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BIPOLAR DISORDER

both manic and depressive episodes

Manic Episode
DSM-IV-TR Criteria

A distinct period of abnormally and persistently


elevated, expansive, or irritable mood, lasting at
least 1 week (or any duration if hospitalization is
necessary).
During the period of mood disturbance, three (or
more) of the following symptoms have persisted
(four if the mood is only irritable) and have been
present to a significant degree:
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
distractibility
increase in goal-directed activity or
psychomotor agitation
excessive involvement in pleasurable
activities that have a high potential for
painful consequences

PATIENT
No mood elevations
There were episodes of irritable mood but not enough
to consider as the prevailing mood in this case.

(3rd
rd year) : very talkative in class
(Oct 08) noted to be very talkative on their way to a
cemetery in Marikina
(3rd
rd year) : numerous ideas running in her mind
hyperactive
(1993) grabbed cars steering wheel while her mom
was driving
(3rd
rd year)
- shopped for clothing items & jewelries, maxing out
her 2 credit cards
- shoplifting [of items she could not afford]
(Oct 08) spent P14000 for shopping ; stayed at an
apartelle for 3 days

Manic Episode
DSM-IV-TR Criteria

The symptoms do not meet criteria for


a mixed episode.

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.

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).

PATIENT

Major Depressive Disorder

DSM-IV-TR Criteria
Five (or more) of the ff. present during the same 2-

Five (or more) of the ff. present during the same 2week 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,
(feels sad or empty) or appears tearful ; irritable
mood
markedly diminished interest or pleasure in all, or
almost all, activities most of the day, nearly every
day
significant weight loss when not dieting or weight
gain
insomnia or hypersomnia nearly every day
psychomotor agitation or retardation nearly every
day
fatigue or loss of energy nearly every day
feelings of worthlessness or excessive or
inappropriate guilt (which may be delusional) nearly
every day
diminished ability to think or concentrate, or
indecisiveness, nearly every day
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

PATIENT

Dec 2002: bus ride approached


by a man and was told that she
looks miserable and sick
- no other description in the hx
that is indicative of a depressed state

Major Depressive Disorder

The symptoms do not meet criteria for


a mixed episode.

The symptoms cause clinically


significant distress or impairment in
social, occupational, or other
important areas of functioning.

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).

The symptoms are not better


accounted for by bereavement, i.e.,
after the loss of a loved one, the
symptoms persist for longer than 2
months or are characterized by
marked functional impairment, morbid
preoccupation with worthlessness,
suicidal ideation, psychotic symptoms,
or psychomotor retardation.

DSM-IV-TR Criteria

PATIENT

Major Depressive Disorder

The symptoms do not meet criteria for


a mixed episode.

The symptoms cause clinically


significant distress or impairment in
social, occupational, or other
important areas of functioning.

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).

The symptoms are not better


accounted for by bereavement, i.e.,
after the loss of a loved one, the
symptoms persist for longer than 2
months or are characterized by
marked functional impairment, morbid
preoccupation with worthlessness,
suicidal ideation, psychotic symptoms,
or psychomotor retardation.

DSM-IV-TR Criteria

PATIENT

BP characteristics
Excited, talkative, hyperactive
Euphoric or irritable (low frustration tolerance)
Delusions in 75% [ patient: (+) delusion of
refernce & non bizaare delusion)
Intact orientation & memory
Assaultive or threatening
Hallmark: impaired judgment: may break laws
- Maxing out credit card
- Shoplifting