Bipolar disorder history and symptoms: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
 
(8 intermediate revisions by 3 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Bipolar disorder}}
{{Bipolar disorder}}
{{CMG}}
{{CMG}} {{AE}} {{nuha}}
==Overview==
==Overview==
==History and symptoms==
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months. Late adolescence and early adulthood are peak years for the onset of the illness. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. Clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with a bipolar depression episode, including information about the patient’s clinical and psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use.
 
==History and Symptoms==
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.<ref>
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.<ref>
{{Citation
{{Citation
Line 30: Line 32:
   | url = http://archpsyc.ama-assn.org/cgi/content/abstract/51/1/8
   | url = http://archpsyc.ama-assn.org/cgi/content/abstract/51/1/8
}}
}}
</ref> Late adolescence and early adulthood are peak years for the onset of the illness.<ref name ="Christie88">{{cite journal|author=Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ |year=1988 |title=Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults |journal=Am J Psychiatry |volume=145 |pages=971-975 |id=|url=http://www.ajp.psychiatryonline.org/cgi/content/abstract/145/8/971 (abstract) |accessdate = 2007-07-01 }}</ref><ref>Goodwin & Jamison. p121</ref> These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.
</ref> Late adolescence and early adulthood are peak years for the onset of the illness.<ref name="Christie88">{{cite journal|author=Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ |year=1988 |title=Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults |journal=Am J Psychiatry |volume=145 |pages=971-975 |id=|url=http://www.ajp.psychiatryonline.org/cgi/content/abstract/145/8/971 (abstract) |accessdate = 2007-07-01 }}</ref><ref>Goodwin & Jamison. p121</ref> These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.
==Diagnosis==
Diagnosis is based on the self-reported experiences of the patient as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a [[psychiatrist]], [[social worker]], [[clinical psychologist]] or other clinician in a clinical assessment. There is a list of criteria that must be met for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms.
 
An initial assessment includes a comprehensive history and physical examination by a physician. Although there are no biological tests which confirm bipolar disorder, tests are carried out to exclude medical illnesses which may rarely present with psychiatric symptoms. These include blood tests measuring [[Thyroid-stimulating hormone|TSH]] to exclude [[hypothyroidism|hypo-]] or [[hyperthyroidism]], [[Blood tests#Blood chemistry tests|basic electrolytes]] and serum [[calcium]] to rule out a metabolic disturbance, [[Complete blood count|full blood count]] including [[Erythrocyte sedimentation rate|ESR]] to rule out a systemic infection or chronic disease, and [[serology]] to exclude [[syphilis]] or [[HIV]] infection; two commonly ordered investigations  are [[Electroencephalography|EEG]] to exclude [[epilepsy]], and a [[Computed tomography|CT scan]] of the head to exclude brain lesions. There are several psychiatric illnesses which may present with similar symptoms; these include [[schizophrenia]],<ref>Pope HG (1983). Distinguishing bipolar disorder from schizophrenia in clinical practice: guidelines and case reports. Hospital and Community Psychiatry, 34: 322–328.</ref> drug intoxication, brief drug-induced psychosis, [[schizophreniform disorder]] and[[borderline personality disorder]].
 
The last is important as both diagnoses involve symptoms commonly known as "mood swings". In bipolar disorder, the term refers to the cyclic episodes of elevated and depressed mood which generally last weeks or months (notwithstanding Rapid Cycling variant of greater than four episodes a year). The term in borderline personality refers to the marked [[Affective_lability|lability]] and reactivity of mood, known as [[emotional dysregulation]], due to response to external psychosocial and intrapsychic stressors; these may arise or subside suddenly and dramatically and last for seconds, minutes, hours or days. A bipolar depression is generally more pervasive with sleep, appetite disturbance and nonreactive mood, whereas the mood in dysthymia of borderline personality remains markedly reactive and sleep disturbance not acute.<ref>Goodwin & Jamison. p108-110</ref>
 
The relationship between bipolar disorder and borderline personality disorder has been debated; some hold that the latter represents a subthreshold form of affective disorder,<ref>{{cite journal |author=Akiskal HS, Yerevanian BI, Davis GC, King D, Lemmi H|year=1985 |title=The nosologic status of borderline personality: Clinical and polysomnographic study |journal=Am J Psychiatry|volume=142 |pages=192-198}}</ref><ref>{{cite journal |author=Gunderson JG, Elliott GR |year=1985 |title=The interface between borderline personality disorder and affective disorder |journal=Am J Psychiatry |volume=142 |pages=277-288}}</ref> while others maintain the distinctness, though noting they often coexist.<ref>{{cite journal |last=McGlashan |first=TH |year=1983 |title=The borderline syndrome:Is it a variant of schizophrenia or affective disorder? |journal=Arch Gen Psychiatry |volume=40|pages=1319-1323}}</ref><ref>{{cite journal |author= Pope HG Jr, Jonas JM, Hudson JI, Cohen BM, Gunderson JG|year=1983 |title=The validity of DSM-III borderline personality disorder: A phenomenologic, family history, treatment response, and long term follow up study |journal= Arch Gen Psychiatry|volume=40 |pages=23-30}}</ref>
 
Investigations are not generally repeated for relapse unless there is a specific ''medical'' indication. These may include serum [[BSL]] if [[olanzapine]] has previously been prescribed, lithium or valproate level to check compliance or toxicity with those medications, renal or thyroid function if lithium has been previously prescribed and taken regularly. Assessment and treatment are usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to self or others.
 
The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's [[Diagnostic and Statistical Manual of Mental Disorders]], the current version being DSM-IV-TR, and the [[World Health Organization|World Health Organization's]] [[ICD|International Statistical Classification of Diseases and Related Health Problems]], currently the ICD-10. The latter criteria are typically used in European countries while the DSM criteria are used in the USA or the rest of the world, as well as prevailing in research studies.
 
===Diagnostic criteria===
{{main|Current diagnostic criteria for bipolar disorder}}
[[Flow (psychology)|Flux]] is the fundamental nature of bipolar disorder. Both within and between individuals with the illness, energy, [[mood]], thought, sleep, and activity are among the continually changing [[biological markers]] of the disorder. The [[diagnostic]] [[subtypes]] of bipolar disorder are thus static descriptions&mdash;snapshots, perhaps&mdash;of an illness in continual change, with a great diversity of symptoms and varying degrees of severity. Individuals may stay in one subtype, or change into another, over the course of their illness. The DSM V, to be published in 2011 , will likely include further and more accurate sub-typing (Akiskal and Ghaemi, 2006).


There are four types of bipolar illness. The [[Diagnostic and Statistical Manual of Mental Disorders|''Diagnostic and Statistical Manual of Mental Disorders-IV-TR'' (DSM-IV-TR)]] details four categories of bipolar disorder, [[Bipolar I]], Bipolar II, [[Cyclothymia]], and [[Bipolar Disorder NOS]] (Not Otherwise Specified).
===Prodrome===
Prodromal signs and symptoms such as irritability, anxiety, mood liability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of bipolar disorder.


For a diagnosis of '''Bipolar I''' disorder according to the [[DSM-IV-TR]], there requires one or more manic or mixed episodes. A depressive episode is not required for the diagnosis of Bipolar I disorder but it frequently occurs.
===Manic episodes===
The course of illness in mania may be marked by a sudden onset, and episodes progress quickly over a few days. The duration of manic episodes ranges from weeks to months.<ref name="DSMV3">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


'''Bipolar II''', which occurs more frequently is usually characterized by at least one episode of [[hypomania]] and at least one depression.  
*Involve clinically significant changes in mood, energy, activity, behavior, sleep, and cognition.
*Abnormally elevated, irritable, and labile mood is a core symptom required to diagnose mania.
*Classic mania is marked by an unusually good, euphoric, or high mood, which may be accompanied by disinhibition, disregard for social boundaries, expansiveness.
*Another core diagnostic symptom of mania is persistently increased energy and activity.
*Increased planning and activity is typically marked by impulsivity, poor judgement.
*Patients are often unable to complete the many tasks or projects that are started.
*Manic patients generally have an exaggerated sense of wellbeing and self-confidence, which may extend to grandiosity of psychotic proportions.
*There is decreased need for sleep.
*Common cognitive symptoms of mania include increased mental activity, racing thoughts, distractibility, and difficulty distinguishing between relevant and irrelevant thoughts; these symptoms result in flight of ideas.
*In addition, patients may not recall events that occur during manic episodes.
*Manic speech is generally loud, pressured or accelerated, and difficult to interrupt.


A diagnosis of [[cyclothymia|Cyclothymic Disorder]] requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet ''full'' criteria for major depressive episodes. The main idea here is that there is a low-grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning.
<br />


If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of '''Bipolar Disorder NOS''' (Not Otherwise Specified).
===Hypomania <ref name="DSMV4">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===


Although a patient will most likely be depressed when they first seek help, it is very important to find out from the patient or the patient's family or friends if a manic or hypomanic episode has ever been present, using careful questioning. This will prevent misdiagnosis of Depressive Disorder and avoids the use of an antidepressant which may trigger a "switch" to hypomania or mania or induce rapid cycling. Recent screening tools such as [http://www.bipolarlab.com/hcl the Hypomanic Check List Questionnaire (HCL-32)] have been developed to assist the quite often difficult detection of Bipolar II disorders.
*Hypomanic episodes are characterized by changes in mood, energy, activity, behavior, sleep, and cognition that are similar to those of mania, but less severe.
*psychotic symptoms do not occur in hypomania, and hypomania never necessitates hospitalization.
*The course of hypomania is such that it generally begins suddenly and progresses quickly over one to two days. Episodes typically resolve within several weeks.


===Delay in diagnosis===
===Major depression===
The behavioral manifestations of bipolar disorder are often not understood by patients nor recognized by mental health professionals, so people may suffer unnecessarily for over 10 years in some cases before receiving proper treatment.<ref>{{cite web|url=http://www.familyaware.org/expertprofiles/drghaemi4.asp|title=Bipolar Disorder: How long does it usually take for someone to be diagnosed for bipolar disorder?|author=S. Nassir Ghaemi|date=2001|accessdate = 2007-02-20}}</ref> 


That treatment lag is apparently not decreasing, even though there is now increased public awareness of this mental health condition in popular magazines and health websites. Recent [[TV special]]s, for example the BBC's ''The Secret Life of the Manic Depressive'',<ref>{{cite web|url=http://www.bbc.co.uk/health/tv_and_radio/secretlife_index.shtml|title=The Secret Life of the Manic Depressive|publisher=BBC|date=2006|accessdate = 2007-02-20}}</ref> MTV's ''True Life: I'm Bipolar'', talk shows, and public radio shows, and the greater willingness of public figures to discuss their own bipolar disorder, have focused on psychiatric conditions thereby further raising public awareness.
*Episodes of major depression involve clinically significant changes in mood, behavior, energy, sleep, and cognition.
*Bipolar major depression is generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity (eg, speech is slow and soft, and output reduced).
*Interest in pleasurable activities (eg, sex) is minimal, energy is low, and memory and concentration are impaired.
*Appetite is typically diminished and accompanied by weight loss.
*Sleep disturbances (insomnia or hypersomnia) often occur in bipolar depression.
*Other features of major depression include poor eye contact, poor hygiene, messy appearance, feelings of hopelessness and helplessness,


Despite this increased focus, individuals are still commonly misdiagnosed.<ref>{{cite web|title=Misdiagnosis of Bipolar Disorder|author=Roy H. Perlis|publication=American Journal of Managed Care|url=http://www.ajmc.com/Article.cfm?Menu=1&ID=2969|date=2005|accessdate = 2007-02-20}}
<br />
</ref>


===Children===
===Mixed features===
{{main|Bipolar disorder in children}}
Children with bipolar disorder do not often meet the strict DSM-IV definition. In pediatric cases, the cycling can occur very quickly (see section above on rapid cycling).<ref name=Kranowitz, C.S. & Post, R., (1996)>Kranowitz, C.S. & Post, R., (1996). Ultra-rapid and ultradian cycling in bipolar affective illness. British Journal of Psychiatry, 168, 314-323.</ref>


Children with bipolar disorder tend to have rapid-cycling or mixed-cycling. Rapid cycling occurs when the cycles between depression and mania occur quickly, sometimes within the same day or the same hour. When the symptoms of both mania and depression occur simultaneously, mixed cycling occurs.  
*Episodes of bipolar mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity, and are referred to as mood episodes with mixed features (eg, major depression with mixed features or hypomania with mixed features).
*Manic or hypomanic episodes with mixed features are characterized by episodes that meet full criteria for mania or hypomania, and at least three of the following symptoms during most days of the episode:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
**Depressed mood
**Diminished interest or pleasure in most activities
**Psychomotor retardation
**Low energy
**Excessive guilt or thoughts of worthlessness
**Recurrent thoughts about death or suicide, or suicide attempt


Often other psychiatric conditions are diagnosed in bipolar children. These other diagnoses may be concurrent problems, or they may be misdiagnosed as bipolar disorder. [[Clinical Depression|Depression]], [[ADHD]], [[ODD]], [[schizophrenia]], and [[Tourette syndrome]] are common [[comorbid]] conditions.  Furthermore some children with histories of abuse or neglect may have Bipolar I Disorder. There is a high comorbidity between [[Reactive attachment disorder]] and Bipolar I Disorder with about 50% of children in the [[Child Welfare]] System who have Reactive Attachment Disorder also have Bipolar I Disorder<ref> Alston, J., (2000), Correlation between Childhood Biploar I Disorder and Reactive Attachment Disorder, Disinhibited Type.  In Attachment Interventions, Edited ty T. Levy, 2000, Academic Press.</ref>
*Major depressive episodes with mixed features are characterized by episodes that meet full criteria for major depression, and at least three of the following symptoms during most days of the episode:<ref name="DSMV2">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
**Elevated or expansive mood
**Inflated self-esteem or grandiosity
**More talkative than usual or pressured speech
**Flight of ideas
**Increased energy
**Decreased need for sleep


Misdiagnosis can lead to incorrect medication.
*Red flags for mixed features include the presence of clinically significant agitation, anxiety, or irritability.
*Patients with mixed features are at greater risk for suicidal ideation and comorbid anxiety disorders and substance use disorders.<ref name="pmid23223893">{{cite journal| author=Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM | display-authors=etal| title=Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. | journal=Am J Psychiatry | year= 2013 | volume= 170 | issue= 1 | pages= 31-42 | pmid=23223893 | doi=10.1176/appi.ajp.2012.12030301 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23223893  }}</ref>
*The esponse to treatment is often poorer in mood episodes with mixed features than in pure bipolar major depression or pure mania.<ref name="pmid20368510">{{cite journal| author=Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG | display-authors=etal| title=Longitudinal course of bipolar I disorder: duration of mood episodes. | journal=Arch Gen Psychiatry | year= 2010 | volume= 67 | issue= 4 | pages= 339-47 | pmid=20368510 | doi=10.1001/archgenpsychiatry.2010.15 | pmc=3677763 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20368510  }}</ref>


On September, 2007, experts (from [[New York]], [[Maryland]] and [[Madrid]]) found that the number of [[United States|American]] [[children]] and [[adolescents]] treated for bipolar disorder increased 40-fold from 1994 to 2003, and it was increasing ever since. However, the increase was due to the fact that [[doctors]] more aggressively applied the [[diagnosis]] to children, and not that the incidence of the [[disorder]] had increased. The study calculated the number of visits which increased, from 20,000 in 1994 to 800,000 in 2003, or 1% of the [[population]] under age 20. <ref>[http://www.nytimes.com/2007/09/04/health/04psych.html?em&ex=1189051200&en=13c932cc4a338702&ei=5087%0A  New York Times, Bipolar Illness Soars as a Diagnosis for the Young]</ref>


==References==
==References==

Latest revision as of 01:28, 5 August 2021

Bipolar disorder Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Causes

Differentiating Bipolar disorder from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Criteria

Bipolar I
Bipolar II
Cyclothymic Disorder
Substance/Medication-Induced Bipolar Disorder
Bipolar Disorder Due to Another Medical Condition
Unspecified Bipolar Disorder

History and Symptoms

Physical Examination

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Bipolar disorder history and symptoms On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Bipolar disorder history and symptoms

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Bipolar disorder history and symptoms

CDC on Bipolar disorder history and symptoms

Bipolar disorder history and symptoms in the news

Blogs on Bipolar disorder history and symptoms

Directions to Hospitals Treating Bipolar disorder

Risk calculators and risk factors for Bipolar disorder history and symptoms

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]

Overview

Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months. Late adolescence and early adulthood are peak years for the onset of the illness. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. Clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with a bipolar depression episode, including information about the patient’s clinical and psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use.

History and Symptoms

Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.[1] Late adolescence and early adulthood are peak years for the onset of the illness.[2][3] These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.

Prodrome

Prodromal signs and symptoms such as irritability, anxiety, mood liability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of bipolar disorder.

Manic episodes

The course of illness in mania may be marked by a sudden onset, and episodes progress quickly over a few days. The duration of manic episodes ranges from weeks to months.[4]

  • Involve clinically significant changes in mood, energy, activity, behavior, sleep, and cognition.
  • Abnormally elevated, irritable, and labile mood is a core symptom required to diagnose mania.
  • Classic mania is marked by an unusually good, euphoric, or high mood, which may be accompanied by disinhibition, disregard for social boundaries, expansiveness.
  • Another core diagnostic symptom of mania is persistently increased energy and activity.
  • Increased planning and activity is typically marked by impulsivity, poor judgement.
  • Patients are often unable to complete the many tasks or projects that are started.
  • Manic patients generally have an exaggerated sense of wellbeing and self-confidence, which may extend to grandiosity of psychotic proportions.
  • There is decreased need for sleep.
  • Common cognitive symptoms of mania include increased mental activity, racing thoughts, distractibility, and difficulty distinguishing between relevant and irrelevant thoughts; these symptoms result in flight of ideas.
  • In addition, patients may not recall events that occur during manic episodes.
  • Manic speech is generally loud, pressured or accelerated, and difficult to interrupt.


Hypomania [5]

  • Hypomanic episodes are characterized by changes in mood, energy, activity, behavior, sleep, and cognition that are similar to those of mania, but less severe.
  • psychotic symptoms do not occur in hypomania, and hypomania never necessitates hospitalization.
  • The course of hypomania is such that it generally begins suddenly and progresses quickly over one to two days. Episodes typically resolve within several weeks.

Major depression

  • Episodes of major depression involve clinically significant changes in mood, behavior, energy, sleep, and cognition.
  • Bipolar major depression is generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity (eg, speech is slow and soft, and output reduced).
  • Interest in pleasurable activities (eg, sex) is minimal, energy is low, and memory and concentration are impaired.
  • Appetite is typically diminished and accompanied by weight loss.
  • Sleep disturbances (insomnia or hypersomnia) often occur in bipolar depression.
  • Other features of major depression include poor eye contact, poor hygiene, messy appearance, feelings of hopelessness and helplessness,


Mixed features

  • Episodes of bipolar mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity, and are referred to as mood episodes with mixed features (eg, major depression with mixed features or hypomania with mixed features).
  • Manic or hypomanic episodes with mixed features are characterized by episodes that meet full criteria for mania or hypomania, and at least three of the following symptoms during most days of the episode:[6]
    • Depressed mood
    • Diminished interest or pleasure in most activities
    • Psychomotor retardation
    • Low energy
    • Excessive guilt or thoughts of worthlessness
    • Recurrent thoughts about death or suicide, or suicide attempt
  • Major depressive episodes with mixed features are characterized by episodes that meet full criteria for major depression, and at least three of the following symptoms during most days of the episode:[7]
    • Elevated or expansive mood
    • Inflated self-esteem or grandiosity
    • More talkative than usual or pressured speech
    • Flight of ideas
    • Increased energy
    • Decreased need for sleep
  • Red flags for mixed features include the presence of clinically significant agitation, anxiety, or irritability.
  • Patients with mixed features are at greater risk for suicidal ideation and comorbid anxiety disorders and substance use disorders.[8]
  • The esponse to treatment is often poorer in mood episodes with mixed features than in pure bipolar major depression or pure mania.[9]


References

  1. ↑ Kessler, RC; McGonagle, KA; Zhao, S; Nelson, CB; Hughes, M; Eshleman, S; Wittchen, HU; Kendler, KS (1994), "Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States", Archives of General Psychiatry, 51 (1): 8–19
  2. ↑ Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ (1988). (abstract) "Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults" Check |url= value (help). Am J Psychiatry. 145: 971–975. Retrieved 2007-07-01.
  3. ↑ Goodwin & Jamison. p121
  4. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  5. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  6. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  7. ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  8. ↑ Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM; et al. (2013). "Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis". Am J Psychiatry. 170 (1): 31–42. doi:10.1176/appi.ajp.2012.12030301. PMID 23223893.
  9. ↑ Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG; et al. (2010). "Longitudinal course of bipolar I disorder: duration of mood episodes". Arch Gen Psychiatry. 67 (4): 339–47. doi:10.1001/archgenpsychiatry.2010.15. PMC 3677763. PMID 20368510.

Template:WH Template:WS

Retrieved from "https://www.wikidoc.org/index.php?title=Bipolar_disorder_history_and_symptoms&oldid=1710340"