Differential for Manic Symptoms

Differential for Manic Symptoms is a study note in Bipolar Disorders.

Manic-like Symptoms

  • Mood/affect
  • Elevated: Mood that is unusually high, euphoric, cheerful, or “up”. The person may seem excessively happy, optimistic, energetic, or enthusiastic beyond what fits the situation.
  • Example: “I feel amazing—everything is perfect, and I can do anything.”
  • Expansive: Mood with excessive openness, confidence, sociability, or grandiosity. The person may be overly familiar, intrusive, uninhibited, or convinced of their special abilities or importance.
  • Example: acting as though they have a special mission, exceptional talents, or unusually close relationships with people they barely know.
  • Irritable: Mood is persistently angry, impatient, touchy, or easily annoyed
  • Examples: easily agitated, hostile, argumentative, or frustrated
  • Speech
  • Pressured Speech: Speech is unusually rapid, loud, forceful, or hard to interrupt
  • Thought Process
  • Flight of ideas: Thoughts move rapidly from one idea to another, often with loose but still traceable connections
  • Thought Content
  • Grandiosity: inflated sense of self-esteem, importance, power, knowledge, ability, identity, or special purpose.
  • Examples:
  • “I’m the smartest person in the hospital.”
  • “I don’t need training—I can run this company better than anyone.”
  • “I have a special mission to change the world.”
  • “I have unique powers or connections others don’t understand.”
  • Cognition
  • Distractibility: attention is easily puled away from irrelevant external stimuli

Manic-like Episode Criteria

  • Can involve any of the manic-like mood symptoms. They can shift, co-exist, or emerge despite the person initially appearing euphoric

Table: DSM Criteria

CharacteristicManic EpisodeHypomanic Episode
Mood elevated / irritable / expansive AND ↑ energy/activityPersistent, lasting >7 daysPersistent, lasting >4 days
Period includes >3 manic symptoms (GSTPAID)
    • Grandiosity (inflated self-esteem)
    • Sleep need ↓
    • Talkative / pressured speech
    • Pleasurable activities, painful consequences (impulsive behavior)
    • Activity increased OR Psychomotor agitation
    • Ideas (flight of)
    • Distractibility
Regarding function…Disturbance causes marked impairment (social / occupational)
    • OR Requires hospitalization to prevent harm to self/others
    • OR Psychotic features
Δ in function, Δ observable by others, Δ in function is not marked (no hospitalization, no psychosis)
Not due to substance or AMC
    • Exception – 2o to antidepressant / ECT

Differential

Primary Mood disorders

Secondary Disorders

Other

  • ADHD
  • Personality Disorder
  • Borderline PD
  • Narcissistic PD
  • Antisocial PD
  • Other specified bipolar and related disorder
  • Unspecified bipolar and related disorder

Table: Feature comparison of bipolar disorders

SymptomsTimeframe of SxEtiology CluesOther Clues
Bipolar IMania (A,B,C,D)>7 days,
OR hospital/psychosis		Mood sx in absence of substance useFmHx of Bipolar
Substance preference for stimulants and ETOH
Bipolar IIHypomania (A,B,C,D) & MDE>4 days
CyclothymicHypomanic & MDE sx periods
Criteria C, D		>2 years, >50% of time
Not w/o for >2 mo
SchizoaffectiveAny mood episodeWith psychosis>2w period of psychosis without mood symptoms
SubstanceCriteria A, CDuring/soon after use
NOT before,
NOT>1mo after		Drug capable of causing sx
(stimulant, EtOH)		Continuous sx
FmHx of externalizing, anxiety D/Os
A.M.C.Criteria A, CEvidence of AMC causing Sx
Other specifiedCriteria A, CReason other criteria not met, is SPECIFIED
UnspecifiedCriteria A, CReason other criteria not met, is NOT SPECIFIED
Borderline PDImpulsive
labile mood
Unstable rel’ns		ChronicRapid mood changes (<1 day). True euphoria rare
Prolonged dysfunction
Self-harm behaviors
Narcissistic PDGrandioseChronicEarly onset need for admiration, lack of empathy
Antisocial PDImpulsiveChronicEarly onset disregard for rights of others