Bipolar & Depressive Disorders

• Bipolar Disorder


  Bipolar I & Bipolar II, Major Depressive Disorder & persistent depressive disorder
• Bipolar Disorder


  • Need to have manic episode
• Manic Episode


  1. A distinct period of abnormally + persistently elevated, expansive, or irritable mood and abnormally + persistently increased activity or energy, lasting at least 1 week (or any duration if hospitalization is necessary)

  2. During period of mood disturbance, 3 (or more) of the following symptoms are present to a significant degree and represent a noticeable change from usual behavior

  3. The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features

  4. Episode not attributable to substance or medical conditions

  
• Hypomanic Episode


  • A distinct period of abnormally + persistently elevated, expansive, or irritable mood and abnormally + persistently increased activity or energy, lasting 4 consecutive days - present most of the day, nearly every day
  • The episode is associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
  • The disturbance in mood and the change in functioning are observable by others
  • The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic
  • Episode is not attributable to substance or medical conditions

  
• Major Depressive Episode


  • Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning, at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The episode is not attributable to the physiological effects of a substance or another medical condition

  
• Bipolar I Disorder


  • Criteria have been met for at least one manic episode
  • At least one manic episode is not better explained by Schizoaffective dx and is not superimposed on Schizophrenia, schizophreniform, delusional disorder, or other specified or unspecified Schizophrenia spectrum and other psychotic disorder

  
• Specifiers for Bipolar I Disorder


  • Severity (mild, moderate, severe)
  • With psychotic features
  • In partial remission
  • In full remission
  • Unspecified
  • With anxious distress
  • With mixed features
  • With rapid cycling
  • With melancholic features
  • With atypical features
  • With mood-congruent psychotic features
  • With mood-incongruent psychotic features
  • With catatonia
  • With peripartum onset
  • With seasonal pattern
• Differential Diagnosis for Bipolar I Disorder


  • Major depressive disorder
  • Other bipolar disorders
  • Generalized anxiety disorder, panic disorder, posttraumatic stress disorder, or other anxiety disorders
  • Bipolar related disorder due to another medical condition
  • Substance/medication-induced bipolar and related disorders
  • Schizoaffective disorder
  • Attention-deficit/hyperactivity disorder
  • Disruptive mood dysregulation disorder
  • Personality disorders
• Comorbidities for Bipolar I Disorder


  • Anxiety disorders
  • Alcohol & other substance use disorders
  • ADHD
  • Sociocultural factors
  • Borderline personality disorder
  • Schizotypal, antisocial personality disorder
  • Medical conditions (multiorgan systems, cardiovascular & autoimmune disorders, sleep apnea, migraine, metabolic syndrome)
• Bipolar II Disorder


  • Need to meet criteria for current or past hypomanic episode & current or past major depressive episode
  • There has never been a manic episode
  • At least one hypomanic episode & at least one major depressive episode are not better explained by Schizoaffective disorder, and are not superimposed on Schizophrenia, schizophreniform disorder, delusional disorder, or other specified or unspecified Schizophrenia spectrum and other psychotic disorder
  • The symptoms of depression or the unpredictability caused by frequent alternation between periods of depression/hypomania causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

  
• Specifiers for Bipolar II Disorder


  • Hypomanic
  • Depressed
  • With anxious distress
  • With mixed features
  • With rapid cycling
  • With peripartum onset
  • With seasonal pattern
  • With melancholic features
  • With atypical features
  • With mood congruent psychotic features
  • With mood incongruent psychotic features
  • Catatonia
  • In partial remission
  • In full remission
  • Severity (mild, moderate, severe)

  
• Differential Diagnosis for Bipolar II Disorder

  • Major depressive disorder
  • Cyclothymic disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Bipolar related disorders due to another medical conditions
  • Substance/medication-induced bipolar and related disorders
  • ADHD
  • Personality disorders
  • Other bipolar disorders
• Comorbidities for Bipolar II Disorder

  • Two or more recurring mental disorders
  • Anxiety disorders
  • Substance use disorders
  • Eating disorders
  • Premenstrual syndrome & premenstrual dysphoric disorder
  • Medical conditions (cardiovascular, migraine, autoimmune disorder)
• Major Depressive Disorder


  • Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning, at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The episode is not attributable to the physiological effects of a substance or another medical condition

  
• Specifiers for Major Depressive Disorder


  • Severity (mild, moderate, severe, with psychotic features)
  • In partial remission
  • In full remission
  • Unspecified
  • With anxious distress
  • With mixed features
  • With melancholic features
  • With atypical features
  • With mood-congruent psychotic features
  • With mood-incongruent psychotic features
  • With Catatonia
  • With peripartum onset
  • With seasonal patterns

  
• Differential Diagnosis for Major Depressive Disorder


  • Manic episodes with irritable mood or with mixed features
  • Bipolar I, Bipolar II disorder or other specified bipolar related disorders
  • Depressive disorder due to another medical conditions
  • Substance/medication-induced depressive disorders
  • Persistent depressive disorder
  • Premenstrual dysphoric disorder
  • Disruptive mood dysregulation disorder
  • Major depressive episodes superimposed on Schizophrenia, delusional disorder, schizophreniform disorder, or other specified or unspecified Schizophrenia spectrum and other psychotic disorders
  • Schizoaffective
  • ADHD

  
• Comorbidities for Major Depressive Disorder


  • Substance abuse disorder, panic disorder, generalized anxiety disorder, PTSD, OCD, anorexia, bulimia, borderline personality disorder
  • For women: anxiety, bulimia, somatoform
  • For men: alcohol & substance abuse

  
• Persistent Depressive Disorder


  • Depressed mood for most of the day, for more days than not, as indicated by either subjective account or observation by others for at least two years (for kids, duration 1 year)
  • Presence, while depressed, of two (or more) of the following: poor appetite or overeating, insomnia or hypersomnia, low energy or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of hopelessness
  • During the 2 year period of disturbance, the individual has never been out
  • Criteria for a major depressive disorder may be continuously present for 2 years
  • There has never been a manic episode or hypomanic episode
  • The disturbance is not better explained by a persistent schizoaffective disorder, Schizophrenia, delusional disorder, or other specified or unspecified Schizophrenia spectrum and other related disorders
  • The symptoms are not attributable to the effects of a substance
  • The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

  
• Specifiers for Persistent Depressive Disorder

  • With anxious distress
  • With atypical features
  • In partial remission
  • In full remission
  • Early or late onset
  • With pure dysthymic syndrome
  • With persistent major depressive episode
  • With intermittent major depressive episodes, with current episode
  • With intermittent major depressive episode, without current episode
  • Severity (mild, moderate, severe)

  
• Differential Diagnosis for Persistent Depressive Disorder


  • Major depressive disorder
  • Other specified depressive disorder
  • Bipolar I & Bipolar II disorder
  • Cyclothymic disorder
  • Psychotic disorders
  • Depressive or bipolar and related disorder due to another medical conditions
  • Substance/medication-induced depressive or bipolar related disorder
  • Personality disorders

  
• Comorbidities for Persistent Depressive Disorder


  • Anxiety disorders
  • Substance use disorders
  • Personality disorders