Question 1

Which of the following statements best apply to a person with "rapid cycling":

Accepted Answer

Rapid cycling is a specifier used to describe someone who experiences at least four manic or depressive episodes within a year. It does not necessarily indicate a more positive or less severe form of bipolar disorder, and manic symptoms can occur at any time, not just during certain seasons.

Question 2

Which of the following features indicates a worse prognosis for someone with bipolar I disorder?

Accepted Answer

Rapid cycling in bipolar I disorder is a feature that indicates a worse prognosis, as it is associated with more frequent and severe mood episodes, decreased response to treatment, and an increased risk for suicidal thoughts and behaviors. Younger age at onset, marital status, and less severe depressive episodes have not been consistently linked with a worse prognosis in bipolar I disorder.

Question 3

What is the difference between the depressive episodes associated with bipolar II disorder from those associated with bipolar I disorder?

Accepted Answer

Depressive episodes in bipolar II disorder are often lengthier than those in bipolar I disorder, although the severity of depression can be similar in both types.

Question 4

A client with a history of bipolar disorder tells the social worker that he has experienced 1 week of an elevated and expansive mood. Which of the following would suggest that this client is having a hypomanic rather than a manic episode?

Accepted Answer

A hypomanic episode is a less severe version of a manic episode and does not involve significant impairment in functioning or require hospitalization. Increased productivity at work may be a symptom of hypomania, whereas irritability, feeling rested after only 3 hours of sleep, and good insight into his condition can be present in both hypomanic and manic episodes.

Question 5

Psychotic features are very rarely noted in the Bipolar I disorder.

Accepted Answer

Psychotic features can occur during manic or depressive episodes in Bipolar I disorder, although they are not always present.

Question 6

Euphoria, boundless optimism, inflated self-esteem and grandiosity are characteristic symptoms of Bipolar I disorder, current or most recent episode manic.

Accepted Answer

Euphoria, boundless optimism, inflated self-esteem and grandiosity are indeed characteristic symptoms of Bipolar I disorder, current or most recent episode manic.

Question 7

Kevin Sanders is a 34 year old man who has been feeling unusually irritable for the past week. He tells the social worker that during this period of time he has had increased energy and activity and sleeps less. Kevin admits that it has been difficult for him to complete reports on the job. His supervisor has become concerned and referred Kevin to the Employee Assistance Department. "I have rapid, pressured speech, and I can't seem to stop talking." said Kevin. He adds, "I just can't seem to sit still, either." The social worker notices that Kevin was easily distracted. Kevin is in good health and takes no medications. What diagnosis best fits Kevin's symptom picture?

Accepted Answer

Kevin presents with symptoms that are consistent with a manic episode, including increased energy and activity, decreased need for sleep, racing thoughts and pressured speech, distractibility, and difficulty completing tasks. Bipolar I disorder may also be a possibility given the severity of his symptoms, but a formal diagnosis cannot be made without further assessment. Hypomanic episodes are similar to manic episodes but are less severe and do not involve significant impairment or require hospitalization. Cyclothymic disorder involves milder and more chronic mood disturbances.

Question 8

The change in the criteria for bipolar and related disorders from the DSM-IV-TR to the DSM-5 is best represented by:

Accepted Answer

The criteria for bipolar and related disorders in the DSM-5 now require changes in both mood and activity or energy. This is a major change from the DSM-IV-TR, which only required changes in mood.

Question 9

Those with a diagnosis of Bipolar II disorder will likely require hospitalization at some point during the course of the illness.

Accepted Answer

While hospitalization may be necessary in some cases, not all individuals with Bipolar II disorder will require hospitalization. Treatment and management may involve medication, therapy, and lifestyle changes.

Question 10

Manic symptoms that can be attributed to the physiological effects of a drug of abuse, the side effects of medications or treatments, or another medical condition do not count toward the diagnosis of bipolar I disorder.

Accepted Answer

This is stated in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for bipolar I disorder.

Question 11

Gene Colman has a history of bipolar I disorder. He currently presents with a new-onset manic episode and it has been successfully treated with an adjustment in his medication. He tells the social worker that he has had chronic depressive symptoms that, looking back, preceded his manic episodes. These symptoms of depression were described as "feeling down," decreased energy, and more often than not having no motivation. While Gene denies other depressive symptoms, he contacted the social worker because his wife has started to complain about his "unpredictable" behavior. "My wife never complained when I was depressed because she knew what to expect," said Gene. What is the most likely diagnosis for Gene?

Accepted Answer

Gene's history of bipolar I disorder and current presentation of a manic episode fits with this diagnosis. Additionally, his chronic depressive symptoms suggest the possibility of co-occurring persistent depressive disorder (dysthymia). The fact that his wife is experiencing difficulty with his behavior suggests that his symptoms are impacting his functioning and relationships. Bipolar II disorder and other specified bipolar and related disorder do not fully capture Gene's history and presentation, and cyclothymic disorder involves milder and more chronic symptoms.

Question 12

Bipolar I disorder is characterized by severe alterations in mood that are usually episodic and recurrent.

Accepted Answer

Bipolar I disorder is indeed characterized by severe mood episodes that can recur over time. These episodes involve either manic or mixed symptoms, and may also include depressive symptoms.

Question 13

A family practice physician who has an office in the same building where you have your private practice refers one of his patients to you suspecting medication abuse. You see a 48 year old man, John Clay Edsel, who tells you that his doctor prescribed an antidepressant to help him with his symptoms of a major depressive episode. In a rapid-fire fashion, Mr. Edsel very quickly describes his symptom picture. As soon as he started his antidepressant medication, Mr. Edsel reported that he began to have increased energy, racing thoughts, found it hard to sit still, and it was difficult for him to concentrate. Mr. Edsel also related a decreased need for sleep adding, "Three hours is all I need to wake up refreshed. I'll sleep longer when I'm retired." He adds, "After about 2 or 3 days I quit taking the antidepressants." Mr. Edsel's depression stopped but the new symptoms have continued. What is Mr. Edsel's diagnosis?

Accepted Answer

Mr. Edsel's symptoms suggest a manic episode, characterized by increased energy, racing thoughts, decreased need for sleep, and difficulty concentrating. These symptoms, especially when they follow the initiation of antidepressant therapy in someone with a history of depression, are indicative of Bipolar I Disorder, where manic episodes can occur with or without preceding depressive episodes.

Question 14

Imagine for a moment that you have an adolescent on your caseload who presents with distractibility. Which of the following symptoms would suggest more of an association with the bipolar II symptom picture rather than attention-deficit/hyperactivity disorder?

Accepted Answer

Evidence that symptoms are episodic is more suggestive of the bipolar II symptom picture than attention-deficit/hyperactivity disorder. Rapid speech, complaints of racing thoughts, and a decreased need for sleep can be seen in both conditions, so they are not as helpful in differentiating between the two.

Question 15

Mason Turner has had "mood swings" for about the past five years. His "high" periods are relatively short-lived and are characterized by an increase in goal-directed activity and an inflated sense of self-esteem. When Mason experiences "low" periods, they, too, are of short duration and characterized by a depressed mood and subsequent fatigue. While Mason does not consider his present problems severe, his wife, Yvonne, feels that he might need some help. Given these symptoms, Mason is most likely suffering from which mood disorder?

Accepted Answer

Mason's symptoms align with Cyclothymic Disorder, characterized by periods of hypomanic symptoms (increased goal-directed activity and inflated self-esteem) and periods of depressive symptoms (depressed mood and fatigue) that are not severe enough to meet the criteria for full manic or major depressive episodes. These symptoms have been present for a significant duration (five years), which also fits the cyclothymic disorder criteria.

Question 16

The diagnostic features of substance/medication-induced bipolar and related disorder are essentially the same as those for mania, hypomania, or depression.

Accepted Answer

Substance/medication-induced bipolar and related disorder can cause symptoms identical to those of mania, hypomania, or depression, which are the diagnostic features of bipolar and related disorders. However, these symptoms are caused by substance or medication use rather than being a result of a primary mental health condition.

Question 17

Which of the following symptoms differentiates cyclothymic disorder from bipolar I disorder?

Accepted Answer

Cyclothymic disorder is characterized by less severe mood swings compared to bipolar I disorder, which includes full-blown manic episodes.

Question 18

Of the bipolar disorders, bipolar I is less serious than bipolar II.

Accepted Answer

Bipolar II is generally considered less severe than bipolar I. In bipolar II, the person experiences hypomanic episodes (less severe than full manic episodes) and major depressive episodes. In bipolar I, the person experiences full manic episodes and often also experiences major depressive episodes. Full manic episodes can be more disruptive and dangerous than hypomanic episodes. However, both bipolar I and II are serious conditions that require treatment.

Question 19

The essential feature of cyclothymic disorder is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from each other.

Accepted Answer

Cyclothymic disorder is a mood disorder characterized by chronic, fluctuating mood disturbances that involve numerous periods of hypomanic symptoms and periods of depressive symptoms that are distinct from each other. It differs from bipolar disorder in that the mood swings are less extreme and do not meet the criteria for full-blown manic or depressive episodes.

Question 20

Mason Turner has had "mood swings" for about the past five years. His "high" periods are relatively short-lived and are characterized by an increase in goal-directed activity and an inflated sense of self-esteem. When Mason experiences "low" periods, they, too, are of short duration and characterized by a depressed mood and subsequent fatigue. While Mason does not consider his present problems severe, his wife Evette, feels that he might need some help. Given these symptoms, Mason is most likely suffering from which mood disorder?

Accepted Answer

Mason's symptoms suggest Cyclothymic Disorder, characterized by periods of hypomanic symptoms (not full-blown mania) and periods of depressive symptoms that are not severe enough to be classified as major depressive episodes. These symptoms have been present for a significant duration (five years), which aligns with the cyclothymic disorder criteria.

Quiz 4: Bipolar and Related Disorders