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Study sets matching "bipolar disorder"

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Study sets matching "bipolar disorder"

110 terms
Bipolar Disorder
Bipolar disorder is a mood disorder th…
Bipolar is classified as
Bipolar I the key diagnostic symptom is
Bipolar II has the same symptoms as bi…
extremely sad or hopeless state of depression to elevated moo…
Bipolar I and Bipolar II
mania but some patients can experience bouts of depression
less severe episodes called hypomania
Bipolar disorder is a mood disorder th…
extremely sad or hopeless state of depression to elevated moo…
Bipolar is classified as
Bipolar I and Bipolar II
38 terms
Bipolar disorder
Why you should not give antidepressant…
MDD first episode is usually before wh…
MDD is more prevalent in what age popu…
MDD has increased risk with?
They are fine for a while and then have manic disorder
30
elderly
chronic illness and stress
Why you should not give antidepressant…
They are fine for a while and then have manic disorder
MDD first episode is usually before wh…
30
70 terms
Bipolar Disorder
epidemiology
comorbidity
bipolar I is more common in males or f…
bipolar II is more common is males or…
-lifetime prevalence of BD in the US is 5%... -bipolar I - more…
-panic attacks... -alcohol abuse (higher in bipolar I than II)... -…
males
females
epidemiology
-lifetime prevalence of BD in the US is 5%... -bipolar I - more…
comorbidity
-panic attacks... -alcohol abuse (higher in bipolar I than II)... -…
61 terms
Bipolar Disorder
Bipolar I
Bipolar II
Cyclothymic
Hypomania
at least one manic episode or a mixed episode AND depressive…
depression and hypomania;
many episodes of depression hypomania, never without those ep…
increased activity or energy lasting at least 4 days and does…
Bipolar I
at least one manic episode or a mixed episode AND depressive…
Bipolar II
depression and hypomania;
9 terms
Bipolar disorder
Ziprasidone
Lurasidone
Aripiprazole
Benzisoxalone
Treat bipolar... Atypicla antipsychotics
Treat bipolar... Atypicla antipsychotics
Treat bipolar... Atypicla antipsychotics
Treat bipolar... Atypicla antipsychotics
Ziprasidone
Treat bipolar... Atypicla antipsychotics
Lurasidone
Treat bipolar... Atypicla antipsychotics
58 terms
Bipolar disorder
manic state... 1st line
Bipolar depression... 1st line
Lurasidone
Lamotrigine
Valproate or Li + an antipsychotica habitual spasmodic contra…
Li or Lamotrigine
also can use as monotherapy for bipolar depression
- bipolar depression... - for maintenance... (NOT beneficial for m…
manic state... 1st line
Valproate or Li + an antipsychotica habitual spasmodic contra…
Bipolar depression... 1st line
Li or Lamotrigine
34 terms
Bipolar Disorder
Manic episode
Manic symptoms
Hypomanic episode
What happens if you psychotic symptoms…
1) elevated, expansive, or irritable mood... 2) at least one wee…
1) grandiosity... 2) decreased need for sleep... 3) increased speec…
Abnormal mood lasting at least 4 days with same symptoms as m…
Automatically becomes mania
Manic episode
1) elevated, expansive, or irritable mood... 2) at least one wee…
Manic symptoms
1) grandiosity... 2) decreased need for sleep... 3) increased speec…
11 terms
Bipolar disorder
DIGFAST
Manic episode
How many cardinal symptoms do you need…
Treatment of hypomania or mania ... sever…
cardinal symptoms of mania: ... distractibility... impulsivity... gran…
requires that the pt has an irritable or euphoric mood along…
3 of the 7 cardinal sx if mood is euphoric... 4 of the 7 if mood…
severe: Li or valproate + antipsych drug... less severe: Li or v…
DIGFAST
cardinal symptoms of mania: ... distractibility... impulsivity... gran…
Manic episode
requires that the pt has an irritable or euphoric mood along…
35 terms
Bipolar Disorder
Bipolar 1
Bipolar II
Cyclothymic disorder
Rapid cycling
one or more manic or mixed episodes usually accompanied b…
one or more major depressive episodes accompanied by atleas…
2 years of numerous periods of hypmanic symptoms that *do not…
a person with the disorder experiences four or more episodes…
Bipolar 1
one or more manic or mixed episodes usually accompanied b…
Bipolar II
one or more major depressive episodes accompanied by atleas…
52 terms
bipolar disorder
what are the two opposite poles of bip…
what does bipolar have the highest rat…
bipolar I
bipolar I mania
manic and depressive
suicide
at least one episode of mania alternating with major depressi…
high self esteem ... aggressive... decrease in nutrition and sleep…
what are the two opposite poles of bip…
manic and depressive
what does bipolar have the highest rat…
suicide
14 terms
Bipolar disorder
Bipolar I
Bipolar II
Cyclothymia
Mania
mania/mixed +/- MDE
hypomania + MDE
Hypomania + "hypo-MDE" -> chronically 2 years
elevated mood where patients have lots of energy, may feel eu…
Bipolar I
mania/mixed +/- MDE
Bipolar II
hypomania + MDE
16 terms
bipolar disorder
Identify possible risk factors for Bip…
Detect drugs that may induce mania.
List differences in the presentation o…
Compare and contrast the mechanism of…
...
...
...
...
Identify possible risk factors for Bip…
...
Detect drugs that may induce mania.
...
20 terms
Bipolar Disorder
Bipolar
BiPo 1
BiPo 2
Bipolar Disorder Manic Episode
the presence of one or more manic episodes. Manic or hypomanic.
has had at least ONE manic episodes
At least one major D and at least one hypomanic epidsode
Systems for at least 4 days to 1 week - hypomania to mania -…
Bipolar
the presence of one or more manic episodes. Manic or hypomanic.
BiPo 1
has had at least ONE manic episodes
26 terms
[BIPOLAR DISORDER]
[MEDICAL CONDITIONS] that [INDUCE][MAN…
[MEDICATIONS] that [INDUCE][MANIA]
[SOMATIC THERAPIES] that [INDUCE][MANIA]
[TYPES of BIPOLAR DISORDERS]
-------------------------------------------------------------…
1. [ALCOHOL INTOXICATION]... ---------------------------------…
1. [BRIGHT-LIGHT][THERAPY]... --------------------------------…
1. [BIPOLAR DISORDER] - [Type][I] ----> [MANIA]... >>>> *[MA…
[MEDICAL CONDITIONS] that [INDUCE][MAN…
-------------------------------------------------------------…
[MEDICATIONS] that [INDUCE][MANIA]
1. [ALCOHOL INTOXICATION]... ---------------------------------…
73 terms
Bipolar disorder
treatment for acute mania
treatment for bipolar depression
maintenance drugs for mood stabilizers
mood stabilizers
lithium, valproic acid, carbamazepine ER
lithium
lithium, lamotrigine
seizure meds
treatment for acute mania
lithium, valproic acid, carbamazepine ER
treatment for bipolar depression
lithium
46 terms
Bipolar Disorder
What is the difference between Bipolar…
What is the goal of treatment?
Name the mood stabilizers
why should antipsyhotics be used w/ ca…
Bipolar I: most severe form of the disorder, key diagnostic s…
to stabilize the mood w/o inducing a depressive or manic state
- lithium (lithobid, Esklaith) ... - valproate... - lamotrigine (La…
*patients w/ bipolar disorder are more susceptible to extrapy…
What is the difference between Bipolar…
Bipolar I: most severe form of the disorder, key diagnostic s…
What is the goal of treatment?
to stabilize the mood w/o inducing a depressive or manic state
41 terms
Bipolar Disorder
What is a manic episode
What is a hypomanic episode
What is a mixed episode
What is rapid cycling
Manic: last one week and involve ... - abrupt onset with symptom…
Less severe form of mania... -Mood that is expansive, irritable,…
Occurrence of manic and depressive symptoms at the same time…
>/= 4 mood episodes within a year
What is a manic episode
Manic: last one week and involve ... - abrupt onset with symptom…
What is a hypomanic episode
Less severe form of mania... -Mood that is expansive, irritable,…
62 terms
Bipolar Disorder
What are some medications that can ind…
What are some medications that can cau…
Define cyclic mood, as seen in bipolar…
How is bipolar different from recurren…
Levodopa... Muscle-relaxers (Lioresal)... Synthroid... Stimulant medic…
BZD... Steroids... Interferon... Statins... Cipro... Beta-blockers
Recurrent extreme fluctuations in mood, energy, and behavior
Bipolar can have manic episodes, mixed episodes, and hypomani…
What are some medications that can ind…
Levodopa... Muscle-relaxers (Lioresal)... Synthroid... Stimulant medic…
What are some medications that can cau…
BZD... Steroids... Interferon... Statins... Cipro... Beta-blockers
13 terms
Bipolar Disorder
Bipolar Disorder
Bipolar I ... Bipolar II
Bipolar II is diagnosed with one hypom…
GST PAID... G = Grandiosity... S = Sleep (d…
A group of disorders characterised by mania and also major de…
What are the types of bipolar disorder?
How does Bipolar I differentiates from Bipolar II?
What is the diagnostic criteria for manic episode?
Bipolar Disorder
A group of disorders characterised by mania and also major de…
Bipolar I ... Bipolar II
What are the types of bipolar disorder?
25 terms
Bipolar Disorder
suicides in people with bipolar disord…
what is the age of onset of bipolar di…
how is bipolar disorder distinguished…
Bipolar I disorder definition
mixed
two peaks: 15-19 years, followed by 20-24 years... -mean 21 years
presence of at least one period of mood elevation or signific…
the presence of at least 1 manic episode with or without a hy…
suicides in people with bipolar disord…
mixed
what is the age of onset of bipolar di…
two peaks: 15-19 years, followed by 20-24 years... -mean 21 years
25 terms
Bipolar Disorder
suicides in people with bipolar disord…
what is the age of onset of bipolar di…
how is bipolar disorder distinguished…
Bipolar I disorder definition
mixed
two peaks: 15-19 years, followed by 20-24 years... -mean 21 years
presence of at least one period of mood elevation or signific…
Flucuates between full manic episodes and episoes of major de…
suicides in people with bipolar disord…
mixed
what is the age of onset of bipolar di…
two peaks: 15-19 years, followed by 20-24 years... -mean 21 years
30 terms
Bipolar Disorder
Definition
What is mania?
What is depression?
Frequent . . .
a disorder in which a person demonstrates extreme changes in…
highs in behavior
lows in behavior
mood swings/mood episodes
Definition
a disorder in which a person demonstrates extreme changes in…
What is mania?
highs in behavior
25 terms
Bipolar Disorder
suicides in people with bipolar disord…
what is the age of onset of bipolar di…
how is bipolar disorder distinguished…
Bipolar I disorder definition
mixed
two peaks: 15-19 years, followed by 20-24 years... -mean 21 years
presence of at least one period of mood elevation or signific…
the presence of at least 1 manic episode with or without a hy…
suicides in people with bipolar disord…
mixed
what is the age of onset of bipolar di…
two peaks: 15-19 years, followed by 20-24 years... -mean 21 years
9 terms
Bipolar disorder
True or False? Patients with Bipolar d…
What OTC medications can increase lith…
What psychotropic agents cause intenti…
Explain the effects of a 2-gm sodium r…
True
NSAIDs
Lithium
Lithium follows salt,
True or False? Patients with Bipolar d…
True
What OTC medications can increase lith…
NSAIDs
11 terms
Bipolar Disorder
Bipolar disorder is a mood disorder wh…
Diagnostic criteria:... Three or more of…
A medication that can treat either man…
Name the three mood stabilizers
mania
mania
mood stabilizer
lithium, valproate, and lamotrigine
Bipolar disorder is a mood disorder wh…
mania
Diagnostic criteria:... Three or more of…
mania
15 terms
Bipolar Disorder
DDx for Manic Episode
Substance-induced Bipolar
DDx for Bipolar: other psychiatric con…
How do distinguish Bipolar from ADHD?
*especially if 1st manic episode is AFTER 50 y.o., think UNDE…
cocaine, amphetamines ... antidepressants... ex: FLUOXETINE-induc…
MDD with irritable mood or mixed features ... ADHD*... *both ADHD…
ADHD is EARLY ONSET (before age 7), CHRONIC, and lack of clea…
DDx for Manic Episode
*especially if 1st manic episode is AFTER 50 y.o., think UNDE…
Substance-induced Bipolar
cocaine, amphetamines ... antidepressants... ex: FLUOXETINE-induc…
52 terms
Bipolar Disorder
Manic Episode
DIGFAST
Hypomanic Episode
Major Depressive Episode
Abnormally and Persistantly elevated, expansive, or irritable…
3 or more of the following:... - Distractibility... - Impulsiveness…
Same criteria as Mania except last at least 4 consecutive days
Having five or more of DSIGECAPS during the past 2 week period
Manic Episode
Abnormally and Persistantly elevated, expansive, or irritable…
DIGFAST
3 or more of the following:... - Distractibility... - Impulsiveness…
12 terms
bipolar disorder
Bipolar I disorder
Bipolar II disorder
cyclothymia
unspecified bipolar disorder
-an episode of mania causing impairment in social and occupat…
-Hypomanic alternating with depression... -no psychosis... -euphori…
-hypomanic alternating with minor depression... -irritable hypom…
does not fit in category
Bipolar I disorder
-an episode of mania causing impairment in social and occupat…
Bipolar II disorder
-Hypomanic alternating with depression... -no psychosis... -euphori…
8 terms
Bipolar Disorder
Etiology
Episodes
Manic Episode
Depression Episode
Biological
Manic or Depressed
Unrealistic beliefs ... Drug abuse... Provacative
Sadness... Guilt... Decreased energy... Decreased intrest
Etiology
Biological
Episodes
Manic or Depressed
19 terms
Bipolar disorder
manic episode
Bipolar 1 disorder
Bipolar 2 disorder
hypomanic episode
A period of at least one week with a prominent and persistent…
- more common... - full manic and major depressive episodes... - ma…
- less common... - hypomanic episodes and major depressive episo…
For at least four days, a person has experienced an abnormall…
manic episode
A period of at least one week with a prominent and persistent…
Bipolar 1 disorder
- more common... - full manic and major depressive episodes... - ma…
40 terms
Bipolar Disorder
What monitoring for Lithium?
What initial side effects do you see w…
What agent is useful in lithium-refrac…
This agent is more effective than lith…
CBC (plasma levels), Renal (Renal changes over time-Nephrotox…
GI distress, fine hand tremor, Inability to concentrate urine.
Carbemazepine
VPA
What monitoring for Lithium?
CBC (plasma levels), Renal (Renal changes over time-Nephrotox…
What initial side effects do you see w…
GI distress, fine hand tremor, Inability to concentrate urine.
8 terms
BIPOLAR DISORDER
1. Bipolar is considered what type of…
2. Name the 3 episodes of bipolar diso…
3. How is bipolar different than a nor…
4. What are factors that might lead to…
MOOD DISORDER
1. MIXED... 2. MANIA... 3. HYPOMANIC
It causes unusual shifts in moods, energy, and active levels…
GENETICS... BRAIN STRUCTURE ( small or frontal cortex)... BRAIN CHE…
1. Bipolar is considered what type of…
MOOD DISORDER
2. Name the 3 episodes of bipolar diso…
1. MIXED... 2. MANIA... 3. HYPOMANIC
12 terms
Bipolar Disorder
Valproic Acid
Lithium
You should not become pregnant while u…
Lamotrigine
In rare cases, it can damage your liver and pancreas.
This medicine can make you feel thirsty (dehydrated), nauseat…
Lithium, valproic acid, and carbamazepine (Category D)
You will need to slowly increase the dose, that's why it come…
Valproic Acid
In rare cases, it can damage your liver and pancreas.
Lithium
This medicine can make you feel thirsty (dehydrated), nauseat…
47 terms
Bipolar Disorder
What is bipolar I disorder?
Does a patient need to have MDE to be…
What is the difference between bipolar…
What is cyclothymic disorder?
One or more manic episodes and depressive episodes OR with mi…
No
Bipolar II never develop into a full manic episode. Only goes…
A form of bipolar disorder consisting of short periods of mil…
What is bipolar I disorder?
One or more manic episodes and depressive episodes OR with mi…
Does a patient need to have MDE to be…
No
62 terms
Bipolar disorders
What is a mood?
What does hyperthymic mood mean?
What does euphoric mood mean?
what does is meat to have an elated mo…
A pervasive and sustained emotion that influences one's perce…
exaggerated emotionalism, extreme hyperactivity
exaggerated sense of well being
feeling of being high or in top of the world
What is a mood?
A pervasive and sustained emotion that influences one's perce…
What does hyperthymic mood mean?
exaggerated emotionalism, extreme hyperactivity
8 terms
Bipolar Disorder
Bipolar 1
Mania
Hypomania
Pharmacologic Treatment of Bipolar Dis…
1. Major depressive disorder AND... 2. Mania... Equal likelihood in…
AT LEAST 1 WEEK of abnormal and persistently elevated mood an…
AT LEAST 4 days of abnormal and persistently elevated mood an…
1. Break the mania with an antipsychotic, anticonvulsant, val…
Bipolar 1
1. Major depressive disorder AND... 2. Mania... Equal likelihood in…
Mania
AT LEAST 1 WEEK of abnormal and persistently elevated mood an…
12 terms
BIPOLAR DISORDER
BIPOLAR DISORDER ASSESSMENT
PHASE 1 (ACUTE MANIA) BIPOLAR DISORDER…
PHASE II (CONTINUATION OF TX.)
PHASE III( MAINTENANCE TX )
ASSESS WHETHER PT IS IN DANGER TO SELF AND OTHERS... MANIC CAN B…
ACUTE MANIA... PREVENT INJURY... BE WELL HYDRATED WITHIN 24 HOURS…
CONTINUATION OF TREATMENT... FOCUS ON ... PT AND FAMILY TO ATTEND P…
MAINTENANCE TX... FOCUS ON PREVENTION OF RELAPSE... MEDICATION COMP…
BIPOLAR DISORDER ASSESSMENT
ASSESS WHETHER PT IS IN DANGER TO SELF AND OTHERS... MANIC CAN B…
PHASE 1 (ACUTE MANIA) BIPOLAR DISORDER…
ACUTE MANIA... PREVENT INJURY... BE WELL HYDRATED WITHIN 24 HOURS…
7 terms
Bipolar disorder
Definition of Bipolar disorder
Bipolar spectrum
Bipolar 1 Disorder
Bipolar II disorder
Mood disorder characterized by recurrent fluctuation in energ…
bipolar disorder type 1 ... bipolar disorder type 2
one more manic or *mixed episodes usually accompanied by MDD
characterized by one of more Major depressive episodes acco…
Definition of Bipolar disorder
Mood disorder characterized by recurrent fluctuation in energ…
Bipolar spectrum
bipolar disorder type 1 ... bipolar disorder type 2
6 terms
Bipolar disorder
Lithium
valproic acid
Carbamazepine
Oxcarbazepine
Range: 0.6-1.2 mEq/L; does not bind to plasma protein.... Drugs…
hepatically metabolized, very high plasma protein binding. (5…
hepatically metabolized, very potent inducer of CYP3A4... SE: dr…
cause induction to CYP3A4 (not as much as carbamazepine) SE:…
Lithium
Range: 0.6-1.2 mEq/L; does not bind to plasma protein.... Drugs…
valproic acid
hepatically metabolized, very high plasma protein binding. (5…
16 terms
Bipolar Disorder
Bipolar I
Bipolar II
Cyclothymic
Hypomania
At least one manic episode or a mixed episode (mania and depr…
Bouts of depression with episodic occurrence of hypomania... Le…
chronic mood disturbance many episodes of depression and hypo…
increased activity or energy lasting at least 4 days and does…
Bipolar I
At least one manic episode or a mixed episode (mania and depr…
Bipolar II
Bouts of depression with episodic occurrence of hypomania... Le…
15 terms
Bipolar Disorder
Bipolar
bipolar treatments
omega 3
glutamate in the hippocampus
person alternates between periods of mania &... depression (form…
lithium, anticonvulsant mood stabilizers, atypical antipsycho…
good evidence as adjunctive therapy, limited / mixed evidence…
Mood stabilizers are thought to interact with various intrace…
Bipolar
person alternates between periods of mania &... depression (form…
bipolar treatments
lithium, anticonvulsant mood stabilizers, atypical antipsycho…
13 terms
Bipolar disorder
sx of mania
goal of treating acute manic episodes
strategies for treating acute manic ep…
goal for treating chronic bipolar diso…
Racing thoughts... Pressured speech... Impulsivity... Irritability... May…
safe management of highly agitated & uncooperative pt
short-term use of antipsychotic agent or a potent sedative be…
stabilize patient's mood and prevent recurrences
sx of mania
Racing thoughts... Pressured speech... Impulsivity... Irritability... May…
goal of treating acute manic episodes
safe management of highly agitated & uncooperative pt
11 terms
Bipolar Disorder
Criteria for Mania
Criteria for hypomania
Criteria for Major Depressive Episode
Bipolar I Disorder Criteria
A.... A distinct period lasting at least a week, on most days, c…
As for mania except... - at least 4 days... - no marked social or o…
A. ... At least 2 weeks of 5 or more of the following symptoms,…
A.... At least 1 manic episode... B.... No better explained by schizo…
Criteria for Mania
A.... A distinct period lasting at least a week, on most days, c…
Criteria for hypomania
As for mania except... - at least 4 days... - no marked social or o…
18 terms
Bipolar Disorder
Bipolar disorder definition
Maniac episode
3 symptoms of the following
Hypomanic episode
-extreme elevation or depression of mood ... -Pt doesn't have to…
abnormal or persistent elevated or irritable mood that lasts…
-inflated self esteem, grandiosity, decrease in sleep, very t…
-meet maniac episode with 2 major expectations... -s/s present…
Bipolar disorder definition
-extreme elevation or depression of mood ... -Pt doesn't have to…
Maniac episode
abnormal or persistent elevated or irritable mood that lasts…
14 terms
Bipolar Disorder
lamotrigine
valproate (valproic acid)
carbamazepine
lithium carbonate
lamictal
depakene/depakote/stavzor/depacon/divalproex [valproic]
equetro [mazepine] - bipolar... carbatrol/epitol/tegretol - seiz…
lithobid/eskalith [carbolith/lithane]
lamotrigine
lamictal
valproate (valproic acid)
depakene/depakote/stavzor/depacon/divalproex [valproic]
8 terms
Bipolar Disorder
manic episode
Symptoms of manic episode (must have a…
hypomanic episode
Differences between manic and hypomani…
distinct period of abnormal or persistently elevated, expansi…
1. grandiosity... 2. racing thoughts or flight of ideas... 3. activ…
distinct period of abnormal or persistently elevated, expansi…
level of impairment, duration, and observed by others. ... hypom…
manic episode
distinct period of abnormal or persistently elevated, expansi…
Symptoms of manic episode (must have a…
1. grandiosity... 2. racing thoughts or flight of ideas... 3. activ…
8 terms
Bipolar Disorder
Symptoms
Mania
Manic episode
Hypomania
Abnormal, persistsant. Expansice, irritable mood.
No sleep, hypoactive, inflated self-esteem. Irritable, grandi…
At least one week. 3 or more symptoms.
At least 4 days. 4 or more symptoms.
Symptoms
Abnormal, persistsant. Expansice, irritable mood.
Mania
No sleep, hypoactive, inflated self-esteem. Irritable, grandi…
Bipolar Disorder
Bipolar 1
Bipolar 2
Cyclothymia
mood and activity level (manic and hyp…
must have an episode of mania... doesn't have to have a depressi…
must have a major depressive episode and hypomanic episode... ca…
has mood swings (up and down) but not high enough to be eithe…
abnormally and persistent... 1. elevated, expansive, or irritabl…
Bipolar 1
must have an episode of mania... doesn't have to have a depressi…
Bipolar 2
must have a major depressive episode and hypomanic episode... ca…
Bipolar Disorder
Bipolar Disorder (BD) Overview
Epidemiology/Etiology
Common comorbid conditions
General approach to tx (overview)
Mania is the cardinal symptom of bipolar disorder: ... o Without…
• Mean age of onset= 20 yrs... o Onset from early childhood to m…
o Anxiety... o Substance use disorder... o ADHD... o Eating disorders…
• Highly recurrent disorder... • Maintenance pharmacotherapy rec…
Bipolar Disorder (BD) Overview
Mania is the cardinal symptom of bipolar disorder: ... o Without…
Epidemiology/Etiology
• Mean age of onset= 20 yrs... o Onset from early childhood to m…
30 terms
Bipolar Disorder
Mood lability
Bipolar 1
Bipolar 2
Rapid cycling
frequent or intense mood changes or shifts. ... occurs more than…
at least one manic episode or a mixed episode AND depressive…
major depression and hypomania... -less impact on functioning... -N…
occurs in bipolar 1, at least 4 or more episodes of mania in…
Mood lability
frequent or intense mood changes or shifts. ... occurs more than…
Bipolar 1
at least one manic episode or a mixed episode AND depressive…
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