropriate medicinal treatment


DMDD can now describe these children

Disruptive Mood Dysregulation



Severe recurrent TEMPER OUTBURSTS manifested verbally/behaviorally that are exag


TOs are inconsistent with developmental level


3x+/week, mood inb/n TOs is irritable


symptoms have been present for 12 mo and are present in at least two of three settings, 1 severe


dx not made before 6 or after 18


by history/observ onset is before 10 yro

Prevalence: DMDD

~2-5% of those age 6-18


2/3 are male


DMDD in childhood may be a risk factor for depressive disorders and GAD in adulthood

Associated Characteristics: DMDD

impaired face processing, particularly for negative emotions such as "sad", "fearful" and "angry"


underactivity of the amygdala during face preception


decreased context-sensitive regulation



Treatment: DMDD

Antidepressants, parent training, CBT, comprehensive family therapy

Differences between DMDD and Bipolar Disoder

Bipolar disorders are episodic while DMDD is persistent and present over many months


No mania in DMDD (no elevated or expansive mood or grandiosity)

Differences between DMDD vs ODD

Mood symptoms are rare in ODD


Remember, if the child meets the crtieria for both ODD an DMDD s/he is diagnosed with DMDD ONLY

when DMDD symptoms occur ONLY during these situations, it's not DMDD

anxiety-povoking context


routines of a child with ASD or OCD


temper outbursts occur in the presence of a mjaor depressive episode