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 Most Recent Episode Depressed

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

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).

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

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

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

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

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

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 . . .

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

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

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)

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)

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

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

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

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

Comments or Questions? Thanks for coming!