DSM-5 Mood Disorders

Bipolar Disorders
Manic Symptoms
Depressive Symptoms
• Elation
• Gloomy
• Euphoric
• Withdrawn
• Socially motivated, talkative
• Inability to make decisions
• Impulsive actions
• Fatigue
• Hyperactivity
• Slowness of thought
• Racing thoughts

DSM-5 Criteria: Manic Episode

These symptoms must represent a significant change

Individuals in a manic phase can be really frantic and distracted

May want to start a lot of things

• Goal directed activity
• incomplete goals

Expansive mood -> feeling like you are on top of the world

The symptoms must cause severe impairment in functioning or necessitate

hospitalization
In the video example
• can impair relationship with others

• When they come down from the manic state and they alienated their social support,
that can make them further feel depressive symptoms and make them feel low.

DSM-5 Criteria: Hypomanic Episode

Lasts for atleast 4 consecutive days.

Need to still have same number of symptoms, 3 or 4, depending on irritable mood

Represent a change of functioning and mood, but NOT caused impairment

However, symptoms do NOT cause marked impairment in social or occupational

functioning.

Hypomanic Episode
• less severe
• Still higher than baseline
• But not causing day to day issues.
Differentiating Between Bipolar
Disorders

Bipolar I Disorder
• History of at least 1 manic episode

• manic episode is key

• more severe

• High percentage of people have recurring

episodes, remaining highly impaired even after
they come down to baseline

Bipolar II Disorder
• History of at least 1 hypomanic episode AND

• History of at least 1 major depressive episode

Question:

Can someone be diagnosed with both

MDD and Bipolar?

No. History of any manic or

hypomanic episodes means the
person will be diagnosed on the
Bipolar Spectrum only and you
remain in that classification

MDD requires you never had manic

or hypermanic episodes

Prevalence of Bipolar Disorders

• Lifetime prevalence:
◦≈ 4% adults

• No observed sex difference

• Manic and hypomanic episodes reoccur

◦50% have recurrence within 1 year

◦> 50% of cases have 4+ episodes

• “Rapid cycling” (10-20%)

◦4 or more episodes in a given year
 ◦Poorer long-term prognosis

• High comorbidity with substance use

Etiology of Bipolar

a. Biological

Heritability
• Concordance rate MZ twins 60% vs. DZ twins 12%
◦Higher in MZ

• Strong heritable component:

◦80% of variability in bipolar disorders is genetic

◦As opposed to environmental factors

Neurotransmitter
• Reduced serotonin leads to both depression and mania

• Implication of higher norepinephrine in mania and manic symptoms

• Work to change the levels of these neurotransmitters in the brain

b. Psychological

Dysregulation in Reward Sensitivity

• Lower reward sensitivity and responsivity -> depression

• Greater reward sensitivity and responsivity -> mania

◦Excessive activation of the Behavioral Activation System
‣ A system that controls the approach behavior or goal directed behavior

‣ Activates emotions, energy, and encourage approach types of behavior

◦Because this system is overactive, it predisposes people to have manic symptoms.

 ◦People in risk of bipolar but did not been diagnosed have a higher BAS.

Evidence-Based Treatments for Bipolar

Unlike some disorders, medication is considered 1st line

• Mood stabilization
◦Lithium:
‣ Very effective for bipolar disorder (up to 80% have some relief)
• Manic and depressive symptoms
• Increases serotonin

‣ Harmful side effects - Kidney function, thyroid function

• Newer mood stabilizers

◦Effective for 50-60% of people with mania

◦Anticonvulsants
‣ Mixed evidence for depressive symptoms

‣ Effective for mania

‣ For example: Depakote, 50-60% response rate

◦Antipsychotics
‣ For example: Zyprexa

‣ Faster onset than lithium and anticonvulsants

Psychosocial treatments are considered adjuncts to pharmacological treatments

• Goals:
◦Prevent relapse
‣ Monitor symptoms

‣ Identify particular warning signs that start a manic or depressive episode

◦Medication compliance
‣ Help them keep them on medication

◦Psychoeducation
‣ For individuals and family

◦Enhance psychosocial functioning

‣ Increasing social support
‣ Reducing stress
‣ Improving coping skills to reduce chances of future episodes

◦Stress management

• For example: CBT