Bipolar II Disorder
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Basics
Description
A mood disorder characterized by at least one episode of major depression (with or without psychosis) and at least one episode of hypomania, a nonsevere mood elevation
Geriatric Considerations
In new onset in older patients (>50 years of age), a workup for organic or chemically induced pathology is strongly recommended.
Pediatric Considerations
Diagnosis is based on the same set of symptoms applied to adults. Need for clarity of symptoms is critical to differentiate between attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), disruptive mood dysregulation, and other diagnoses with overlapping symptoms that are common in childhood.
Pregnancy Considerations
- Pregnancy does not reduce risk of mood episodes.
- Need to weigh risk of exposure to mood episode to that of medication
- Avoid divalproex (Depakote) due to high teratogenicity risk.
- Postpartum caries high risk of severe acute episode with psychosis and/or infanticidal ideation.
Epidemiology
Onset usually between 15 and 30 years of age
Prevalence
- 0.5–1.0% lifetime prevalence
- More common in women
Etiology and Pathophysiology
Dysregulation of biogenic amines or neurotransmitters (particularly serotonin, norepinephrine, and dopamine)
Genetics
Heritability estimate: >77%
Risk Factors
Genetics, major life stressors, or substance misuse
General Prevention
Treatment adherence and education can help to prevent further episodes.
Commonly Associated Conditions
Substance misuse, ADHD, anxiety disorders, and eating disorders
-- To view the remaining sections of this topic, please log in or purchase a subscription --
Basics
Description
A mood disorder characterized by at least one episode of major depression (with or without psychosis) and at least one episode of hypomania, a nonsevere mood elevation
Geriatric Considerations
In new onset in older patients (>50 years of age), a workup for organic or chemically induced pathology is strongly recommended.
Pediatric Considerations
Diagnosis is based on the same set of symptoms applied to adults. Need for clarity of symptoms is critical to differentiate between attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), disruptive mood dysregulation, and other diagnoses with overlapping symptoms that are common in childhood.
Pregnancy Considerations
- Pregnancy does not reduce risk of mood episodes.
- Need to weigh risk of exposure to mood episode to that of medication
- Avoid divalproex (Depakote) due to high teratogenicity risk.
- Postpartum caries high risk of severe acute episode with psychosis and/or infanticidal ideation.
Epidemiology
Onset usually between 15 and 30 years of age
Prevalence
- 0.5–1.0% lifetime prevalence
- More common in women
Etiology and Pathophysiology
Dysregulation of biogenic amines or neurotransmitters (particularly serotonin, norepinephrine, and dopamine)
Genetics
Heritability estimate: >77%
Risk Factors
Genetics, major life stressors, or substance misuse
General Prevention
Treatment adherence and education can help to prevent further episodes.
Commonly Associated Conditions
Substance misuse, ADHD, anxiety disorders, and eating disorders
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