BIPOLAR DISORDER

both manic and depressive episodes

manic episodes alone

Manic Episode

DSM-IV-TR Criteria

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

• During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

– inflated self-esteem or grandiosity – decreased need for sleep– more talkative than usual or pressure

to keep talking – flight of ideas or subjective experience

that thoughts are racing – distractibility– increase in goal-directed activity or

psychomotor agitation – excessive involvement in pleasurable

activities that have a high potential for painful consequences

PATIENT• No mood elevations• There were episodes of irritable mood but not

enough to consider as the prevailing mood in this case.

• (3rd year) : very talkative in class• (Oct 08) noted to be very talkative on their way to a

cemetery in Marikina

• (3rd year) : numerous ideas running in her mind

• “hyperactive”

• (1993) grabbed car’s steering wheel while her mom was driving

• (3rd year)- shopped for clothing items & jewelries, maxing out

her 2 credit cards- shoplifting [of items she could not afford]

• (Oct 08) spent P14000 for shopping ; stayed at an apartelle for 3 days

Manic Episode

DSM-IV-TR Criteria

• The symptoms do not meet criteria for a mixed episode.

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

• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

PATIENT

Major Depressive DisorderDSM-IV-TR Criteria

• Five (or more) of the ff. 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.– depressed mood most of the day, nearly every day,

(feels sad or empty) or appears tearful ; irritable mood

– markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day

– significant weight loss when not dieting or weight gain

– insomnia or hypersomnia nearly every day – psychomotor agitation or retardation nearly every

day– fatigue or loss of energy nearly every day – feelings of worthlessness or excessive or

inappropriate guilt (which may be delusional) nearly every day

– diminished ability to think or concentrate, or indecisiveness, nearly every day

– recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide

PATIENT

• Dec 2002: bus ride – approached by a man and was told that she looks miserable and sick

- no other description in the hx that is indicative of a depressed state

Major Depressive DisorderDSM-IV-TR Criteria

• The symptoms do not meet criteria for a mixed episode.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

• The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

PATIENT

Major Depressive DisorderDSM-IV-TR Criteria

• The symptoms do not meet criteria for a mixed episode.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).

• The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation.

PATIENT

BP characteristics• Excited, talkative, hyperactive• Euphoric or irritable (low frustration tolerance)• Delusions in 75% [ patient: (+) delusion of refernce & non

bizaare delusion)• Intact orientation & memory• Assaultive or threatening• Hallmark: impaired judgment: may break laws

- Maxing out credit card- Shoplifting