Bipolar Disorder For Dummies. Joe Kraynak
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Название: Bipolar Disorder For Dummies
Автор: Joe Kraynak
Издательство: John Wiley & Sons Limited
Жанр: Зарубежная образовательная литература
Серия: For Dummies
isbn: 9781119121879
isbn:
Doctors in countries throughout the world (not the United States) rely on the World Health Organization’s (WHO) International Classification of Diseases, a classification system for all health issues. Chapter V of the ICD specifically addresses mental and behavioral disorders.
The major difference between DSM-5 and ICD-10 is that the WHO manual doesn’t use the labels bipolar I and bipolar II as primary distinctions. Instead, ICD-10 refers to the disorder as bipolar affective disorder and then further classifies it by the nature of the current episode: currently hypomanic, currently manic, currently depressed, mixed disorder, or in remission. In addition, the ICD-10 requires two or more mood episodes, with at least one being manic or hypomanic, to qualify for a bipolar diagnosis, while the DSM requires only a single manic or hypomanic episode.
The APA and WHO work together closely to coordinate their efforts. So in clinical practice, a doctor using one manual should arrive at a similar diagnosis as a doctor using the other.
Exploring the Poles of Bipolar Disorder: Mania and Depression
Bipolar diagnoses rely heavily on the type of mood episode(s) a person is experiencing or has experienced in the past, so to understand the different diagnoses, you need to know what constitutes a mood episode – specifically a manic, hypomanic, and major depressive episode. In the following sections, we present the DSM-5 diagnostic criteria for each mood episode type.
A manic episode is a period of abnormally elevated energy and mood that interferes with a person’s ability to function as he normally does. Merely having some manic symptoms isn’t the same as experiencing a manic episode. The symptoms must meet the following four criteria.
The episode must last for at least one week or require hospitalization, and it must be characterized by “abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy” that’s “present most of the day, nearly every day.”
Three of the following symptoms must also be present during the week of mania (four, if the mood is irritable rather than elevated or expansive). The symptoms must be present to a significant degree and represent a change from usual behavior.
✔ Markedly inflated self-esteem or grandiosity
✔ Decreased need for sleep (for example, feeling well rested after three hours or less of sleep)
✔ Excessive talking or the need to talk continuously (pressured speech)
✔ Flight of ideas – when thoughts flow rapidly and shift topics rapidly and indiscriminately – and/or the feeling that one’s thoughts are racing
✔ Inability to concentrate and being easily distracted by insignificant external stimuli
✔ Significant increase in goal-directed activity (socially, at work or school, or sexually) or significant physical movement or agitation (aimless activity)
✔ Excessive involvement in risky, potentially self-destructive activities, including sexual indiscretions, unrestrained shopping sprees, and optimistic investments in pyramid schemes
The mood episode must be severe enough to
✔ Impair the person’s ability to socialize or work, or
✔ Require hospitalization to prevent the person from harming herself or others, or
✔ Cause psychotic features (paranoia, hallucinations, or delusions) indicating that the person is out of touch with reality
For more details, see the later section, “Presence or absence of psychosis.”
For a manic episode to count toward bipolar diagnosis, the mania must satisfy the following conditions:
✔ The mania can’t be exclusively drug-induced or attributed to medical treatments. For example, if you’re taking an antidepressant, steroid, or cocaine at the time you experience manic symptoms, then the episode doesn’t count toward a diagnosis of bipolar disorder, unless symptoms persist after the effects of the substance have worn off.
✔ The mania isn’t attributable to another medical condition. Mania that is caused by a medical condition is identified as a separate form of bipolar disorder, as described in the later section, “Distinguishing Types of Bipolar Disorder.”
A hypomanic episode requires the same number and types of symptoms as a manic episode that we discuss in the preceding section. For instance, the symptoms must represent a distinct change from a person’s usual behavior patterns, and the changes must be observable by others. However, a hypomanic episode differs from a manic episode in the following ways:
✔ May be shorter in duration (just four consecutive days is enough to qualify as a hypomanic episode)
✔ Doesn’t cause severe functional impairment
✔ Doesn’t require hospitalization
✔ Doesn’t include psychosis
During a major depressive episode you may feel like you’re swimming in a sea of molasses. Everything is slow, dark, and heavy. To qualify as a major depressive episode, five or more of the following symptoms must be present for at least two weeks straight. These symptoms must be changes from usual behavior, and the episode must include at least one symptom of depressed mood or loss of interest or pleasure.
✔ Depressed mood most of the day nearly every day
✔ Markedly diminished interest nearly every day in activities previously considered pleasurable, which may include sex
✔ Notable increase or decrease in appetite nearly every day or a marked change in weight, up or down (5 percent or more) in a span of one month or less that isn’t due to planned dietary changes
✔ Sleeping too much or too little nearly every day
✔ Moving uncharacteristically slowly or having physical agitation observable by others, not just internal sensations
✔ Daily fatigue
✔ Feelings of worthlessness, excessive guilt, or inappropriate guilt nearly every day
✔ Uncharacteristic indecisiveness or diminished ability to think СКАЧАТЬ