There are a lot of criteria
to diagnose bipolar disorder.
So I want to review that with you
here because it’s really important.
So when you’re thinking about the
diagnostic criteria for bipolar,
you want to think about
a distinct period
of abnormally and persistently
elevated expansive or irritable mood.
And abnormally and persistently
increased activity or energy
that lasts at least one week
and is present most of the
day for nearly everyday.
The patient meets that criteria,
you’re going to more specifically dig
to see if they meet three or
more of the following criteria.
Now, if the patient has an elevated
and persistently irritable mood,
you’re going to look for four
of the following criteria.
Grandiosity, which is an
Maybe a patient coming
in and saying to you,
“Doctor, I’m going to be the next
president. I ‘m going to be king.”
So they have a very inflated
sense of themselves.
Maybe they have a
decreased need for sleep
and they tell you, “You know, doctor,
I haven’t slept in three nights
and guess what, I don’t need to.
I’m full of energy.”
And usually patients tend to
kind of like this symptom.
They may sound very pressured.
So this is where they don’t pause
in between what they’re saying,
but rather they go and on and
they’re completely uninterruptible.
They have flight of ideas
where their ideas are just –
they’re sharing with them with you one
after the other in rapid succession.
But they don’t necessarily
link together all that well.
The patient may seem very distractible
and they’re constantly having their attention
drawn to something else in the room
and they can’t stay
focused on you.
They have increased
and a clinical example might be a
patient who says to you, you know,
“Doctor, I’m so busy lately.
I’m training for a marathon.
I’m writing the next
great American novel.
I’m staying up all night washing
my house from room to room.”
So they’re doing lots of things,
but then they also tell you,
“But you know, doctor, even though
I’m doing all of these things,
I’m not really getting
any of it done,
I just kind of start these
projects and then they fall apart."
And another symptom
So a patient who’s taking on
very reckless, impulsive acts.
This may be something like spending all
of their money on a whole bunch of junk
that they don’t need or
speeding in their car
or having a lot of sexual indiscretions
that’s out of character with them.
Bipolar mania causes marked impairment
in social and occupational functioning.
And it is not due to any other substance
or general medical condition,
very important things to keep in mind
when you’re formulating your diagnosis.
Here is a really handy acronym
to remembering the criteria
and target symptoms of mania.
So keep this in mind.
The D is distractibility,
grandiosity, flight of ideas,
activity or agitation, such as
increased goal-directed activity,
pressured speech and also
thoughtless disregard of others.
So keep that in mind.
A manic episode is a
because of severely impaired
judgment, very important point.
We talked about hypomania
earlier, so let me define it for you here.
This is a distinct period of
abnormally and persistently
elevated expansive or irritable mood
and abnormally and persistently
increased activity or energy
lasting at least four consecutive days
and present most of the
day nearly every day.
So slightly different from a manic episode.
Unlike mania, hypomania
episodes are not severe enough
to cause marked impairment in
social or occupational functioning.
So this is a very important point.
While mania involves
this huge shifted mood
where people get people get so elevated
that it really impairs their lives.
Hypomania is a very small degree of that.
So life isn’t really being disrupted.
In fact, in clinical practice,
most people will tell you that they
enjoy their hypomanic episodes.
If during a period of elation
and uncharacteristic behaviors,
symptoms are present,
then by definition that episode
is considered a manic episode.
So basically, a mood elevation
with psychotic features
is going to qualify for a mania
as opposed to hypomania.
Sometimes people with bipolar disorder
will have depressed episodes.
And I’m going to take an
opportunity her to review with you
the depressed symptoms and what
that assessment looks like.
So patients here are going to meet five
or more of the following target symptoms:
Having a depressed mood, nearly every day,
or weight changes,
sleep disturbance, whether
it’s too much or too little.
loss of energy,
feeling worthless or
thoughts of suicide.
When it comes to bipolar
symptoms cause a marked impairment in
social and occupational functioning.
And of course, you must rule
out that these symptoms
are not due to general medical
condition or substance use.
Here’s a quick
mnemonic to remember,
the major depressive
target symptoms, SIGECAPS.
This is very helpful
to keep in mind.
So sleep disturbance,
loss of interest, guilt,
energy changes, concentration changes,
appetite alterations, psychomotor
activity and also suicidal thoughts.
Major depressive episodes can be present
in both bipolar I or bipolar II disorder.
And patients will experience depression
after the resolve of a manic episode.
When it comes to cyclothymic disorder,
this is numerous periods of both hypomania
and depression within a discrete timeframe.
Rapid cycling is another way
to describe bipolar disorder
and this includes four or more mood
episodes during a 12-month period.
Rapid cycling is basically
defined as the occurrence
of four or more mood episodes
in a one-year period.
There are also seasonal
patterns to bipolar disorder.
There can be a temporal relationship
between shift in mood
and the time of year.
And some common substances that can induce
mania or look like a bipolar disorder
are PCP or angel dust, cocaine, stimulants,
and corticosteroids, along with SSRIs.
I said this earlier and it’s
a really important point
that antidepressants can
actually unmask a manic episode.
So it’s very important in a patient whom
you might think is very depressed
to warn them and also observe
them for any emerging signs
of hypomania or mania once
they start an antidepressant.