Bipolar Disorder I
| Presentation | Presence of at least 1 manic episode for at least 1 week (↑ Mood → cheerful, enthusiastic, Expansive or Irritable + ≥ 3 or 4 (if irritable) of 7 of DIGFAST) • Manic = DIG FAST → ≥3 symptoms 1. Distractibility 2. Impaired judgment/ Indiscretion 3. Grandiosity 4. Flight of ideas 5. Activity ↑ 6. Sleep deficit 7. Talkativeness |
| Management | -lithium 1st line -valproic acid, carbamazepine -second-generation antipsychotics (olanzapine), first-generation antipsychotics (haloperidol) or benzos may be added if psychosis or agitation develops -other treatment: electroconvulsive therapy, MAOI, SSRIs, TCAs (however antidepressants medications may precipitate mania) -therapy: CBT, interpersonal, good sleep hygiene recommended |
Bipolar Disorder II
| Presentation | • Hypomania = TAD HIGH 1. Talkative 2. Attention-deficit 3. Decreased need for sleep 4. High self-esteem/ grandiosity 5. Ideas that race 6. Goal-directed activity increased 7. High-risk activity |
| Hypomania Characteristics | -≥ 1 hypomanic episode + ≥ 1 major depressive episode -mania or mixed episodes are absent -symptoms similar to manic symptoms -> period of elevated, expansive, or irritably mood at least 4 days that is clearly different from the usual non-depressed mood but does not cause marked impairment, no psychotic features and does not require hospitalization usually -does not include racing thoughts or excessive psychomotor agitation |
| Management | -similar to bipolar I (antipsychotics, mood stabilizers, benzos) 1. acute mania: mood stabilizers (lithium), valproate, second-generation antipsychotics 2. depression: lithium, valproate, carbamazepine, second-generation antipsychotics 3. mixed: atypical antipsychotics, valproate |
Cyclothymic Disorder
| Presentation | 2 years (1-year in Children and Adolescents) of hypomania + mild depressive symptoms (not MDE) – Mildly depressed mood and Mild mania (cycles) – No symptom-free period > 2 months – Dysthymia and Hypomania → milder form of bipolar disorder lasting at least 2 years – At least 2 years of hypomanic symptoms that DO NOT meet criteria for Manic Episode and numerous periods of depressive symptoms that DO NOT meet the criteria for MDE |
| Management | -similar to bipolar I: mood stabilizers and neuroleptics |
Depressed Mood
| Presentation | |
| Work-up | – Physical Exam (PE) – Mental Status Exam (MSE) – Blood alcohol – TSH – CBC – Urine Toxicology (Urine Tox) |
| Management |
Major Depressive Disorder (MDD)
| Presentation | Last ≥ 2 weeks with ≥ 5 symptoms and MUST Include Depressed Mood or Anhedonia (loss of interest) SIGECAPS – Sleep disturbance (↑ or ↓) – Interest Loss → MUST Include (or depressed mood) – Guilt → Feeling worthless or inappropriately guilty – Energy Loss → Fatigue – Concentration Loss → impaired concentration or indecisiveness – Appetite (weight) changes (↑ or ↓) – Psychomotor Changes (agitation or retardation) – Suicidal ideation → thoughts of death |
| Management | mild to mood: – psychotherapy – SSRIs 1st line meds |
Persistent Depressive Disorder (Dysthymic)
| Presentation | Milder form of depression lasting at least 2 years → Not as severe or disabling HE’S 2 SAD 1. Hopelessness 2. Energy loss or fatigue 3. Self-esteem is low 4. 2 years minimum of depressed mood most of day, for more days than not 5. Sleep disorder (↑ or ↓) 6. Appetite change (↑ or ↓) 7. Decision-making or concentration impaired |
| Overview | 1. generalized loss of interest, social withdrawal, pessimism, decreased productivity 2. chronic depressed mood > 2 years in adults (> 1 year in children.adolescents) for most of the day, more days than not -in that 2 year period, the patient is not symptom-free for > 2 months at a time -may say things like “I’ve always been this way” 3. at least 2 of the following conditions must be present: insomnia or hypersomnia, fatigue, low self-esteem, decreased appetite or overeating, hopelessness, poor concentration, indecisiveness -patients are usually able to function (may experience mild decreased productivity) -MC in women, begins MC in late teens, early adulthood -may progress over time to develop into MMD or bipolar |
| Management | -similar to depression: psychotherapy principal treatment, SSRIs first-line medical treatment -second line: SNRIs, bupropion, TCAs, and in some cases MAOI |
