Mood disorders present significant disturbance in mood with episodes of manic, depressive, mixed, or hypomanic behavior.
Bipolar II disorder, as described in the DSM-IV-TR, does not include such episodes when they result from substance abuse or physiological medical conditions. Medication induced symptoms are also not included in a diagnosis of Bipolar II disorder. Bipolar II disorder does not present the symptoms that involve enough impairment or severity require hospitalization, and there is not or the psychosis, manic or mixed episodes of other mood disorders.
This is very important as many substance abusers complain of, or claim to have bipolar disorders, when they are actually undergoing the highs and depressions that relate to the drug use, not to the recognized causes of Bipolar II disorder.
Diagnosis of Bipolar II disorder involves one or more episodes of major depression, then applies criterion A through E.
Criterion A involves having at least one Hypomanic Episode in relation to the major depressive episode. Criterion A1 is the individual’s self description of feeling sad, hopeless, depressed, discouraged, and so on.
Criterion B involves not getting a manic episode confused with the improved or euthymic eposide that follows remission of a major depression. The euthymic episode is a return to the normal, reasonibly positive mood of not depressed nor highly elevated.
Also, Criterion C involves having Manic or Mixed Episodes, which rules out a diagnosis of Bipolar II disorder.
Criterion D covers alternative disorders that might be confused with true Bipolar II disorder. These include: Substance-Induced Mood Disorder that are the direct physiological effects of taking the substance, somatic depression treatment, toxin, or drugs of abuse.General medical conditions are alternatives that may rule out a diagnosis of true Bipolar II disorder.
Criterion D enters the territory of “not better accounted for by” other disorders, or is not superimposed on top of these disorders: Schizoaffective Disorder, Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder that has unspecific cause.
Criterion E is the standard factor of the disorder causing significant impairment of ability to function in social, job, and other important areas of life.
Major Depression:
The core problem that is present is the major depressive episode, where mood depression or the loss of interest or pleasure from almost every activity lasts for at least two weeks. Children may exhibit an irritable instead of sad mood.
Accompanying the assessment is a list of symptoms, at least four of which must be present: First are the changes: appetite, weight, sleep and psycho-motor activity. Then, there is decrease: energy. There are the feelings: worthlessness or guilt. In some cases there are the “blahs”, or no feelings, feeling anxious, facial expressions and demeanor that indicate feelings. Aches and pains may be described in place of stating feelings of sadness.
There is behavior: irritability, angry outbursts, blaming others, excessive frustration over “the little things”, or a “spoiled child” behavior in children.
There are the difficulties: thinking, concentrating, making decisions. There are the thoughts: death, suicidal ideas, suicide plans, suicide attempts.
There is the mood described by the individual: depressed, sad, hopeless, discouraged, “down in the dumps”. With the current wider spread understandings of depression, the statement might clearly be “I feel depressed”.
There are times and recencies that must be met: either the symptom is new or has obviously gotten worse than it was before the depressive episode. Persistence: most of the day, almost every day, at least 2 consecutive weeks.
Hypomanic Episodes:
The actual disorder manifests with Hypomanic Episodes which may not be viewed as pathological, but instead may be viewed by professionals and others as “erratic”. The individual may not remember the Hypomanic episodes, which makes other people such as family, close friends and others important in describing the behavior and symptoms.
A hypomanic episode is a period of at least four days where the mood is “abnormally and persistently elevated, expansive or irritable”. Unlike a Manic Episode, there is not enough severity to warrant hospitalization, there are no psychotic elements, and there is not enough impairment to require hospitalization.
Criterion B involves: For diagnosis of a hypomanic episode there are the following symptoms, three of which must accompany the abnormal mood:
Inflated self esteem or grandiosity that is nondelusional. Less need for sleep, a concept called “pressure” of speech, a concept called “flighty ideas”, easily distracted, more involvement in goal-directive activities or agitation in psychomotor activities; too much involvement in risky activities. Finally, there is a change from the persons normal mood and functioning.
As wtih major depression, the history, statements and descriptions of other persons are important in the Hypomania diagnosis.
DSM-IV-TR: Bipolar II Disorder
http://www.psychiatryonline.com/content.aspx?aID=2585&searchStr=bipolar+ii+disorder
DSM-IV-TR: Major Depressive Episode
http://www.psychiatryonline.com/content.aspx?aID=2089&searchStr=major+depressive+episode
DSM-IV-TR: Hypomanic Episode
http://www.psychiatryonline.com/content.aspx?aID=2228&searchStr=hypomanic+episode
The Free Dictionary, “Euthymic Definition” http://medical-dictionary.thefreedictionary.com/euthymic
