Bipolar Disorder


 Bipolar disorders (BD) are a collection of heterogeneous
conditions characterized by marked variations in mood.
 Patients with BD lie on a spectrum; according to DSM-5
those who experience manic episodes in addition to major
depressive episodes (MDE) are said to suffer from BD
type I.
 While patients who have recurrent hypomanic episodes
along with MDEs are considered as having BD type II.
Introduction


 Diagnostic Criteria ( DSM 5 )
• For a diagnosis of bipolar I disorder, it is necessary
to meet the criteria for a manic episode.
• The manic episode may have been preceded by and
may be followed by hypomanic or major depressive
episodes.
Bipolar I Disorder


A. A distinct period of abnormally and persistently
elevated, expansive, or irritable mood and
abnormally and persistently increased goal-directed
activity or energy, lasting at least 1 week and present
most of the day, nearly every day (or any duration if
hospitalization is necessary).
B. During the period of mood disturbance and
increased energy or activity, three (or more) of the
following symptoms (four if the mood is only
irritable) are present to a significant degree and
represent a noticeable change from usual behavior:
Manic Episode

1. Inflated self-esteem or grandiosity.
2. Decreased need for sleep (e.g., feels rested after only 3 hours of
sleep).
3. More talkative than usual or pressure to keep talking.
4. Flight of ideas or subjective experience that thoughts are racing.
5. Distractibility (i.e., attention too easily drawn to unimportant or
irrelevant external stimuli), as reported or observed.
6. Increase in goal-directed activity (either socially, at work or school,
or sexually) or psychomotor agitation (i.e., puφoseless non-goal-
directed activity).
7. Excessive involvement in activities that have a high potential for
painful consequences (e.g.,engaging in unrestrained buying sprees,
sexual indiscretions, or foolish business investments).

C. The mood disturbance is sufficiently severe to cause
marked impairment in social or occupational
functioning or to necessitate hospitalization to
prevent harm to self or others, or there are
psychotic features.
D. The episode is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a
medication, other treatment) or to another medical
condition.
• Note: Criteria A-D constitute a manic episode. At least
one lifetime manic episode is required for the diagnosis of
bipolar I disorder.


Hypomanic Episode
C. The episode is associated with an unequivocal
change in functioning that is uncharacteristic of
the individual when not symptomatic.
D. The disturbance in mood and the change in
functioning are observable by others.


E. The episode is not severe enough to cause marked
impairment in social or occupational
functioning or to necessitate hospitalization. If there
are psychotic features, the episode is, by definition,
manic.
F. The episode is not attributable to the physiological
effects of a substance (e.g., a drug of abuse, a
medication, other treatment).
Note: Criteria A-'F constitute a hypomania episode.
Hypomania episodes are common in bipolar I disorder but
are not required for the diagnosis of bipolar I disorder.


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.
Major Depressive Episode

1. Depressed mood most of the day, nearly every day, as indicated
by either subjective report (e.g., feels sad, empty, or hopeless) or
observation made by others (e.g., appears tearful).
(Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all,
activities most of the day, nearly every day (as indicated by either
subjective account or observation).
3. 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. (Note: In children,
consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day
(observable by others; not merely subjective feelings of
restlessness or being slowed down).

6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt
(which may be delusional) nearly every day (not merely self-
reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness,
nearly every day (either by subjective account or as observed by
others).
9. 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.
B. The symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
C. The episode is not attributable to the physiological effects of a
substance or another medical condition.
Note: Criteria A-C constitute a major depressive episode. Major depressive
episodes are common in bipolar I disorder but are not required for the
diagnosis of bipolar I disorder.


Bipolar I Disorder
A. Criteria have been met for at least one manic
episode (Criteria A-D under “Manic Episode”
above).
B. The occurrence of the manic and major
depressive episode(s) is not better explained by
schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder,
or other specified or unspecified schizophrenia
spectrum and other psychotic disorder.


Current or Current or Current or Current or
most recent most recent most recent most recent
Bipolar
1disorder
episode Episode episode episode
Manic Hypomania Depressed
unspecified*
*
Mild (p. 154) 296.41 ΝΑ 296.51 NA
(F31.11) (F31.31)
Moderate (p.
154) 296.42 ΝΑ 296.52 NA
(F31.12) (F31.32)
Severe (p. 154) 296.43 ΝΑ 296.53 NA
(F31.13) (F31.4)
Diagnostic Code
DSM V


 Bipolar or related disorders (BlockL2‐6A6)
• Bipolar and related disorders are episodic mood
disorders defined by the occurrence of Manic, Mixed
or Hypomanic episodes or symptoms. These
episodes typically alternate over the course of these
disorders with Depressive episodes or periods of
depressive symptoms.
Diagnostic Criteria
ICD 11

6A60 Bipolar type I disorder
•Episodic mood disorder defined by the occurrence of one or more manic or
mixed episodes.
•A manic episode is an extreme mood state lasting at least one week unless
shortened by a treatment intervention characterized by euphoria,
irritability, or expansiveness, and by increased activity or a subjective
experience of increased energy.
•Accompanied by other characteristic symptoms such as rapid or pressured
speech, flight of ideas, increased self-esteem or grandiosity, decreased need
for sleep, distractibility, impulsive or reckless behavior, and rapid changes
among different mood states (i.e., mood liability).
•The diagnosis can be made based on evidence of a single manic or mixed
episode, typically manic or mixed episodes alternate with depressive
episodes over the course of the disorder.

6A60.0 Bipolar type I disorder, current episode manic, without psychotic
symptoms
•Diagnosed when the definitional requirements for Bipolar type I disorder
are met.
•The current episode is manic.
•There are no delusions or hallucinations present during the episode.
•Manic episode is an extreme mood state.

6A60.1 Bipolar type I disorder, current episode manic, with psychotic
symptoms
•The current episode is Manic
•There are delusions or hallucinations present during the episode.
•A manic episode is an extreme mood state.

6A60.2 Bipolar type I disorder, current episode hypomanic
•Current episode is hypomanic.
•A hypomanic episode is a persistent mood state lasting at least several
days characterized by mild elevation of mood or increased irritability and
increased activity or a subjective experience of increased energy,
•Accompanied by other characteristic symptoms such as rapid speech,
rapid or racing thoughts, increased self-esteem, an increase in sexual drive
or sociability, decreased need for sleep, distractibility, or impulsive or
reckless behaviour.
•The symptoms are not severe enough to cause marked impairment in
occupational functioning.

6A60.3 Bipolar type I disorder, current episode depressive, mild
•Current episode is depressive at a mild level of severity.
•A depressive episode is characterized by a period of almost daily
depressed mood or diminished interest in activities lasting at least two
weeks accompanied by other symptoms such as difficulty concentrating,
feelings of worthlessness or excessive or inappropriate guilt, hopelessness,
recurrent thoughts of death or suicide, changes in appetite or sleep,
psychomotor agitation or retardation, and reduced energy or fatigue.
• In a mild depressive episode, none of the symptoms are present to an
intense degree.
•An individual with a mild depressive episode typically has some, but not
considerable, difficulty in continuing with ordinary work, social, or
domestic activities and there are no delusions or hallucinations.

6A60.4 Bipolar type I disorder, current episode depressive, moderate
without psychotic
•Current episode is depressive at a moderate level of severity.
•There are no delusions or hallucinations during the episode.
•In a moderate depressive episode, several symptoms of a depressive
episode are present to a marked degree, or a large number of depressive
symptoms of lesser severity are present overall.
•An individual with a moderate depressive episode typically has
considerable difficulty in continuing with work, social, or domestic
activities, but is still able to function in at least some areas.

6A60.5 Bipolar type I disorder, current episode depressive, moderate with
psychotic
•Current episode is depressive at a moderate level of severiy.
•There are delusions or hallucinations during the episode.

6A60.6 Bipolar type I disorder, current episode depressive, severe without
psychotic
•Current episode is severe.
•There are no delusions or hallucinations during the episode.
•In a severe depressive episode, many or most symptoms of a depressive
episode are present to a marked degree, or a smaller number of symptoms
are present and manifest to an intense degree.
•The individual is unable to function in personal, family, social, educational,
occupational, or other important domains, except to a very limited degree.

6A60.7 Bipolar type I disorder, current episode depressive, severe with
psychotic
•Current episode is severe.
•There are delusions or hallucinations during the episode.
are present and manifest to an intense degree.
•The individual is unable to function in personal, family, social,
educational, occupational, or other important domains, except to a very
limited degree.

6A60.8 Bipolar type I disorder, current episode depressive, unspecified
severity
•Current episode is depressive, but there is insufficient information to
determine the severity of the current depressive episode.
•The symptoms are associated with at least some difficulty in continuing
with ordinary work, social, or domestic activities.

6A60.9 Bipolar type I disorder, current episode mixed, without
psychotic symptoms
•Current episode is mixed and there are no delusions or hallucinations
present during the episode.
•A mixed episode is characterized by either a mixture or very rapid
alternation between prominent manic and depressive symptoms on most
days during a period of at least one week.
6A60.A Bipolar type I disorder, current episode mixed, with psychotic
symptoms
•Current episode is mixed and there are delusions or hallucinations
present during the episode.
•A mixed episode is characterized by either a mixture or very rapid
alternation between prominent manic and depressive symptoms on most
days during a period of at least one week.

6A60.B Bipolar type I disorder, currently in partial remission, most
recent episode
•The full definitional requirements for a manic or hypomanic episode are
no longer met but some significant mood symptoms remain.
•In some cases, residual mood symptoms may be depressive rather than
manic or hypomanic, but do not satisfy the definitional requirements for a
depressive episode.
6A60.C Bipolar type I disorder, currently in partial remission, most
recent episode
•The most recent episode was a depressive episode.
•The full definitional requirements for the episode are no longer met but
some significant depressive symptoms remain.

6A60.D Bipolar type I disorder, currently in partial remission, most
recent episode
Mixed Bipolar type I disorder, currently in partial remission, most recent
episode mixed is diagnosed when the definitional requirements for
Bipolar type I disorder have been met and the most recent episode was a
mixed episode. The full definitional requirements for the episode are no
longer met but some significant mood symptoms remain.
6A60.E Bipolar type I disorder, currently in partial remission, most
recent episode
Unspecified Bipolar type I disorder, currently in partial remission, most
recent episode unspecified is diagnosed when the definitional
requirements for Bipolar type II disorder have been met but there is
insufficient information to determine the nature of the most recent mood
episode. The full definitional requirements for a mood episode are no
longer met but some significant mood symptoms remain.

6A60.F Bipolar type I disorder, currently in full remission
Bipolar type I disorder, currently in full remission is diagnosed when the full
definitional requirements for Bipolar I disorder have been met in the past but
there are no longer any significant mood symptoms.
6A60.Y Other specified bipolar type I disorder
6A60.Z Bipolar type I disorder, unspecified


 6A60
 6A60.0 – 6A60.9
 6A60.A – 6A60.F
 6A60.Y
 6A60.Z
Diagnostic Code
ICD 11

Major depressive disorder
 It may also be accompanied by hypomania or manic
symptoms (i.e., fewer symptoms or for a shorter duration
than required for mania or hypomania).
 When the individual presents in an episode of major
depression, one must depend on corroborating history
regarding past episodes of mania or hypomania.
 Symptoms of irritability may be associated with either
major depressive disorder or bipolar disorder, adding to
diagnostic complexity.
Differential Diagnosis

Other Bipolar Disorders
•Diagnosis of bipolar I disorder is differentiated from bipolar II disorder by
determining whether there have been any past episodes of mania.
•Other specified and unspecified bipolar and related disorders should be
differentiated from bipolar I and II disorders by considering whether either
the episodes involving manic or hypo-manic symptoms or the episodes of
depressive symptoms fail to meet the full criteria for those conditions.
•Bipolar disorder due to another medical condition may be distinguished
from bipolar I and II disorders by identifying, based on best clinical
evidence, a causally related medical condition.

Generalized anxiety disorder, panic disorder, posttraumatic stress
disorder, or other anxiety disorders
•These disorders need to be considered in the differential diagnosis as
either the primary disorder or, in some cases, a comorbid disorder.
•A careful history of symptoms is needed to differentiate generalized
anxiety disorder from bipolar disorder, as anxious ruminations may be
mistaken for racing thoughts, and efforts to minimize anxious feelings
may be taken as impulsive behaviour.
•Similarly, symptoms of posttraumatic stress disorder need to be
differentiated from bipolar disorder. It is helpful to assess the episodic
nature of the symptoms described, as well as to consider symptom
triggers, in making this differential diagnosis.

Substance/medication-induced bipolar disorder
•Substance use disorders may manifest with substance medication-induced
manic symptoms that must be distinguished from bipolar I disorder.
•Response to mood stabilizers during a substance/medication-induced
mania may not necessarily be diagnostic for bipolar disorder.
•There may be substantial overlap in view of the tendency for individuals
with bipolar I disorder to overuse substances during an episode.
•A primary diagnosis of bipolar disorder must be established based on
symptoms that remain once substances are no longer being used.

Attention-deficit/hyperactivity disorder
•This disorder may be misdiagnosed as bipolar disorder, especially in
adolescents and children.
•Many symptoms overlap with the symptom of mania, such as rapid speech,
racing thoughts, distractibility, and less need for sleep.
•The "double counting" of symptoms toward both ADHD and bipolar disorder
can be avoided if the clinician clarifies whether the symptom(s) represents a
distinct episode.

Personality disorders
•Personality disorders such as borderline personality disorder may have
substantial symptomatic overlap with bipolar disorders, since mood ability
and impulsivity are common in both conditions.
•Symptoms must represent a distinct episode, and the noticeable increase
over baseline required for the diagnosis of bipolar disorder must be present.
•A diagnosis of a personality disorder should not be made during an
untreated mood episode.


 Inflated self-esteem is typically present, ranging from uncritical
self-confidence to marked grandiosity, and may reach
delusional proportions.
 Decreased need for sleep.
 Speech can be rapid, pressured, loud, and difficult to interrupt.
 Often the individual's thoughts race at a rate faster than they
can be expressed through speech.
 Distractibility
Clinical Manifestations


 Gambling and antisocial behaviours may accompany the manic
episode.
 Some individuals may become hostile and physically
threatening to others and, when delusional, may become
physically assaultive or suicidal.
 Loss of insight, and hyperactivity.
 Mood may shift very rapidly to anger or depression.
 Depressive symptoms may occur during a manic episode and,
if present, may last moments, hours, or, more rarely, days.
Etiology


 Genetic and physiological
 Environmental
 Course Modifiers
Prognosis


Prevalence
 The 12-month prevalence estimate in the continental
United States was 0.6% for bipolar I disorder as
defined in DSM-IV.
 Twelve-month prevalence of bipolar I disorder
across 11 countries ranged from 0.0% to 0.6%.
 The lifetime male-to-female prevalence ratio is
approximately 1.1:1.


 Outpatient treatment
 Inpatient treatment
 Dual Diagnosis treatment
Treatment


 The specific goals of drug treatment in bipolar disorder
will change depending on the stage of the illness.
 In the acute phase, reduction of active target symptoms
and overall mood stabilization are the focus.
 Once these occur, medications are continued to prevent
future mood episodes and to enhance the chances of
improved psychosocial functioning.
Pharmacotherapy


 It can provide valuable time for an individual to learn and
practice effective strategies for coping with the disorder
and managing symptoms. Also provide valuable
psychoeducation for problem-solving, developing self-
care habits, and building resilience.
 Cognitive behavioral therapy can help an individual
challenge negative thinking patterns and the behaviors
that follow.
 Family therapy can help family members learn to
communicate calmly and effectively and reduce overall
stress in relationship systems.
Psychotherapy


 Diagnostic Criteria ( DSM 5 )
Major Depressive Episode
C. The episode is associated with an unequivocal
change in functioning that is uncharacteristic of the
individual when not symptomatic.
D. The disturbance in mood and the change in
functioning are observable by others.
Bipolar II Disorders


E. The episode is not severe enough to cause
marked impairment in social or occupational
functioning or to necessitate hospitalization.
If there are psychotic features, the episode is, by
definition, manic.
F. The episode is not attributable to the
physiological effects of a substance (e.g., a drug
of abuse, a medication or other treatment).


A. Criteria have been met for at least one
hypomanie episode (Criteria A-F under “Hypo-
manic Episode” above) and at least one major
depressive episode (Criteria A-C under “Major
Depressive Episode” above).
B. There has never been a manic episode.
Bipolar II Disorder
296.89 (F31.81 )


C. The occurrence of the hypomanie episode(s) and
major depressive episode(s) is not better explained by
schizoaffective disorder, schizophrenia,
schizophreniform disorder, delusional disorder, or
other specified or unspecified schizophrenia
spectrum and other psychotic disorder.
D. The symptoms of depression or the unpredictability
caused by frequent alternation between periods of
depression and hypomania causes clinically
significant distress or impairment in social,
occupational, or other important areas of functioning.

 6A61 Bipolar type II disorder
Episodic mood disorder defined by the occurrence of
one or more hypomanic episodes and at least one
depressive episode.
The symptoms represent a change from the
individual’s typical behavior and are not severe enough
to cause marked impairment in functioning.
Depressive episode is present.There is no history of
manic or mixed Episodes.
Diagnostic Criteria
ICD 11

6A61.0 Bipolar type II disorder, current episode hypomanic
•A hypomanic episode is a persistent mood state lasting at least several
days characterized by mild elevation of mood or increased irritability and
increased activity or a subjective experience of increased energy,
accompanied by other characteristic symptoms such as rapid speech, rapid
or racing thoughts, increased self-esteem, an increase in sexual drive or
sociability, decreased need for sleep, distractibility, or impulsive or
reckless behavior.
•The symptoms are not severe enough to cause marked impairment in
occupational functioning or in usual social activities or relationships with
others, does not necessitate hospitalization, and there are no
accompanying delusions or hallucinations.

6A61.1 Bipolar type II disorder, current episode depressive, mild
•Current episode is depressive at a mild level of severity.
•Depressive episode is present.
•In a mild depressive episode, none of the symptoms are present to an
intense degree.
•An individual with a mild depressive episode typically has some, but not
considerable, difficulty in continuing with ordinary work, social, or
domestic activities and there are no delusions or hallucinations.

6A61.2 Bipolar type II disorder, current episode depressive, moderate
without psychotic
•Current episode is depressive at a moderate level of severity and there are
no delusions or hallucinations during the episode.

6A61.3 Bipolar type II disorder, current episode depressive, moderate with
psychotic
•Current episode is depressive at a moderate level of severity and there are
delusions or hallucinations during the episode.
considerable difficulty in continuing with work, social, or domestic activities,
but is still able to function in at least some areas.

6A61.4 Bipolar type II disorder, current episode depressive, severe
without psychotic
•Current episode is severe and there are no delusions or hallucinations
during the episode.
episode are present to a marked degree, or a smaller number of
symptoms are present and manifest to an intense degree.
limited degree.

6A61.5 Bipolar type II disorder, current episode depressive, severe with
psychotic
•Current episode is severe and there are delusions or hallucinations during
the episode.
are present and manifest to an intense degree
limited degree.

6A61.6 Bipolar type II disorder, current episode depressive, unspecified
severity
•Current episode is depressive, but there is insufficient information to
determine the severity of the current depressive episode.
•The symptoms are associated with at least some difficulty in continuing
with ordinary work, social, or domestic activities.

6A61.7 Bipolar type II disorder, currently in partial remission, most
recent episode
•The most recent episode was a hypomanic episode.
•The full definitional requirements for a hypomanic episode are no longer
met but some significant mood symptoms remain.
•In some cases, residual mood symptoms may be depressive rather than
hypomanic, but do not satisfy the definitional requirements for a
depressive episode.

6A61.8 Bipolar type II disorder, currently in partial remission, most recent
episode
•The most recent episode was a depressive episode.
•The full definitional requirements for the episode are no longer met but
some significant depressive symptoms remain.
6A61.9 Bipolar type II disorder, currently in partial remission, most recent
episode
•Requirements for Bipolar type II disorder have been met but there is
insufficient information to determine the nature of the most recent mood
episode.
•The full definitional requirements for a mood episode are no longer met
but some significant mood symptoms remain.

6A61.A Bipolar type II disorder, currently in full remission
Bipolar type II disorder, currently in full remission, is diagnosed when the
definitional requirements for Bipolar type II disorder have been met but
there are no longer any significant mood symptoms.
6A61.Y Other specified bipolar type II disorder
6A61.Z Bipolar type II disorder, unspecified


Diagnostic Code
ICD 11
 6A61
 6A61.0 – 6A61.9
 6A61.A
 6A61.Y
 6A61.Z


Major depressive disorder
It may be accompanied by hypomania or manic symptoms that
do not meet full criteria (i.e., either fewer symptoms or a shorter
duration than required for a hypomania episode).
This is especially true in evaluating individuals with symptoms
of irritability, which may be associated with either major
depressive disorder or bipolar II disorder.

Cyclothymic disorder
• In cyclothymic disorder, there are numerous periods of hypomanic
symptoms and numerous periods of depressive symptoms that do not meet
symptom or duration criteria for a major depressive episode.
•Bipolar II disorder is distinguished from cyclothymic disorder by the
presence of one or more major depressive episodes.
•If a major depressive episode occurs after the first 2 years of cyclothymic
disorder, the additional diagnosis of bipolar II disorder is given.
Other bipolar disorders
Diagnosis of bipolar II disorder should be differentiated from bipolar I
disorder by carefully considering whether there have been any past
episodes of mania and from other specified and unspecified bipolar and
related disorders by confirming the presence of fully syndromal hypomania
and depression.

Attention-deficit/hyperactivity disorder
•It may be misdiagnosed as bipolar II disorder, especially in adolescents and
children.
•Many symptoms of ADHD, such as rapid speech, racing thoughts,
distractibility, and less need for sleep, overlap with the symptoms of
hypomania.
•The double counting of symptoms to ward both ADHD and bipolar II
disorder can be avoided if the clinician clarifies whether the symptoms
represent a distinct episode and if the noticeable increase over baseline
required for the diagnosis of bipolar II disorder is present.

Personality disorders
•The same convention as applies for ADHD also applies when evaluating an
individual for a personality disorder such as borderline personality
disorder, since mood and impulsivity are common in both personality
disorders and bi polar II disorder.
•Symptoms must represent a distinct episode, and the noticeable increase
over baseline required for the diagnosis of bipolar II disorder must be
present.
•A diagnosis of a personality disorder should not be made during an
untreated mood episode unless the lifetime history supports the presence of
a personality disorder.


 A clinical course of recurring mood episodes consisting of
one or more major depressive episodes (Criteria A-C
under "Major Depressive Episode") and at least one
hypomania episode (Criteria A-F under "Hypomania
Episode").
 The major depressive episode must last at least 2 weeks,
and the hypomania episode must last at least 4 days, to
meet the diagnostic criteria.
 The presence of a manic episode during the course of
illness precludes the diagnosis of bipolar II disorder
(Criterion B under "Bipolar II Disorder").


 Impulsivity, which can contribute to suicide at
tempts and substance use disorders.
 Impulsivity may also stem from a concurrent
personality disorder, substance use disorder, anxiety
disorder, another mental disorder, or a medical
condition.
 There may be heightened levels of creativity in some
individuals with a bipolar disorder.
Etiology


 Genetic and physiological
 Course modifiers
Prognosis


 The 12-month prevalence of bipolar II disorder,
internationally, is 0.3%. In the United States, 12-month
prevalence is 0.8%.
 The prevalence rate of pediatric bipolar II disorder is
difficult to establish.
 DSM-IV bipolar I, bipolar II, and bipolar disorder not
otherwise spec ified yield a combined prevalence rate of
1.8% in U.S. and non-U.S. community samples, with
higher rates (2.7% inclusive) in youths age 12 years or
older.
Prevalence


 Mood stabilizers
 Antipsychotics
 Antidepressants
Treatment


 Psychotherapy involves counselling services.
 It is centered on talking through emotions and
problems associated with bipolar disorder and other
life issues.
 It may also include behavioural management, such
as creating action plans on what to do during mood
alterations.
Psychotherapy


A. For at least 2 years (at least 1 year in children
and adolescents) there have been numerous periods
with hypomanie symptoms that do not meet
criteria for a hypomanie episode and
numerous periods with depressive symptoms
that do not meet criteria for a major depressive
episode.
B. During the above 2-year period (1 year in children
and adolescents), the hypomanie and depressive
periods have been present for at least half the time
and the individual has not been without the
symptoms for more than 2 months at a time.
Cyclothymic Disorder
301.13 (F34.0)
Diagnostic Criteria DSM 5

C. Criteria for a major depressive, manic, or
hypomanie episode have never been met.
D. The symptoms in Criterion A are not better
explained by schizoaffective disorder,
schizophrenia, schizophreniform disorder,
delusional disorder, or other specified or un
specified schizophrenia spectrum and other
psychotic disorder.
E. The symptoms are not attributable to the
physiological effects of a substance (e.g., a drug of
abuse, a medication) or another medical condition
(e.g., hyperthyroidism).


Diagnostic Criteria
ICD 11
 6A62 Cyclothymic disorder
• Cyclothymic disorder is characterized by a persistent
instability of mood over a period of at least 2 years,
involving numerous periods of hypomanic (e.g.,
euphoria, irritability, or expansiveness, psychomotor
activation) and depressive (e.g., feeling down,
diminished interest in activities, fatigue) symptoms
that are present during more of the time than not.

The hypomanic symptomatology may or may not be
sufficiently severe or prolonged to meet the full
definitional requirements of a hypomanic episode (see
Bipolar type II disorder), but there is no history of manic
or mixed episodes (see Bipolar type I disorder).
The depressive symptomatology has never been
sufficiently severe or prolonged to meet the diagnostic
requirements for a depressive episode (see Bipolar type II
disorder).
The symptoms result in significant distress or
significant impairment in personal, family, social,
educational, occupational or other important areas of
functioning.


 In cyclothymic disorder, there are numerous periods of
hypomanic symptoms and numerous periods of
depressive symptoms that do not meet symptom or
duration criteria for a major depressive episode.
 Bipolar II disorder is distinguished from cyclothymic
disorder by the presence of one or more major depressive
episodes.
 If a major depressive episode occurs after the first 2 years
of cyclothymic disorder, the additional diagnosis of
bipolar II disorder is given.


 Mood swings between short periods of mild
depression and hypomania.
 The highs of cyclothymia include symptoms of an
elevated mood (hypomanic symptoms)
 The lows consist of mild or moderate depressive
symptoms.


 The causes are unknown.
 It is distinguished from a mood disorder due to general
medical condition.
 People with this disorder usually have a family history of
depression, bipolar disorder, suicide, alcohol and drug
dependence.
 There is a 15-50% chance that the person will
subsequently develop Bipolar I or Bipolar II disorder.
Etiology


 Biological
 Psychosocial
Prognosis


 The lifetime prevalence of cyclothymic disorder is
approximately 0.4%-l%.
 Prevalence in mood disorders clinics may range from 3%
to 5%.
 In the general population, cyclothymic disorder is
apparently equally common in males and females.
 In clinical settings, females with cyclothymic disorder
may be more likely to present for treatment than males.
Prevalence


 Treatment usually involves counselling and therapy.
In rare cases, medication may be used.
1. Psychotherapy
2. Cognitive Behavioral Therapy
3. Family Therapy
Treatment


 Antipsychotics
 Antidepressants
Pharmacotherapy


 Also known as psychological counselling or talk
therapy is a vital part of the treatment and can be
provided in individual, family or group settings.
 Cognitive Behavioral Therapy (CBT)
 Interpersonal and Social Rhythm Therapy (ISRT)
Psychotherapy

Bipolar Disorder

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