_Disorder INHIMA双相情感障碍的课件.ppt

Diagnosing Bipolar Disorder “We’re all a little that way” MH Disorders in OP Psychiatry 25% “Other” = Schiz, Anx, ADHD, PD 25% Depression -(often treatment resistant) 25% Bipolar disorder 25% “Bipolar Spectrum” Complicated, confusing, comorbid, poor treatment outcome Diagnosis of Mood Disorders The possibilities: Bipolar I = Mania with or w/o depression Bipolar II = Hypomania with depression Cyclothymia = hypomania with “minor” depression Major Depression = depression “Bipolar spectrum” = Depression + other complexities Bipolar NOS or Mood DO NOS Always consider these: Significant medical condition Depression due to general med condition History of many physical symptoms Secondary depression Significant recent substance use Meth and cocaine and pot = mania/psychosis Alcohol and cocaine withdrawal = depression Diagnosis of BPAD Assessment of cross sectional symptoms inadequate for dx One session = “One cut of an MRI” Assessment of longitudinal course essential Collateral info = other providers, admits, family history and input, follow-up visits “The whole MRI” “Biography” Diagnosis DSM IV TR criteria for mania Distinct period of abnormally and persistently elevated or irritable mood lasting a week or requiring hospitalization, or with psychosis Three or more of: grandiosity, decreased need for sleep; talkative; flight of ideas; distractibility; increase in goal directed activity; excessive involvement in pleasurable activities = buying sprees, sexual indiscretions, foolish business investments DSM 4TR criteria for depression(MDD) Depressed mood most of the day almost every day Diminished interest or pleasure Appetite and wt changes Sleep changes Agitation or slowness of movement Fatigue Guilt or “worthlessness” Poor concentration Thoughts of death or suicide Other features of Depression Psychosis--paranoia or hallucinations Seasonal component = SAD Postpartum onset Catatonic features=marked psychomotor disturbance, immobility or stupor Melancholic f