BIPOLAR DISORDER

Presented by
Mansoor Jamshed
 OUTLINE
Diagnostic Criteria
Beyond ICD 10 and DSM V - TR
Clinical Features
Interventions
 ICD 11

Primary types:
Depressive episode - Mixed Episode - Hypomanic - Manic
 6A60: BIPOLAR TYPE I DISORDER
INTRODUCTION
It is an episodic mood disorder defined by the occurrence of one or more manic
or mixed episodes (a mixture or very rapid alternation between prominent manic
and depressive symptoms on most days during a period of at least 2 weeks.)

Duration: at least 1 week (without intervention).

Core features include Euphoria, Irritability, expansiveness (unrestrained

emotional expression), and increased energy or activity.

Other features: 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 state
6A60.0 BIPOLAR 1 DISORDER, CURRENT
EPISODE MANIC, WITHOUT PSYCHOTIC
FEATURES.

6A60.1 BIPOLAR 1 DISORDER,

CURRENT EPISODE MANIC, WITH
PSYCHOTIC FEATURES: THE SYMPTOMS
MANIA IS ACCOMPANIED BY
HALLUCINATIONS AND DELUSIONS.
6A60.2 BIPOLAR 1 DISORDER,
CURRENT EPISODE HYPOMANIC,
WITHOUT PSYCHOTIC FEATURES.
Duration: at least several days
Core features: Mild elevation of mood or increased irritability and
increased activity or a subjective experience of increased energy
Other features: 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.
Distinction from mania: The symptoms are not severe enough to
cause marked impairment in occupational functioning or in usual
social activities or relationships with others, do not necessitate
hospitalization, and there are no accompanying delusions or
hallucinations.
 Requirement: Bipolar 1 disorder
6A60.3 BIPOLAR 1
requirements have been met.
DISORDER,
Duration: 2 weeks
CURRENT EPISODE Features: Difficulty concentrating,
DEPRESSIVE, MILD 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.
Distinction: The symptoms are not
intense, but considerable difficulty in
continuing daily chores and work.
Absence of any delusions and
hallucinations.
6A60.4 Bipolar 1 Disorder, current
episode depressive, moderate
without psychotic features.

Requirement: Bipolar 1 disorder

requirements have been met.
Distinction: Symptoms present to a
marked degree, with more indication of
psychomotor retardation with
considerable difficulty in continuing
with work, social, or domestic activities,
but is still able to function in at least
some areas.
6A60.5 Bipolar 1 Disorder, current episode depressive, moderate with psychotic
features.
6A60.6 Bipolar 1 Disorder, current episode depressive, severe without psychotic
features.
Distinction: Unable to maintain functionality
6A60.7 Bipolar 1 Disorder, current episode depressive, severe with psychotic
features.
6A60.8 Bipolar type I disorder, current episode depressive, unspecified severity
6A60.9 Bipolar type I disorder, current episode mixed, without psychotic
symptoms
Duration: 1 week with alteration of mood
6A60.A Bipolar type I disorder, current episode mixed, with psychotic symptoms
6A60.B BIPOLAR TYPE I
DISORDER, CURRENTLY IN
PARTIAL REMISSION, MOST
RECENT EPISODE MANIC OR
HYPOMANIC

Distinction: The full

definitional requirements for a
manic or hypomanic episode
are no longer met but some
significant mood symptoms
remain.
6A60.C Bipolar type I disorder, currently in partial remission, most
recent episode depressive

Distinction: The full definitional requirements for the episode are no longer met
but some significant depressive 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.
 6A61 BIPOLAR
TYPE II DISORDER
1. 6A61.0 BIPOLAR TYPE II DISORDER, CURRENT EPISODE HYPOMANIC
2. 6A61.2 BIPOLAR TYPE II DISORDER, CURRENT EPISODE DEPRESSIVE, MODERATE WITHOUT PSYCHOTIC
SYMPTOMS
3. 6A61.3 BIPOLAR TYPE II DISORDER, CURRENT EPISODE DEPRESSIVE, MODERATE WITH PSYCHOTIC
SYMPTOMS
4. 6A61.4 BIPOLAR TYPE II DISORDER, CURRENT EPISODE DEPRESSIVE, SEVERE WITHOUT PSYCHOTIC
SYMPTOMS
5. 6A61.5 BIPOLAR TYPE II DISORDER, CURRENT EPISODE DEPRESSIVE, SEVERE WITH PSYCHOTIC SYMPTOMS
6. 6A61.6 BIPOLAR TYPE II DISORDER, CURRENT EPISODE DEPRESSIVE, UNSPECIFIED SEVERITY
7. 6A61.7 BIPOLAR TYPE II DISORDER, CURRENTLY IN PARTIAL REMISSION, MOST RECENT EPISODE
HYPOMANIC
8. 6A61.8 BIPOLAR TYPE II DISORDER, CURRENTLY IN PARTIAL REMISSION, MOST RECENT EPISODE
DEPRESSIVE
9. 6A61.9 BIPOLAR TYPE II DISORDER, CURRENTLY IN PARTIAL REMISSION, MOST RECENT EPISODE
UNSPECIFIED
10. 6A61.A BIPOLAR TYPE II DISORDER, CURRENTLY IN FULL REMISSION
 BEYOND ICD 11 AND DSM V
BIPOLAR 1: FULL-BLOWN MANIA
BIPOLAR 1.5: DEPRESSION WITH PROTRACTED (LASTING A LONG TIME)
HYPOMANIA: FUNCTIONALITY IS PRESENT, BUT THE PERSON IS
IRRITABLE AND RESTLESS
BIPOLAR 2: DEPRESSION WITH HYPOMANIA
BIPOLAR 2.5: CYCLOTHYLAMIC DEPRESSION: 4 DAYS - SHORT TERM
HYPOMANIA FOLLOWED BY MINI-EPISODES OF DEPRESSION .
BIPOLAR 3: ANTI-DEPRESSION ASSOCIATED HYPOMANIA:
BIPOLAR 3.5: BIPOLAR MASKED AND MASKED BY THE USE OF
STIMULANT
BIPOLAR IV: HYPERTHYMIC DEPRESSION: HYTHYMIC TEMPERAMENT
NOT EPISODE BOUND: STRONG SEXUAL APPETITE, WITH A STABLE
LIFESTYLE.
MANIA
CLINICAL FEATURES

An elevated, expansive, or irritable mood is the hallmark of

a manic episode. The elevated mood is euphoric and often
infectious and can even cause a countertransferential
denial of illness by an inexperienced clinician.
More irritable when plans are thwarted
Testing the limit of rules, blaming others, and creating
conflicts.
They are often preoccupied by religious, political, financial,
sexual, or persecutory ideas that can evolve into complex
delusional systems
In adolescents:
Misdiagnosed as ODD, ASPD, or schizophrenia, and
substance use.
POSITIVE FINDINGS IN MSE -
DEPRESSION
Speech: Single words and exhibit delayed responses to
questions. The examiner may literally have to wait 2 or 3
minutes for a response to a question.
Perceptual Disturbances: Mood-congruent delusions in a
depressed person include those of guilt, sinfulness,
worthlessness, poverty, failure, persecution, and terminal
somatic illnesses (such as cancer and a “rotting” brain)
Depressed patients customarily have negative views of
the world and of themselves.
Thought blocking and profound poverty of content
 POSITIVE FINDINGS IN MSE -
DEPRESSION
Memory: About 50 to 75 percent of all depressed patients
have a cognitive impairment, sometimes referred to as
depressive pseudodementia
Impulse control: 15 percent of all depressed patients
commit suicide, and about two-thirds have suicidal ideation.
Delusional systems, but the most severely depressed
patients often lack the motivation or the energy to act in an
impulsive or violent way. As they begin to improve and
regain the energy needed to plan and carry out a suicide
Interviews and conversations, depressed patients
overemphasize the bad and minimize the good.
 Manic patients are excited, talkative,
MANIA: sometimes amusing, and frequently
FEATURES: hyperactive.
Manic patients classically are euphoric but
can also be irritable, especially when mania
has been present for some time.
They also have a low frustration tolerance,
which can lead to feelings of anger and
hostility
Their speech is often disturbed. As the mania
gets more intense, speech becomes louder,
and more rapid - Prolixity. and difficult to
interpret. As the activated state increases,
their speech is filled with puns, jokes, rhymes,
plays on words, and irrelevancies
 Associations become loosened, the ability to
MANIA: concentrate fades, and flight of ideas, clanging, and
neologisms appear.
FEATURES In 75 percent of all manic patients. Mood-congruent
manic delusions are often concerned with great
wealth, extraordinary abilities, or power.
The manic patient’s thought content includes themes
of self-confidence and self-aggrandizement
“delirious mania.” Emil Krapelin - orientation
difficulties.
Impaired judgment is a hallmark of manic patients.
They may break laws about credit cards, sexual
activities, and finances and sometimes involve their
families in financial ruin
Unreliable information, inexperienced clinician may
treat them with disdain.
 DIFFERENTIAL DIAGNOSIS:

The workup should include tests for thyroid and adrenal functions
because disorders of both of these endocrine systems can appear as
depressive disorders
Substance Use
Dementia - confabulate
Bereavement - mummification, belonging with the deceased.
For manic symptoms, borderline, narcissistic, histrionic, and antisocial
personality disorders need special consideration.
Patients with borderline personality disorder often have a severely
disrupted life, similar to that of patients with bipolar II disorder, because
of the multiple episodes of significant mood disorder symptoms.
 PROGNOSIS:
Bipolar I disorder has a poorer prognosis than do patients with
major depressive disorder. About 40 to 50 percent of patients with
bipolar I disorder may have a second manic episode within 2
years of the first episode. Although lithium prophylaxis improves
the course and prognosis of bipolar I disorder
 FOR HOSPITALISATION
Food and shelter, and the need for diagnostic procedures. A history of
rapidly progressing symptoms and the rupture of a patient’s usual
support systems are also indications for hospitalization
Psychotherapies:

Cognitive therapies
Interpersonal and Social Rhythm Therapy
(IPSRT)
Behavioral Therapy
Psychoanalytically oriented therapy
Family therapy
Sleep Deprivation
Phototherapy: 1500 to 10,000 lux
 THANK YOU

For your participation & curiosity!