Bipolar I Disorder DSM- 5 2. ICD- 1. 0- CM Multiple Codes)go. A clinical psychologist presents links to large general resources and original content relating to specific topics. ADHD:n maailmanlaajuiseksi esiintyvyydeksi 6. The worldwide prevalence of ADHD: a. Primary care practitioners treat many civilians and veterans of all ages who exhibit symptoms of PTSD, but many lack the necessary knowledge to identify PTSD and. DSM-5 Category: Bipolar and Related Disorders Introduction. Extremes of mood have been recognized since Greek antiquity. DSM- 5 Category: Bipolar and Related Disorders. Introduction. Extremes of mood have been recognized since Greek antiquity. The alternation of mania and melancholy was described in the 1st Century AD by Aretaeus of Cappadocia, who also described migraine. Jules Baillarger identified folie . At the turn of the 2. ![]() Century, Emil Kraepelin distinguished this illness from schizophrenia (dementia praecox) and termed it “manic- depressive psychosis”(Burton, 2. What by the 1. 95. Manic- Depressive Illness has now been elaborated into a spectrum of Bipolar Disorder. The new nomenclature derives from the fundamental characteristic of these illnesses, that patients have periods of mania (elevated or agitated mood) in alternation with major depression, as well as the great variability in clinical features and course that has been recognized. Patients may also have hypomania (less severe mood elevation or agitation) and depression that is less severe than the “major” variety. Bipolar affective disorders are classified as Type I (one or more manic episodes, with or without depression or hypomania), Type II (one or more depressive episodes with at least one episode of hypomania), and Cyclothymic (hypomania alternating with non- major depression) disorders. Previous editions of the Diagnostic and Statistical Manual of Mental Disorders additionally recognized the catchall category of “Bipolar Disorder NOS (not otherwise specified)” for manic- depressive illness that did not fit into the other categories(American Psychiatric Association, 2. The new edition of the manual (DSM- 5) has eliminated the “NOS” categories for incompletely- characterized psychiatric disorders, and allows clinicians in such cases to either identify the reason(s) that criteria for a particular disorder are not met (“other specified disorder”) or forgo specification if information is not available (“unspecified disorder”)(American Psychiatric Association, 2. DSM- 5 changes for the bipolar disorders simplify the characterization of mood episodes in which manic and depressive features alternate (“mixed features”) and recognize the importance of anxiety as an aggravating factor in mania and depression (“anxious distress”), even though anxiety is not part of bipolar disorder diagnostic criteria. Symptoms of Bipolar I Disorder. The defining feature of bipolar disorder generally, and of Type I particularly, is mania. It represents a distinct period of elevated or irritable mood, lasting for at least a week. Patients may be euphoric, grandiose, anxious, or irritable and even enraged. Increased energy, decreased need for sleep, increased sexual drive and decreased attention span are frequent, along with racing thoughts and pressured speech, impaired judgement and risky or inappropriate behavior, substance abuse and impulsive behavior such as spending sprees. Severe mania may result in psychosis, with delusions and thought disorder as well as mood disorder, but not hallucinations. The new Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) has a number of important updates and changes made to major depression (also. Postpartum depression (PPD) is a common and serious mental health problem that is associated with maternal suffering and numerous negative consequences for offspring. Manic episodes are preceded by changes in activity, appetite and sleep, and sometimes by anxiety, for up to 3 weeks(Mansell & Pedley, 2. Depressive symptoms are similar to those of major depression, except that major depression persists for more than 2 weeks and the depressive episodes of bipolar disorder may not. Severe depression may progress to psychosis, and this may be accompanied by hallucinations as well as delusions. The initial mood episodes of bipolar disorders tend to be depressive in younger patients, and the onset of bipolar depression may be mistaken for major depression(Muzina et al., 2. Hypomania involves mild- to- moderate mood elevation, often with optimism rather than grandiosity, slight pressure of speech, increased activity level and decreased need for sleep. ![]() Hypersexuality may be present, but not delusions or hallucinations. Many hypomanic patients feel good, have increased energy and are more productive, while patients with mania are often irritable and less productive due to inattention(Angst & Sellaro, 2. Mixed episodes are increasingly recognized, and can be problematic and even dangerous, These episodes combine manic and depressive features, and suicide attempts, substance abuse and unpredictable behavior are increased in likelihood in these periods(Goldman, 1. Diagnostic Criteria. Bipolar I disorder is characterized by at least one episode of mania or mixed depressive and manic symptoms. The symptoms must cause social or occupational distress or impairment, and cannot be better accounted for by schizoaffective disorder. The manic or mixed episodes must not be superimposed on schizoaffective disorder, schizophrenia, delusional disorder or other psychotic condition. Manic episodes are characterized by elevated, expansive or irritable mood and increased energy and activity, which last for a week or more, accompanied by 3 of the following (4 if the mood is irritable): grandiosity or inflated self- esteem, decreased need for sleep, increased talkativeness, racing thoughts or flight of ideas, distractibility, psychomotor agitation or increased goal- directed behavior, or increased risky behavior. These symptoms must be severe enough to cause occupational or social impairment, hospitalization or psychosis, and may not be due to substance use or a medical condition. Mixed episodes involve mania or hypomania with at least 3 depressive symptoms occurring concurrently nearly every day: subjective depression, guilt or self- reproach, worry, negative self- evaluation, hopelessness, anhedonia, fatigue, psychomotor retardation or suicidal thought or behavior(American Psychiatric Association, 2. DSM5 changes with respect to bipolar I disorder involve recognition that manic and hypomanic episodes involve increased energy and activity, not just elevated mood. The diagnosis of mixed episodes previously required that the patient meet criteria for both mania and major depressive episode; the new specifier “with mixed episodes” includes both manic and hypomanic episodes when features of major depression are present and episodes of depression when features of mania and hypomania are present. Since anxiety frequently aggravates the severity of the bipolar disorders, a new specifier for “anxious distress” allows the identification of patients whose manic episodes or periods of mixed mania and depression are complicated by severe anxiety. Epidemiology The lifetime prevalence of bipolar I disorder is approximately 2 per cent(Soldani et al., 2. Men and women are about equally affected and prevalence and incidence of the bipolar disorders are about the same throughout the world, but disability may be greater in developing countries(Ayuso- Mateos, 2. In the United States, blacks and whites are equally affected, while Asians have lower rates of bipolar disorder(Kurasaki, 2. The peak incidence is in late adolescence, but mania begins after age 5. Goodwin, 2. 00. 7). Approximately 5. 0 per cent of those hospitalized for first- episode mania or hypomania achieve syndromic recovery in 6 weeks, and 9. Forty per cent had a recurrent episode within 2 years after recovery, and 1. Tohen et al., 2. 00. Suicide is a source of mortality: 1/3 of bipolar patients reported past suicide attempts or were successful, and the suicide rate is 0. Novick et al., 2. Pathophysiology. A familial tendency toward all bipolar disorders has been noted since the 1. Century. Twin studies suggest that the concordance rate for bipolar I in monozygotic twins with the same genes is about 4. Kieseppa et al., 2. If type II and cyclothymic disorders are included, the overall heritability is about 0. Edvardsen et al., 2. There have been suggestions of responsible genetic loci on chromosomes 6q and 8q. Kato, 2. 00. 7). MRI studies have suggested increased volume of thee lateral ventricles and globus pallidus, along with hyperintensities in deep white matter(Kempton et al., 2. Functional MRI findings suggest that the limbic system, especially the amygdale, and ventral prefrontal cortex may be deficient in modulating mood and emotions(Strakowski, 2. Mostly nonspecific and rarely epileptiform EEG abnormalities are reported in bipolar disorder, especially with rapid cycling between mania and depression or negative family history of affective disorder(Shelley et al., 2. Computer- assisted quantitative EEG has shown increased slow activity and left temporal asymmetry in nonresponders to therapy (Small et al., 1. Neuropsychological assessments have shown widespread cognitive abnormalities in symptomatic patients, and deficits in verbal memory and sustained attention in between episodes. This results in decreased dopaminergic transmission during a depressive episode, and homeostatic up- regulation eventually restarts the cycle (Berk et al., 2. It has been suggested (the “kindling” hypothesis) that environmental stresses in susceptible individuals initiate this cycle but the threshold for its activation becomes lower and lower, until at length spontaneous cycling occurs (Post, 1. Glutamate also causes elevated mood, and is increased in dorsolateral prefrontal cortex during mania but returns to normal when the manic phase is over (Michael et al., 2. Gamma- amino- butyric acid (GABA) causes mood elevation, and is higher in concentration in bipolar disorder (Brady et al., 2. The hypothalamic- pituitary- adrenal axis may also be involved in an abnormal cyclical response to stressors, with cortisol increased in both manic and depressive episodes (Watson et al., 2. There is also a suggestion that manic episodes may have evolutionary value, accounting for the preservation of genes for bipolar disorder that might be expected to be selected against on account of the functional impairment and mortality of mixed depression and mania. Hypomanic or mild manic episodes can increase productivity and creativity, while depressive episodes may facilitate withdrawal, sleep and conservation of resources at times of adversity.
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