In this video I describe the symptoms and prevalence of several disorders in the DSM-5 category of Bipolar and Related Disorders, formerly in the category of mood disorders. I describe the symptoms and prevalence of Bipolar I, Bipolar II, and Cyclothymic Disorder. Please note that the symptoms described in this video are not comprehensive and there are other symptoms involved in diagnosis for each of these disorders.
An Unquiet Mind – Kay Redfield Jamison (Amazon affiliate link)
Video Transcript
Hi, I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to look at the category of bipolar and related disorders in the DSM-5 and I can begin by noting that this is also a new category in the DSM-5. So if you look at earlier editions of the DSM you’ll see that bipolar disorders were classified as mood disorders but, as we’ll see, not all of the symptoms of bipolar disorders relate directly to mood. And so for this reason it was considered more appropriate to create a new category for bipolar and related disorders.
Now we can start by looking at the term bipolar which literally means two poles or two extremes and what these refer to is the occurrence of manic episodes and depressive episodes. So we’ll start by looking at bipolar I disorder and what the characteristics are of a manic episode. So a manic episode is defined as a period where most of the day, for at least 7 days, a person experiences symptoms of inflated self-esteem, feelings of grandiosity, they often show decreased need for sleep, sleeping only 3 or 4 hours per night, they also show increases in their goal-directed activity and also increases in impulsive activities like shopping sprees, or sexual promiscuity, or engaging in risky investments. In addition, they often show increased talkativeness and in their speech we see what’s called “flight of ideas“, this is where a person jumps very rapidly from one topic to another, it’s very difficult to follow the conversation.
So that’s the criteria for a manic episode and then in addition to a manic episode in bipolar I we also see depressive episodes. So that’s our other extreme and so a depressive episode, you may recall, is a period of depressed mood that lasts most of the day, every day, for a period of at least two weeks. And the same criteria are used for bipolar I disorder and a depressive episode that we saw in major depressive disorder which is what I talked about in the previous video. So if you want more details on what exactly a depressive episode refers to, you can check out that video and the criteria are the same for bipolar 1 diagnosis.
Now the previous name for bipolar disorders, if you look at early editions of the DSM, was manic depressive disorder. Both of these names manic depressive disorder and bipolar disorder can be criticized for downplaying the occurrence of what are known as mixed states. And this is feelings of depressed mood but combined with agitation, energy, and aggression. This is something that doesn’t quite fit into these two extremes, it’s sort of a mix of both of these, hence the name mixed states. This is something that was discussed by Kay Redfield Jamison in her excellent book “An Unquiet Mind” and Jamison is an expert on bipolar disorder and she’s also a sufferer of the disorder. So her book provides a really fascinating personal as well as professional account of the disorder and I highly recommend checking it out if you’re interested in learning more about bipolar disorders, and I’ll post a link in the video description where you can find the book.
Ok, the estimated 12-month prevalence for bipolar I disorder is about 0.6% and it’s slightly more common in males than females with a ratio of about 1.1 to 1 and the mean age of onset is about 18. One of the most important things to know about bipolar I disorder is that it does carry a highly elevated risk of suicide. So the risk of suicide is estimated to be about 15 times greater for sufferers of bipolar I disorder compared to the general population. And it’s also estimated that about 25% of all completed suicides are by people suffering from bipolar I disorder.
Okay next we’ll look at bipolar II disorder. So in bipolar II disorder we also see the same major depressive episodes that we saw in major depressive disorder and bipolar I, so that extreme is the same but in bipolar II the manic episodes are not as intense; they’re not full-blown manic episodes. They’re what are called hypomanic episodes and so the criteria for a hypomanic episode is lasting 4 or more days, but with not severe enough symptoms to have the same occupational or social impairments that we see in a full manic episode. And so that’s the main characteristic that distinguishes between bipolar I and bipolar II is how severe the manic episodes are. Are they full manic episodes or hypomanic episodes?
The estimated 12-month prevalence for bipolar two disorder is about 0.8% in the United States and it’s estimated to be lower internationally at about 0.3% and the onset is slightly later in the mid-20s. Now this brings us to an area of difficulty when it comes to the diagnosis of bipolar disorders which is that the occurrence of these symptoms doesn’t happen in the same order for all sufferers, and so it’s possible that you begin by having a manic or hypomanic episode and that makes it a bit easier to diagnose you with a bipolar I or bipolar II disorder. But if your symptoms begin with a depressive episode it’s very difficult because it looks like a depression initially. So someone might experience a depressive episode and they’ll receive a diagnosis of major depressive disorder based on this depressive episode and then later it’s possible that they have a hypomanic episode and if this occurs then now their diagnosis needs to be changed to be bipolar II. And then about 5 to 15% of these people who have now been diagnosed with bipolar II after a major depressive disorder diagnosis will experience the full manic episode. When this occurs now the diagnosis must be changed again to bipolar I disorder.
We can see this makes it especially difficult to diagnose these disorders and this is especially important because it’s dangerous in that antidepressants are known to trigger manic episodes. The treatments for bipolar disorders and for depression, major depressive disorder, are not the same and taking antidepressants might increase the risk that somebody has a hypomanic or manic episode in the future. Now it’s also worth noting that bipolar II also carries an elevated risk of suicide and it’s estimated that about 1 in 3 sufferers of bipolar II disorder attempt suicide at some point.
Okay finally we’ll look at the final disorder in this category of bipolar and related disorders and this is cyclothymic disorder. So this is where a patient suffers from mood fluctuations, similar to what we see bipolar disorders, but the hypomanic and depressive episodes are not as frequent, not as severe, or not long-lasting enough to fully meet the criteria for a diagnosis of one of the bipolar disorders. So we still see the same types of mood fluctuations but in a less severe way but it’s still interrupting the person’s life interfering with their ability to function properly and as a result they can receive a diagnosis of cyclothymic disorder. Okay so I hope you found that helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!
