Bipolar and Related Dx Flashcards

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1

Bipolar and Related Dx- List

  1. Bipolar I
  2. Bipolar II
  3. Cyclothymic Dx
  4. Substance/education induced bipolar
  5. Bipolar and related dx due to another medical condition
  6. Other specified bipolar

2

Bipolar I Dx

  • For a diagnosis of bipolar I, it is necessary to meet the criteria for a manic episode. The manic episode may have been preceded by and may be followed by a hypomanic or a major depressive episode (but does not have to be preceded or followed by these episodes)
  • A. criteria met for at least one manic episode
  • B. at least one manic episode is not better explained by schizoaffective dx and is not superimposed on schizophrenia, schizophreniform dx, delusional dx, or other specified or unspecified schizophrenia spectrum dx
  • Coding depends on type of most recent episode (manic, hypomanic, depressive), current severity (mild, moderate, severe), presence of psychotic features, and remission status. BUT current severity and psychotic features are only indicated if full criteria are currently met for a manic or major depressive episode. Remission specifiers are only indicated if the full criteria are not current met fo rmanic, hypomanic, or major depressive episode.

3

Bipolar I Dx- specifiers

  • Coding depends on type of most recent episode (manic, hypomanic, depressive), current severity (mild, moderate, severe), presence of psychotic features, and remission status.
  • BUT current severity and psychotic features are only indicated if full criteria are currently met for a manic or major depressive episode.
  • Remission specifiers are only indicated if the full criteria are not current met for manic, hypomanic, or major depressive episode.
  • Specify if: with
    • anxious distress, mixed features, rapid cycling, melancholic features, atypical features, mood-congruent psychotic features, mood incongruent psychotic features, with catatonia, with peripartum onset, with seasonal pattern

4

Bipolar II Dx

  • A. Criteria have been met for at least 1 hypomanic episode and at least 1 major depressive episode
  • B. There has never been a manic episode
  • C. At least one hypomanic episode and at least one major depressive episode are not better explained by schizoaffective dx, and are not superimposed on schizophrenia, schizophreniform dx, delusional dx, or other specified or unspecific schizophrenia spectrum dx
  • D. the symptoms of depression or the unpredictability cause by frequent alternation between periods of depression and hypomania cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

5

Bipolar II Dx-Specifiers

  • unlike Bipolar I, there's only one code. should specify most recent episode, presence of psychotic features, and other specifiers should be written out
  • Specify current or most recent episode: hypomanic, depressed
  • If most recent was hypomanic, Specify if
    • with anxious distress, with mixed features, with rapid cycling, with peripartum onset, with seasonal pattern
    • there should not be psychotic features-- if there are then its by definition a manic episode and not a hypomanic
  • If most recent was depressive, Specify if
    • 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
  • If full criteria for a mood episode is not currently met: must specify if in full or partial remission
  • Specify severity if full criteria for major depressive ep are met: mild, moderate, severe

6

Manic Episode Criteria

  • A. a distinct period of abnormally/ persistently elevated, expansive, irritable mood and increased activity or energy, lasting at least 1 week and present most of the day, nearly everyday (or any duration if hospitalization is necessary)
  • B. During the period of mood disturbance and increased energy, 3 or more of the following present to a significant degree and represent a noticeable change from usual bx:
    • 1. inflated self esteem, 2. decreased need for sleep, 3. more talkative than usual or pressure to keep talking, 4.flight of ideas or racing thoughts, 5. distractibility, as reported or observed, 6. increase in goal oriented activity, 7. excessive involvement in activities that have a high potential for painful consequences
  • C. mood disturbance is severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm, or there are psychotic symptoms
  • D. episode not attributable to the effects of a substance or other medical condition

7

Hypomanic Episode Criteria

  • A. distinct period of abnormally, persistently elevated, expansive, or irritable mood and increased energy lasting at least 4 consecutive days and present most of the day, nearly everyday
  • B. during the mood disturbance and increased energy, three or more of the following have been present to a significant degree:
    • 1. inflated self esteem, 2. decreased need for sleep, 3. more talkative than usual or pressure to keep talking, 4.flight of ideas or racing thoughts, 5. distractibility, as reported or observed, 6. increase in goal oriented activity, 7. excessive involvement in activities that have a high potential for painful consequences
  • C. Mood episode not associated with an unequivocal change in functioning that is uncharacteristic of the individual when not symptomatic
  • D. disturbance in mood and change in functioning observable by others
  • E. episode is not severe enough to cause marked impairment in social/occupational functioning, or does not necessitate hospitalization. If there are psychotic features then the episode is by definition actually a manic episode
  • F. Episode is not attributable to the effects of a substance or another medical condition

8

Depressive Episode Criteria

  • A. 5 or more of the following symptoms present during the same 2 week period and represent a change from previous functioning; at least one of the symptoms have to be depressed mood or loss of interest/pleasure
    • 1. depressed mood most of the day, nearly everyday; 2. marked diminished interest or pleasure; 3. significant weight loss or gain without intent (5% change in month), 4. insomnia or hypersomnia nearly everyday, 5. psychomotor agitation nearly everyday, 6. fatigue or loss of energy nearly everyday, 7. feelings of worthlessness or guilt, 8. diminished ability to think or concentrate nearly everyday, 9. recurrent thoughts of death, SI, or attempt
  • B. symptoms cause clinically significant distress or impairment in social/occupational/ or other areas of functioning
  • C. episode not attributable to the effects of a substance or other medical condition

9

Cyclothymic Dx

  • A. for at least 2 years (or 1 year in children/adols) there have been numerous periods of hypomanic symptoms that do not meet criteria for the hypomanic episode and numerous periods with depressive symptoms that do not meet criteria for major depressive ep
  • B. during that same 2 year period, Criterion A symptoms been present at least 1/2 the time and the individual has not been without symptoms for more than 2 months at a time
  • C. Criteria for major depressive ep, manic, or hypomanic eps have never been met
  • D. symptoms in Criterion A are not better explained by schizoaffective dx, schizophrenia, schizophreniform, delusion dx, or other psychotic dx
  • E. symptoms not attributable to the effects of a substance or other medical condition
  • F. cause clinically significant distress or impairment in areas of functioning
  • specify if with anxious distress

10

With anxious distress

  • bipolar I (manic, hypomanic, depressive) and bipolar II (hypomanic, depressive), and cyclothymic specifier
  • 2+ of these symptoms during the mood episode:
    • 1.feeling keyed up/tense
    • 2. feeling restless
    • 3. difficulty concentrating bc of worry
    • 4.fear that something awful will happen
    • 5.feeling that you might lose control of yourself
  • Specify if
    • mild=2 sx
    • moderate= 3 sx
    • moderate-severe= 4-5 sx
    • severe= 4-5 sx with motor agitation

11

With mixed features

  • bipolar I (manic, hypomanic, depressive) and bipolar II (hypomanic, depressive), and cyclothymic specifier
  • pretty much feeling depressed or meeting depressive episode symptoms during a manic or hypomanic episode
  • AND/ OR pretty much feeling hypomanic or manic during a depressive episode
  • ***mixed features associated with a depressive episode are a significant risk factor in developing bipolar 1 or 2

12

With rapid cycling

  • bipolar I (manic, hypomanic, depressive) and bipolar II (hypomanic, depressive) specifier
  • presence of at least 4 mood episodes in the previous 12 months
  • **episodes are demarcated by partial or full permission of at least 2 months or a switch to an episode of the opposite polarity

13

with melancholic features

  • bipolar I (depressive) and bipolar II (depressive) specifier
  • pretty much nearly a COMPLETE absence capacity for pleasure
  • applied if the features are present at the most severe stage of the episode

14

With atypical features

  • bipolar 1 and 2 (only depressive ep) specifier
  • applied when these features predominate during the majority of the days of the depressive episode
  • A. mood reactivity (brightens)
  • B. 2+ of following
    • 1. significant weight gain or increase in appetite
    • 2. hypersomnia
    • 3. leaden paralysis (heavy feeling in limbs)
    • 4. long standing pattern of interpersonal rejection sensitivity
  • C. criteria not met for melancholic features or with catatonia

15

with psychotic features

  • specifier
  • delusions or hallucinations present at any time during the current manic or depressive eps in bipolar 1 or 2 (again psychotic features cant exist in hypomania)
  • can be mood congruent (delusions/ hallucinations reflect the current episode) or mood incongruent (delusions/ hallucinations do not reflect the current episode)

16

with catatonia

  • bipolar specifier (for manic or depressive eps)
  • doesn't apply to hypomania

17

with peripartum onset

  • applied to current manic, hypomanic, or major depressive ep if onset of mood symptoms occurs during pregnancy or in the 4 weeks following delivery
  • peripartum onset mood eps can present with psychotic features

18

with seasonal pattern

  • applies to the lifetime pattern of mood episodes
  • essential feature sis a regulars seasonal pattern of at least 1 type of mood episode

19

in partial vs full remission

  • there is a period of less than 2 months without any significant symptoms of mood eps
  • during the past 2 months, there have no significant signs/ symptoms of mood eps

20

severity of manic eps

  • mild= minimum symptoms criteria met
  • moderate= very significant increase in activity or impairment in judgement
  • severe= almost continual supervision required in order to prevent physical harm to self or others

21

severity of depressive ep

  • mild= few symptoms in excess of those required to make diagnosis, intensity of symptoms is distressing but manageable, and symptoms result in minor impairment
  • moderate= number of symptoms, intensity of symptoms, and functional impairment is between mild and severe
  • severe= number of symptoms is substantially in excess of what's required to make the diagnosis, intensity is seriously distressing and unmanageable, and interfere with functioning