MOOD DISORDER

Bipolar Disorder

Presenter:
Maricon Hernandez
PUP, Sta. Mesa Manila
Mood Disorder
➢psychological disorders
characterized by disturbances
of mood
Bipolar Disorder
➢ psychological disorder characterized
by mood swings between states of
extreme elation and depression.
Bipolar Disorder
➢ characterized by repeated, at least
two episodes in which the patient’s
mood and activity levels are
significantly disturbed
(manic or depressive episodes)
Manic Episode
➢ a period of unrealistically heightened
euphoria, extreme restlessness, and
excessive activity characterized by
disorganized behavior and impaired
judgment.
Criteria for Manic Episode: DSM-5
a. A distinct period of abnormally and
persistently elevated, expansive, or
irritable mood, lasting at least 1 week
(or any duration if hospitalization is
necessary).
b. During the period of mood
disturbance, 3 (or more) of the
following symptoms have persisted (4r
if the mood is only irritable)
▪ 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
▪ increase in goal - directed activity
(either socially, at work or school, or
sexually) or psychomotor agitation
▪ excessive involvement in pleasurable
activities that have a high potential
for painful consequences
c. 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.

d. 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).
Hypomania
➢ A relatively mild state of mania
Hypomania
➢ characterized by
–persistent mild elevation of mood
for at least several days
–increased energy and activity
–usually marked feelings of well-being
and both physical and mental
efficiency
 Increased sociability, talkativeness,
overfamiliarity, increased sexual energy,
and a decreased need for sleep are often
present but not to the extent that they
lead to severe disruption of work or
result in social rejection.
There are no hallucinations or
delusions
Hypomanic Criteria

–Similarities with Manic Episode

• Same symptoms
–Differences from Manic Episode
• Length of time
• Impairment not as severe
• May not be viewed by the individual
as pathological
–However, others may be troubled
by erratic behavior
Depressive Episodes
–depressed mood
–loss of interest and enjoyment
–reduced energy leading to increased
fatigability and diminished activity
–marked tiredness after only slight
effort
–reduced concentration and attention
–reduced self-esteem and self-
confidence
–ideas of guilt and unworthiness
–bleak and pessimistic views of the
future
–ideas or acts of self-harm or suicide,
–disturbed sleep and diminished
appetite
Criteria for Major Depressive Episode:
(DSM – V)
A. Five (or more) of the following symptoms
have been 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, as indicated by either subjective
report or observation made by others.
Criteria for Major Depressive
Episode: DSM - V
▪ Significant weight loss when not dieting
or weight gain (e.g., a change of more
than 5 % of body weight in a month), or
decrease or increase in appetite nearly
every day.
Criteria for Major Depressive
Episode: DSM - V
▪ Insomnia or hypersomnia nearly every
day.
▪ Psychomotor agitation or retardation
nearly every day (observable by others,
not merely subjective feelings of
restlessness or being slowed down)
Criteria for Major Depressive
Episode: DSM - V
▪ Fatigue or loss of energy nearly every
day.
▪ Feelings of worthlessness or excessive or
inappropriate guilt (which may be
• delusional) nearly every day (not merely
self - reproach or guilt about being sick).
Criteria for Major Depressive
Episode: DSM - V
▪Diminished ability to think or
concentrate, or indecisiveness, nearly
every day (either by subjective account or
as observed by others).
▪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.
Criteria for Major Depressive Episode:
DSM - V
C. The symptoms cause clinically significant
distress or impairment in social,
occupational or other important areas of
functioning.
D. 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).
Types of Bipolar Disorder
(DSM-V)
 Diagnostic Classifications
1. Bipolar I Disorder
• One or more Manic Episode or Mixed
Manic Episode
• Minor or Major Depressive Episodes
often present
• May have psychotic symptoms

25
APA (2013)
2. Bipolar II Disorder
• One or more Major Depressive
Episode
• One or more Hypomanic Episode
• No full Manic or Mixed Manic
Episodes
3. Cyclothymia
• For at least 2 years (1 in children and
adolescents), numerous periods with
hypomanic symptoms that do not meet the
criteria for hypomanic
– Present at least ½ the time and not
without for longer than 2 months
• Criteria for major depressive, manic, or
hypomanic episode have never been met
Cyclothymic Disorder
Characteristics
• For at least two years, presence of numerous
Hypomanic Episodes and numerous periods with
depressed mood or loss of interest or pleasure that
did not meet criterion A of a Major Depressive
Episode
• During a two year period (one year in children and
adolescents) of the disturbance, never without
hypomanic or depressive symptoms for more than a
two month time
Cyclothymia
For cyclothymia persistent instability of
mood, involving periods of mild depression
and mild elation is typical.

This instability usually develops early in

adult life and pursues a chronic course,
although the mood may be normal and
stable for months at a time.
The mood swings are usually perceived by
the individual as being unrelated to life
events.
Characteristics (Cont.)
• No clear evidence of a Major Depressive
Disorder, or Manic Episode during the
first two years of the disturbance (or one
year for children and adolescents)
• Not due to the direct physiologic affects
of a substance or a general medical
condition
3. Other Specified Bipolar and Related
Disorder
296.89 (F31.89)
This category applies to presentations in which
symptoms characteristic of a bipolar and
related disorder that cause clinically significant
distress or impairment in social, occupational,
or other important areas of functioning
predominate but do not meet the full criteria
• for any of the disorders in the bipolar and
related disorders diagnostic class.
4. Unspecified Bipolar and Related Disorder 296.80
(F31.9)
This category applies to presentations in which
symptoms characteristic of a bipolar and
related disorder that cause clinically significant distress
or impairment in social, occupational,
or other important areas of functioning predominate
but do not meet the full criteria
• for any of the disorders in the bipolar and related
disorders diagnostic class. .
Prevalence
Lifetime Prevalence
• 0.4 – 1.0 %
Equal in males and females
– Increased prevalence in upper
socioeconomic classes
• Age of Onset
– Usually late adolescence or early
adulthood. However some after
age 50. Late onset is more
commonly Type II.
Lifetime prevalence
Bipolar I
• 0.0% - 0.6%(0 to 6 people in 1,000) for
bipolar I disorder
Age of onset: 18 years (mean age)
Suicide Risk: 15 times than that of normal
population (32.4%)

Source: DSM - V
Lifetime prevalence
Bipolar II
• 0.3% (3 people in 1,000) for bipolar II
disorder
Average Age of onset: mid 20s
Suicide Risk: 36.3%

Source: DSM - V
Lifetime prevalence
Cyclothymic Disorder
• 0.4% - 1%
• Age of onset: adolescence or early
adulthood

Source: DSM - V
Theories of Bipolar Disorder
I. Biological Theories
➢ Genetic Factors
➢ Brain abnormalities
➢ Neurotransmitter Factors
Theories of Bipolar Disorder

II. Psychosocial contributors

Treatment
• Education and Support
• Medication
Acute mania
Lithium, Carbamazepine,Valproate,
Lamotrigine, antipsychotics,
benzodiazepine
Long Term Mood Stabilization
Lithium, Carbamazepine,Valproate,
Lamotrigine, possibly atypical antipsychotics
Treatment

• Therapy
–Psycho-Education
–Family Interventions
– Cognitive-Behavioral Therapy (CBT)
 Bipolar I
Alternative Diagnosis Differential Consideration
Major Depressive Person with depressive Sx never had Manic/Hypomanic
Disorder episodes
Bipolar II Hypomanic episodes, w/o a full Manic episode
Cyclothymic Disorder Lesser mood swings of alternating depression -
hypomania (never meeting depressive or manic criteria)
cause clinically significant distress/impairment
Normal Mood Swings Alternating periods of sadness and elevated mood,
without clinically significant distress/impairment
Schizoaffective Disorder Sx resemble Bipolar I, severe with psychotic features but
psychotic Sx occur absent mood Sx
Schizophrenia or Psychotic symptoms dominate. Occur without prominent
Delusional Disorder mood episodes
Substance Induced Stimulant drugs can produce bipolar Sx
Bipolar Disorder
 Bipolar II
Alternative Diagnosis Differential Consideration
Major Depressive Person with depressive Sx never had Manic/Hypomanic
Disorder episodes
Bipolar II Hypomanic episodes, w/o a full Manic episode
Cyclothymic Disorder Lesser mood swings of alternating depression -
hypomania (never meeting depressive or manic criteria)
cause clinically significant distress/impairment
Normal Mood Swings Alternating periods of sadness and elevated mood,
without clinically significant distress/impairment
Schizoaffective Disorder Sx resemble Bipolar I, severe with psychotic features but
psychotic Sx occur absent mood Sx
Schizophrenia or Psychotic symptoms dominate. Occur without prominent
Delusional Disorder mood episodes
Substance Induced Stimulant drugs can produce bipolar Sx
Bipolar Disorder
 Cyclothymic Disorder

Alternative Diagnosis Differential Consideration

Normal Mood Swings Ups &downs without clinically significant
distress/impairment
Major Depressive Had a major depressive episode
Disorder
Bipolar I At least one Manic episode
Bipolar II At least one clear Major Depressive episode
Substance Induced Mood swings caused by antidepressant medication or
Bipolar Disorder cocaine. Stimulant drugs can produce bipolar symptoms
 References:
American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders (5th ed.).
Washington, DC: Author.
Hart, S. R., & Brock, S. E., & Jeltova, I. (2013). Assessing,
identifying, and treating bipolar disorder at school. New
York: Springer.
Nolen-Hoeksema. (2013). Abnormal Psychology. New
York”McGraw-Hill
Thank you!