Bipolar disorder history and symptoms: Difference between revisions
Jump to navigation
Jump to search
| Line 3: | Line 3: | ||
{{CMG}} {{AE}} {{nuha}} | {{CMG}} {{AE}} {{nuha}} | ||
==Overview== | ==Overview== | ||
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months. Late adolescence and early adulthood are peak years for the onset of the illness. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. Clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with a bipolar depression episode, including information about the patient’s clinical and psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use. | |||
==History and Symptoms== | ==History and Symptoms== | ||
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.<ref> | Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.<ref> | ||
| Line 32: | Line 34: | ||
</ref> Late adolescence and early adulthood are peak years for the onset of the illness.<ref name="Christie88">{{cite journal|author=Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ |year=1988 |title=Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults |journal=Am J Psychiatry |volume=145 |pages=971-975 |id=|url=http://www.ajp.psychiatryonline.org/cgi/content/abstract/145/8/971 (abstract) |accessdate = 2007-07-01 }}</ref><ref>Goodwin & Jamison. p121</ref> These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. | </ref> Late adolescence and early adulthood are peak years for the onset of the illness.<ref name="Christie88">{{cite journal|author=Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ |year=1988 |title=Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults |journal=Am J Psychiatry |volume=145 |pages=971-975 |id=|url=http://www.ajp.psychiatryonline.org/cgi/content/abstract/145/8/971 (abstract) |accessdate = 2007-07-01 }}</ref><ref>Goodwin & Jamison. p121</ref> These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. | ||
=== Prodrome === | ===Prodrome=== | ||
Prodromal signs and symptoms such as irritability, anxiety, mood liability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of bipolar disorder. | Prodromal signs and symptoms such as irritability, anxiety, mood liability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of bipolar disorder. | ||
=== Manic episodes === | ===Manic episodes=== | ||
The course of illness in mania may be marked by a sudden onset, and episodes progress quickly over a few days. The duration of manic episodes ranges from weeks to months.<ref name="DSMV3">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | The course of illness in mania may be marked by a sudden onset, and episodes progress quickly over a few days. The duration of manic episodes ranges from weeks to months.<ref name="DSMV3">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
* Involve clinically significant changes in mood, energy, activity, behavior, sleep, and cognition. | *Involve clinically significant changes in mood, energy, activity, behavior, sleep, and cognition. | ||
* Abnormally elevated, irritable, and labile mood is a core symptom required to diagnose mania. | *Abnormally elevated, irritable, and labile mood is a core symptom required to diagnose mania. | ||
* Classic mania is marked by an unusually good, euphoric, or high mood, which may be accompanied by disinhibition, disregard for social boundaries, expansiveness. | *Classic mania is marked by an unusually good, euphoric, or high mood, which may be accompanied by disinhibition, disregard for social boundaries, expansiveness. | ||
* Another core diagnostic symptom of mania is persistently increased energy and activity. | *Another core diagnostic symptom of mania is persistently increased energy and activity. | ||
* Increased planning and activity is typically marked by impulsivity, poor judgement. | *Increased planning and activity is typically marked by impulsivity, poor judgement. | ||
* Patients are often unable to complete the many tasks or projects that are started. | *Patients are often unable to complete the many tasks or projects that are started. | ||
* Manic patients generally have an exaggerated sense of wellbeing and self-confidence, which may extend to grandiosity of psychotic proportions. | *Manic patients generally have an exaggerated sense of wellbeing and self-confidence, which may extend to grandiosity of psychotic proportions. | ||
* There is decreased need for sleep. | *There is decreased need for sleep. | ||
* Common cognitive symptoms of mania include increased mental activity, racing thoughts, distractibility, and difficulty distinguishing between relevant and irrelevant thoughts; these symptoms result in flight of ideas. | *Common cognitive symptoms of mania include increased mental activity, racing thoughts, distractibility, and difficulty distinguishing between relevant and irrelevant thoughts; these symptoms result in flight of ideas. | ||
* In addition, patients may not recall events that occur during manic episodes. | *In addition, patients may not recall events that occur during manic episodes. | ||
* Manic speech is generally loud, pressured or accelerated, and difficult to interrupt. | *Manic speech is generally loud, pressured or accelerated, and difficult to interrupt. | ||
<br /> | <br /> | ||
=== Hypomania <ref name="DSMV4">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> === | ===Hypomania <ref name="DSMV4">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>=== | ||
* Hypomanic episodes are characterized by changes in mood, energy, activity, behavior, sleep, and cognition that are similar to those of mania, but less severe. | *Hypomanic episodes are characterized by changes in mood, energy, activity, behavior, sleep, and cognition that are similar to those of mania, but less severe. | ||
* psychotic symptoms do not occur in hypomania, and hypomania never necessitates hospitalization. | *psychotic symptoms do not occur in hypomania, and hypomania never necessitates hospitalization. | ||
* The course of hypomania is such that it generally begins suddenly and progresses quickly over one to two days. Episodes typically resolve within several weeks. | *The course of hypomania is such that it generally begins suddenly and progresses quickly over one to two days. Episodes typically resolve within several weeks. | ||
=== Major depression === | ===Major depression=== | ||
* Episodes of major depression involve clinically significant changes in mood, behavior, energy, sleep, and cognition. | *Episodes of major depression involve clinically significant changes in mood, behavior, energy, sleep, and cognition. | ||
* Bipolar major depression is generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity (eg, speech is slow and soft, and output reduced). | *Bipolar major depression is generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity (eg, speech is slow and soft, and output reduced). | ||
* Interest in pleasurable activities (eg, sex) is minimal, energy is low, and memory and concentration are impaired. | *Interest in pleasurable activities (eg, sex) is minimal, energy is low, and memory and concentration are impaired. | ||
* Appetite is typically diminished and accompanied by weight loss. | *Appetite is typically diminished and accompanied by weight loss. | ||
* Sleep disturbances (insomnia or hypersomnia) often occur in bipolar depression. | *Sleep disturbances (insomnia or hypersomnia) often occur in bipolar depression. | ||
* Other features of major depression include poor eye contact, poor hygiene, messy appearance, feelings of hopelessness and helplessness, | *Other features of major depression include poor eye contact, poor hygiene, messy appearance, feelings of hopelessness and helplessness, | ||
<br /> | <br /> | ||
=== Mixed features === | ===Mixed features=== | ||
* Episodes of bipolar mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity, and are referred to as mood episodes with mixed features (eg, major depression with mixed features or hypomania with mixed features). | *Episodes of bipolar mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity, and are referred to as mood episodes with mixed features (eg, major depression with mixed features or hypomania with mixed features). | ||
* Manic or hypomanic episodes with mixed features are characterized by episodes that meet full criteria for mania or hypomania, and at least three of the following symptoms during most days of the episode:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *Manic or hypomanic episodes with mixed features are characterized by episodes that meet full criteria for mania or hypomania, and at least three of the following symptoms during most days of the episode:<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
** Depressed mood | **Depressed mood | ||
** Diminished interest or pleasure in most activities | **Diminished interest or pleasure in most activities | ||
** Psychomotor retardation | **Psychomotor retardation | ||
** Low energy | **Low energy | ||
** Excessive guilt or thoughts of worthlessness | **Excessive guilt or thoughts of worthlessness | ||
** Recurrent thoughts about death or suicide, or suicide attempt | **Recurrent thoughts about death or suicide, or suicide attempt | ||
* Major depressive episodes with mixed features are characterized by episodes that meet full criteria for major depression, and at least three of the following symptoms during most days of the episode:<ref name="DSMV2">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | *Major depressive episodes with mixed features are characterized by episodes that meet full criteria for major depression, and at least three of the following symptoms during most days of the episode:<ref name="DSMV2">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref> | ||
** Elevated or expansive mood | **Elevated or expansive mood | ||
** Inflated self-esteem or grandiosity | **Inflated self-esteem or grandiosity | ||
** More talkative than usual or pressured speech | **More talkative than usual or pressured speech | ||
** Flight of ideas | **Flight of ideas | ||
** Increased energy | **Increased energy | ||
** Decreased need for sleep | **Decreased need for sleep | ||
* Red flags for mixed features include the presence of clinically significant agitation, anxiety, or irritability. | *Red flags for mixed features include the presence of clinically significant agitation, anxiety, or irritability. | ||
* Patients with mixed features are at greater risk for suicidal ideation and comorbid anxiety disorders and substance use disorders.<ref name="pmid23223893">{{cite journal| author=Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM | display-authors=etal| title=Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. | journal=Am J Psychiatry | year= 2013 | volume= 170 | issue= 1 | pages= 31-42 | pmid=23223893 | doi=10.1176/appi.ajp.2012.12030301 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23223893 }}</ref> | *Patients with mixed features are at greater risk for suicidal ideation and comorbid anxiety disorders and substance use disorders.<ref name="pmid23223893">{{cite journal| author=Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM | display-authors=etal| title=Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis. | journal=Am J Psychiatry | year= 2013 | volume= 170 | issue= 1 | pages= 31-42 | pmid=23223893 | doi=10.1176/appi.ajp.2012.12030301 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23223893 }}</ref> | ||
* The esponse to treatment is often poorer in mood episodes with mixed features than in pure bipolar major depression or pure mania.<ref name="pmid20368510">{{cite journal| author=Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG | display-authors=etal| title=Longitudinal course of bipolar I disorder: duration of mood episodes. | journal=Arch Gen Psychiatry | year= 2010 | volume= 67 | issue= 4 | pages= 339-47 | pmid=20368510 | doi=10.1001/archgenpsychiatry.2010.15 | pmc=3677763 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20368510 }}</ref> | *The esponse to treatment is often poorer in mood episodes with mixed features than in pure bipolar major depression or pure mania.<ref name="pmid20368510">{{cite journal| author=Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG | display-authors=etal| title=Longitudinal course of bipolar I disorder: duration of mood episodes. | journal=Arch Gen Psychiatry | year= 2010 | volume= 67 | issue= 4 | pages= 339-47 | pmid=20368510 | doi=10.1001/archgenpsychiatry.2010.15 | pmc=3677763 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20368510 }}</ref> | ||
Latest revision as of 01:28, 5 August 2021
|
Bipolar disorder Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Bipolar disorder history and symptoms On the Web |
|
American Roentgen Ray Society Images of Bipolar disorder history and symptoms |
|
Risk calculators and risk factors for Bipolar disorder history and symptoms |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Nuha Al-Howthi, MD[2]
Overview
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months. Late adolescence and early adulthood are peak years for the onset of the illness. These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset. Clinical assessment for patients with a manic, hypomanic, or mixed episode, or those with a bipolar depression episode, including information about the patient’s clinical and psychosocial status, medical and psychiatric comorbidities, current and past medications as well as medication compliance, and substance use.
History and Symptoms
Bipolar disorder is a cyclic illness where people periodically exhibit elevated (Manic) and depressive episodes. Most people will experience a number of episodes, averaging 0.4 to 0.7 a year with each lasting 3-6 months.[1] Late adolescence and early adulthood are peak years for the onset of the illness.[2][3] These are critical periods in a young adult's social and vocational development, and they can be severely disrupted by disease onset.
Prodrome
Prodromal signs and symptoms such as irritability, anxiety, mood liability (“mood swings”), agitation, aggressiveness, sleep disturbance, and hyperactivity may precede onset of bipolar disorder.
Manic episodes
The course of illness in mania may be marked by a sudden onset, and episodes progress quickly over a few days. The duration of manic episodes ranges from weeks to months.[4]
- Involve clinically significant changes in mood, energy, activity, behavior, sleep, and cognition.
- Abnormally elevated, irritable, and labile mood is a core symptom required to diagnose mania.
- Classic mania is marked by an unusually good, euphoric, or high mood, which may be accompanied by disinhibition, disregard for social boundaries, expansiveness.
- Another core diagnostic symptom of mania is persistently increased energy and activity.
- Increased planning and activity is typically marked by impulsivity, poor judgement.
- Patients are often unable to complete the many tasks or projects that are started.
- Manic patients generally have an exaggerated sense of wellbeing and self-confidence, which may extend to grandiosity of psychotic proportions.
- There is decreased need for sleep.
- Common cognitive symptoms of mania include increased mental activity, racing thoughts, distractibility, and difficulty distinguishing between relevant and irrelevant thoughts; these symptoms result in flight of ideas.
- In addition, patients may not recall events that occur during manic episodes.
- Manic speech is generally loud, pressured or accelerated, and difficult to interrupt.
Hypomania [5]
- Hypomanic episodes are characterized by changes in mood, energy, activity, behavior, sleep, and cognition that are similar to those of mania, but less severe.
- psychotic symptoms do not occur in hypomania, and hypomania never necessitates hospitalization.
- The course of hypomania is such that it generally begins suddenly and progresses quickly over one to two days. Episodes typically resolve within several weeks.
Major depression
- Episodes of major depression involve clinically significant changes in mood, behavior, energy, sleep, and cognition.
- Bipolar major depression is generally characterized by dysphoria, as well as slowing in the pace of mental and physical activity (eg, speech is slow and soft, and output reduced).
- Interest in pleasurable activities (eg, sex) is minimal, energy is low, and memory and concentration are impaired.
- Appetite is typically diminished and accompanied by weight loss.
- Sleep disturbances (insomnia or hypersomnia) often occur in bipolar depression.
- Other features of major depression include poor eye contact, poor hygiene, messy appearance, feelings of hopelessness and helplessness,
Mixed features
- Episodes of bipolar mania, hypomania, and major depression can be accompanied by symptoms of the opposite polarity, and are referred to as mood episodes with mixed features (eg, major depression with mixed features or hypomania with mixed features).
- Manic or hypomanic episodes with mixed features are characterized by episodes that meet full criteria for mania or hypomania, and at least three of the following symptoms during most days of the episode:[6]
- Depressed mood
- Diminished interest or pleasure in most activities
- Psychomotor retardation
- Low energy
- Excessive guilt or thoughts of worthlessness
- Recurrent thoughts about death or suicide, or suicide attempt
- Major depressive episodes with mixed features are characterized by episodes that meet full criteria for major depression, and at least three of the following symptoms during most days of the episode:[7]
- Elevated or expansive mood
- Inflated self-esteem or grandiosity
- More talkative than usual or pressured speech
- Flight of ideas
- Increased energy
- Decreased need for sleep
- Red flags for mixed features include the presence of clinically significant agitation, anxiety, or irritability.
- Patients with mixed features are at greater risk for suicidal ideation and comorbid anxiety disorders and substance use disorders.[8]
- The esponse to treatment is often poorer in mood episodes with mixed features than in pure bipolar major depression or pure mania.[9]
References
- ↑ Kessler, RC; McGonagle, KA; Zhao, S; Nelson, CB; Hughes, M; Eshleman, S; Wittchen, HU; Kendler, KS (1994), "Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States", Archives of General Psychiatry, 51 (1): 8–19
- ↑ Christie KA, Burke JD Jr, Regier DA, Rae DS, Boyd JH, Locke BZ (1988). (abstract) "Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults" Check
|url=value (help). Am J Psychiatry. 145: 971–975. Retrieved 2007-07-01. - ↑ Goodwin & Jamison. p121
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM; et al. (2013). "Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis". Am J Psychiatry. 170 (1): 31–42. doi:10.1176/appi.ajp.2012.12030301. PMID 23223893.
- ↑ Solomon DA, Leon AC, Coryell WH, Endicott J, Li C, Fiedorowicz JG; et al. (2010). "Longitudinal course of bipolar I disorder: duration of mood episodes". Arch Gen Psychiatry. 67 (4): 339–47. doi:10.1001/archgenpsychiatry.2010.15. PMC 3677763. PMID 20368510.