front 1 Bipolar and Related Dx- List | back 1 - Bipolar I
- Bipolar II
- Cyclothymic Dx
- Substance/education induced bipolar
- Bipolar and related
dx due to another medical condition
- Other specified
bipolar
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| back 2 - 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.
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| back 3 - 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
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| back 4 - 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
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| back 5 - 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
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| back 6 - 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
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front 7 Hypomanic Episode Criteria | back 7 - 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
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front 8 Depressive Episode Criteria | back 8 - 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
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| back 9 - 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
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| back 10 - 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
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| back 11 - 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
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| back 12 - 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
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front 13 with melancholic features | back 13 - 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
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| back 14 - 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
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| back 15 - 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)
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| back 16 - bipolar specifier (for manic or depressive eps)
- doesn't apply to hypomania
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| back 17 - 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
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| back 18 - applies to the lifetime pattern of mood episodes
- essential feature sis a regulars seasonal pattern of at least 1
type of mood episode
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front 19 in partial vs full remission | back 19 - 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
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| back 20 - 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
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front 21 severity of depressive ep | back 21 - 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
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