Mood episodes of mania, hypomania and depression

Mania

1) A period of abnormally and persistently elevated, expansive or irritable mood and energy lasting at least one week

2) Three or more

• Inflated self-esteem

• Decreased need for sleep

• More talkative or pressure

• Flight of ideas

• Distractilbility

• Increase in goal-oriented activity

• Excessive activities that have a high potential for painful consequences

3) Mood disturbance is severe

4) No attributable to other causes

Hypomania

1) As above by lasting at least 4 days

2) Change in functioning that is uncharacteristic

3) Mood disturbance observed by others

4) No marked impairment in social or work function

Depression

1) 5 or more over 2 weeks

• Depressed mood

• Diminished pleasure

• Weight loss or gain

• Hypersomnia or insomnia

• Psychomotor agitation

• Worthlessness or guilt

• Diminished ability to think

• Thoughts of death

2) Symptoms cause significant distress or impairment

3) Not attributable to another cause

Presents with depression (54%), mania (22%) and mixed (24%)
Associated feature in that non-psychotic perception of senses is enhanced

Mania Episodes

• 25% resolved within 4 weeks

• 50% resolved within 7 weeks

• 75% resolved within 15 weeks

Hypomania

• Can be elevated and euphoric but often irritability, dysphoria, depression

• Self esteem up but never grandiose

• Thinking is quick

• Speech is loud and rapid

• Risk-taking is mild to moderate

• No psychosis

Episodes

• 25% resolve within 2 weeks

• 50% within 3 weeks

• 75% within 6 weeks

Major Depression

• Bipolar I

  • Deprssion was present in 34% of follow up

  • Mania / Hypomania was present in 10%

• Bipolar II

  • Depression in 40%

  • Hypomania in 5%

Mania with Mixed Episodes

• Meet criteria for mania / hypomania and at least 3 for depression

  • Depressed mood

  • Diminised interest

  • Low energy

  • Psychomotor retardation

  • Excessive guilt

  • Recurrent thoughts of death

Major Depression with Mixed Features

• Meet criteria for major depression plus at least 3 of

  • Elevated mood

  • Inflated self-esteem

  • More talkative

  • Flight of ideas

  • Increased energy

  • Activities with high potential for painful consequences

  • Decreased need for sleep

Psychosis

• Delusions - False beliefs that can involve grandiosity or persecutions

• Hallucinations - False sensory perceptions that are typically auditory

• Disorganised thinking and behaviour

• Lifetime prevalence is 60 to 75%

Medical comorbidity

Relatively common

• Arthritis

• Asthma

• CV disease

• Migraines

• Thyroid disease

Suicide attempts

• 20%

• Multiple attempts in 32%

Diagnosis

• Bipolar I - One or more manic episodes

• Bipolar II - One or more episodes of hypomania

• Cyclothymia - Numerous periods of hypomania symptoms falling short of criteria for a hypomanic episode

• Substance / medication induced Bipolar - Mood disturbance soon after substance (cocaine / phencyclidine / Corticosteroids / Stimulants)

• Bipolar due to another medical condition - Hypercortisolism, MS, stroke, TBA, SLE

• Other specific bipolar disorder

Mood specifiers

• Rapid cycling - Four or more episodes during 12 months

• Seasonal pattern - One type of episode at a specific time of year for 2 or more years

Treatment