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Bipolar Disorder and Substance Use Disorders

Bipolar Disorder and Substance Use Disorders. Bipolar I Disorder. Includes one or more Manic Episodes or Mixed Episodes, sometimes with Major Depressive Episodes as well Single Manic Episode Most Recent Episode Hypomanic Most Recent Episode Manic Most Recent Episode Mixed

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Bipolar Disorder and Substance Use Disorders

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  1. Bipolar DisorderandSubstance Use Disorders

  2. Bipolar I Disorder Includes one or more Manic Episodes or Mixed Episodes, sometimes with Major Depressive Episodes as well • Single Manic Episode • Most Recent Episode Hypomanic • Most Recent Episode Manic • Most Recent Episode Mixed • Most Recent Episode Depressed

  3. Manic Episode • A period of unusual and ongoing elevated, expansive, or irritable mood, of at least 1 week duration

  4. Manic Episode • Three (3) or more of the following occur: • Inflated self-esteem or grandiosity; • Decreased sleep needs; • More talkative than usual; • Racing thoughts; • Distractibility; • Increase in activity or psychomotor agitation; • Excessive involvement in pleasurable activities with high potential for painful consequences (ex. spending, sex).

  5. Manic Episode • The mood disturbance is severe enough: • to significantly impair occupational functioning, or • to significantly impair usual social activities or relationships, or • to require hospitalization to prevent harm to self or others

  6. Manic Episode • Symptoms are NOT due to the direct effects of a substance (including prescribed medication and/or intoxication or withdrawal syndromes of substances of abuse), or a general medical condition

  7. Hypomanic Episode • A period of unusual and ongoing elevated, expansive, or irritable mood, lasting through at least 4 days, that is clearly different from the usual non-depressed mood • Manic symptoms (see) • Significant functional impairment • Symptoms are NOT due to substances of abuse

  8. Cocaine Intoxication • Euphoria (elevated, expansive mood) • Changes in sociability (more talkative) • Hypervigilance • Interpersonal sensitivity(irritability) • Anxiety, tension or anger • Impaired judgment • Impaired social or occupational functioning • Psychomotor agitation

  9. Alcohol Withdrawal • Insomnia • Psychomotor agitation • Anxiety • Hand tremor • Temporary hallucinations • Nausea, vomiting • Seizures • Impaired social or occupational functioning

  10. Depressive Episode • Five or more of the following are present during the same 2-week period, and represent a change from previous functioning, and at least one of the symptoms is either (1) depressed mood, or (2) loss of interest . . .

  11. Depressive Episode • Depressed mood most of the day, every day • Loss of interest or pleasure in most all activities, every day • Significant weight loss w/o dieting • Insomnia / hypersomnia every day • Psychomotor agitation / retardation every day • Fatigue or energy loss every day • Worthlessness or inappropriate guilt feelings nearly every day • Decreased ability to think, concentrate or make decisions nearly every day • Recurrent thoughts of death, or suicidal ideation, with or without plan &/or attempt

  12. Depressive Episode • Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

  13. Depressive Episode • Symptoms are NOT due to the effects of a substance(e.g., drug of abuse, or medication) or a general medical condition (e.g., hyperthyroidism)

  14. Depressive Episode • Symptoms are not better accounted for by Bereavement (i.e. lasting longer than 2 months after a significant loss, or characterized by severe degree of functional impairment, preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation)

  15. Sedative Intoxication • Inappropriate sexual or aggressive behavior • Slurred speech • Stupor • Impaired attention or memory • Mood lability • Impaired judgment • Psychomotor retardation or agitation • Impaired social, occupational, or other functioning

  16. Cocaine Withdrawal • Depressed mood • Fatigue • Vivid, unpleasant dreams • Insomnia or hypersomnia • Increased appetite • Psychomotor retardation or agitation • Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

  17. Mixed Episode • Criteria are met for both a Manic Episode, and for a Major Depressive Episode (except for duration) for at least a 1-week period

  18. Bipolar II Disorder • Presence (or history) of one or more Major Depressive Episodes • Presence (or history) of at least one Hypomanic Episode • There has never been a Manic Episode, or a Mixed Episode • Symptoms are NOT better accounted for by another disorder (including Substance Use disorders) • Symptoms impairment in social, occupational, or other important areas of functioning

  19. Comments or Questions? Thanks for coming!

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