Manic Episode

DSM-IV dx criteria for manic episode

1) A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hosp is necessary).

2) During this period of mood disturbance, at least 3 of the following symptoms (4 if mood is only irritable) and have been present to a significant degree.

(a) Inflated self-esteem or grandiosity

(b) decreased need for sleep; e.g., feels rested after only 3 hours of sleep

(c) More talkative than usual or pressure to keep talking

(d) Flight of ideas or subjective experience that thoughts are racing. (c. & d. are separate and may be difficult to untangle)

(e) Distractibility; i.e., attention too easily drawn to unimportant or irrelevant stimuli.

(f) Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation

(g) Excessive involvement in pleasurable activities which have a high potential for painful consequences;

(h) Mood disturbance 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. If this symptom is not met, but first two are, hypomanic episode.

(i) Not due to organic factor

(j) No delusions or hallucinations for at least 2 weeks in absence of mood symptoms (explain this is to differentially dx from e.g., Sz)

(k) Not superimposed upon other Psychotic disorder: Sz, Szoform, Delusional Disorder.

(l) Not due to ECT, light therapy, meds

3) DSM-IV add'l coding: mild, moderate, severe w/o psychotic features, mood (in)congruent psychotic features.

Developmental expressions of Manic and Depressive Symptoms

Mania in children vs. adults

Features

The mood of mania in children is most often irritable, rather than expansive and euphoric as in adults.

Episode cycling

Heritability – MZ=50-70% concordance and DZ = 13-30%

DSM-IV classification scheme

Episodic vs. Chronic

Cyclothymia

Epidemiology/Genetics

UP depression vs BP Disorder

2-3:1, F:M = sex ratio

Lifetime risk 3% M, 5-8% F 1% M & F (expl LRisk)

Age Onset peaks 35-45 yrs peaks 25-35 yrs (Mdn = 43)

No rltnshp to SES > prevalance in ^ SES

psymotor agitation ^ likely psymotor retardation ^ likely

Hypo somnia ^ common Hypersomnia common

More Anger Mild/no Anger

Anxiety often present Less anxiety

F's likely to have multiple multiple episodes clearly the

episodes rule for M & F

Mean # episodes = 6 Mean # episodes = 8 (w/ tx)

15% will develop mania - - - - - - - - - - - - -

- - - - - - - - - - - - Increased fam hx (not nec BP)