Bipolar Disorder Modules

Excellent information here from Australia on the management of bipolar disorder.

Clicky.

An easy way to find out if your mood is off.

Okay, so if you read the DSM-IV TR, the most recent Bible for mental health diagnosing, you can come up with the criteria for a major depressive episode.  They are as follows (take a deep breath before diving into all of this–the good stuff is after all of this):

A. Five (or more) of the following symptoms have been present during the same 2-week 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.

Note:  Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others)

(9) 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

B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D. 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).

E. 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.

Similarly, the diagnosis for bipolar disorder is: as follows:

Criteria for a hypomanic episode DSM-IV-TR

1. A distinct period of persistently elevated, expansive, or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual non depressed mood.
2. 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:
   1. inflated self-esteem or grandiosity
   2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
   3. more talkative than usual or pressure to keep talking
   4. flight of ideas or subjective experience that thoughts are racing
   5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
   6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
   7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
3. The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
4. The disturbance in mood and the change in functioning are observable by others.
5. The episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalization, and there are no psychotic features.
6. 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).

 

[edit] Criteria for a mixed episode DSM-IV-TR

1. The criteria are met both for a Manic Episode and for a Major Depressive Episode (except for duration) nearly every day during at least a 1-week period.
2. 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.
3. The symptoms are not due to the direct physiological effects of a substance (e.g., an illicit drug, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).

 

[edit] Criteria for a manic episode DSM-IV-TR

1. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week (or any duration if hospitalization is necessary).
2. 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:
   1. inflated self-esteem or grandiosity, potentially including grandiose delusions
   2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) or persistent difficulty falling asleep
   3. more talkative than usual or pressure to keep talking
   4. flight of ideas or subjective experience that thoughts are racing
   5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
   6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
   7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
3. The symptoms do not meet criteria for a Mixed Episode.
4. 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.
5. 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).

Still with us this far?

Got it memorized?  No?

OK, so this is not a scientific set of criteria like the above (it is based on finding out what my clients find the most helpful for monitoring their mood), but it really is what you need if you are just trying to ask yourself if you are depressed or manic after you have been given the diagnosis by a licensed mental health professional.

Nate’s Big Three

SLEEP
(too much or too little, frequent
awakening, insomnia, early morning
awakening)
SOCIAL ACTIVITY
(isolation, not wanting to be bothered,
suddenly becoming the life of the party)
THOUGHT CONTENT
(negative, overly optimistic, grandiose)

Essentially, if you see changes in these areas that last for more than 3 days or so, you may want to talk to your therapist about them or your psychiatrist.

That’s a little easier to track than the other stuff above.  Hope this helps.  Let me know if you have any questions.

Mood Charting Software

After yesterday’s post about mood charting, I received a comment from someone who is developing what looks like promising mood charting software which will include a mobile version.  Neat!

Here is the link:  http://www.findingoptimism.com/

And a screenshot of the software:

Mood Charts

Sample Mood Chart from Moodtracker.com

For those of you who have depression and/or bipolar disorder (what used to be called “manic-depression”), mood charting can be very helpful.  A mood chart is a tool which helps you track your mood and other significant symptoms over time in a graphical manner so you can share your information with your therapist or psychiatrist.  The one above is from Moodtracker.com, a site that lets you share your chart information with your clinician online.  The handout I use in my own practice is here.

Mood charts are completed on a daily basis and handed in at your visit with your clinician.  It takes some perseverence to adapt to the habit of recording your mood on paper a daily basis, although the actual work is about 30 seconds a day (if done on paper), mostly spent in finding your pencil and the mood chart.  For that reason, I usually suggest to clients that they put the mood chart on their bedside table with a pencil nearby.

It’s a simple way to get a lot of information about how you are doing and how your medications (if you take them) are working.  It can also help you find out if you are having a mixed episode (if you are bipolar) or if you are a rapid-cycler.

Overall, it is a good weapon to have in your arsenal against depression or bipolar disorder.