Even a single episode of mania warrants a diagnosis of bipolar disorder in DSM-IV.
What is the proportion of patients with pure recurrent mania without depression among these patients?
B. Bipolar disorder starts with depression in up to 70% of patients. In a small proportion (10–20%) only recurrent mania is observed (still classed as bipolar under DSM); 90% of those who experienced mania are likely to have another, while the remaining 10% have only one episode of mania throughout their lifetime.
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A patient with a family history of affective disorders presents with recurrent periods of elated mood and grandiose delusions believing that he is King Solomon. These episodes last for only 4 days.
Which of the following is the most appropriate diagnosis?
A. The concept tested here is that any patient who has psychotic features in a background of elated mood has mania irrespective of the duration criteria. Also remember that any patient with elation and psychosocial impairment that necessitates hospitalization is diagnosed to have mania and not hypomania according to DSM-IV, irrespective of the duration criteria. In the absence of psychotic symptoms or hospitalization, clinical features must last for at least 7 days before a manic episode can be diagnosed.
Which of the following is the most important diagnostic information that differentiates bipolar disorder from schizophrenia?
A. Delusions of all types can present in bipolar disorder, as they do in schizophrenia. Family history of affective disorders is not uncommon in patients with schizophrenia, invalidating this aspect as a strong feature to differentiate the two major psychoses. Cannabis use and religious hallucinations can also occur in bipolar disorder. Ever since Kraeplinian concept of dementia praecox was introduced, one reasonable, though not always reliable, feature that differentiates these two illnesses is the absence of interepisodic residual symptoms in bipolar disorder. In the majority of patients with schizophrenia significant impairment is noted even between full-blown psychotic episodes. But note that residual cognitive impairment is increasingly noted in euthymic bipolar patients.
Which of the following statements about the gender distribution of affective disorders is correct?
A. Bipolar disorder has no gender variation in prevalence rates. Unipolar depressive disorder is more common in women of all ages compared to men. The only time in life where the incidence is equal or slightly higher in males is when depression is prepubertal, and this is rare. The gender gap narrows with advancing age and in geriatric population the incidence rates across the genders are very much closer than in early adult life. Rapid cycling is more common in women, for unknown reasons.
According to twin studies, the strongest evidence of a genetic cause is for which of the following disorders?
B. Bipolar is the most heritable of all psychiatric disorders. Apart from being a risk factor for the development of bipolar disorder, a family history of bipolar disorder increases the risk for any mood disorders. Overall, in families of patients with bipolar illness, unipolar depression is the most common expressed phenotype. Note that a significant proportion of these unipolar patients can later get a revised diagnosis of bipolar disorder. Thus the mood disorders do not breed true on their own. The heritability of schizophrenia is around 50–60%. Conduct disorders and alcoholism have lower heritability rates than the psychoses.
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