Lecture 8 – bipolar and crime
DSM-5
- Bipolar I: Must meet criteria for a manic episode:
- A: a distinct period of abnormally and persistently elevated, expansive, or irritable
mood, and abnormally and persistently increased goal-directed activity or energy,
lasting at least 1 week and present most of the day, nearly every day (or any
duration if hospitalisation needed)
- B: During this period, three or more (or four or more if the mood is only irritable) are
present to a significant degree and represent a noticeable change in usual behaviour:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual
- Distractibility
- Racing thoughts
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful
consequences
- C: The mood disturbance is sufficiently severe to cause marked impairment in social
or occupational functioning, or to necessitate hospitalisation to prevent harm to self
or others, or there are psychotic features
- D: the episode is not attributable to the physiological effects of substances or
another medical condition
- At least one lifetime manic episode is needed for a bipolar I diagnosis
- A major depressive episode is not required for bipolar I but are very common
Bipolar II: must meet the criteria for a past or current hypomanic episode and a current
or past depressive episode
- Hypomania criteria are almost the same as manic, with the key differences that it
must last 4 consecutive days rather than 7, and it’s not severe enough to cause
marked impairment in social or occupational functioning, or to necessitate
hospitalisation. If there is any psychotic features it’s manic
ICD-10
, - Hypomania: A disorder characterized by a persistent mild elevation of mood,
increased energy and activity, and usually marked feelings of well-being and both
physical and mental efficiency. Increased sociability, talkativeness, over-familiarity,
increased sexual energy, and a decreased need for sleep are often present but not to
the extent that they lead to severe disruption of work or result in social rejection.
Irritability, conceit, and boorish behaviour may take the place of the more usual
euphoric sociability. The disturbances of mood and behaviour are not accompanied
by hallucinations or delusions.
- Mania without psychotic symptoms: Mood is elevated out of keeping with the
patient's circumstances and may vary from carefree joviality to almost
uncontrollable excitement. Elation is accompanied by increased energy, resulting in
overactivity, pressure of speech, and a decreased need for sleep. Attention cannot
be sustained, and there is often marked distractibility. Self-esteem is often inflated
with grandiose ideas and overconfidence. Loss of normal social inhibitions may result
in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and
out of character.
- Mania with psychotic symptoms: In addition to the clinical picture described in
F30.1, delusions (usually grandiose) or hallucinations (usually of voices speaking
directly to the patient) are present, or the excitement, excessive motor activity, and
flight of ideas are so extreme that the subject is incomprehensible or inaccessible to
ordinary communication.
- Depressive episode: In typical mild, moderate, or severe depressive episodes, the
patient suffers from lowering of mood, reduction of energy, and decrease in activity.
Capacity for enjoyment, interest, and concentration is reduced, and marked
tiredness after even minimum effort is common. Sleep is usually disturbed and
appetite diminished. Self-esteem and self-confidence are almost always reduced
and, even in the mild form, some ideas of guilt or worthlessness are often present.
The lowered mood varies little from day to day, is unresponsive to circumstances
and may be accompanied by so-called "somatic" symptoms, such as loss of interest
and pleasurable feelings, waking in the morning several hours before the usual time,
depression worst in the morning, marked psychomotor retardation, agitation, loss of
appetite, weight loss, and loss of libido. Depending upon the number and severity of
the symptoms, a depressive episode may be specified as mild, moderate or severe.
Bipolar and Crime;
DSM-5
- Bipolar I: Must meet criteria for a manic episode:
- A: a distinct period of abnormally and persistently elevated, expansive, or irritable
mood, and abnormally and persistently increased goal-directed activity or energy,
lasting at least 1 week and present most of the day, nearly every day (or any
duration if hospitalisation needed)
- B: During this period, three or more (or four or more if the mood is only irritable) are
present to a significant degree and represent a noticeable change in usual behaviour:
- Inflated self-esteem or grandiosity
- Decreased need for sleep
- More talkative than usual
- Distractibility
- Racing thoughts
- Increase in goal-directed activity or psychomotor agitation
- Excessive involvement in activities that have a high potential for painful
consequences
- C: The mood disturbance is sufficiently severe to cause marked impairment in social
or occupational functioning, or to necessitate hospitalisation to prevent harm to self
or others, or there are psychotic features
- D: the episode is not attributable to the physiological effects of substances or
another medical condition
- At least one lifetime manic episode is needed for a bipolar I diagnosis
- A major depressive episode is not required for bipolar I but are very common
Bipolar II: must meet the criteria for a past or current hypomanic episode and a current
or past depressive episode
- Hypomania criteria are almost the same as manic, with the key differences that it
must last 4 consecutive days rather than 7, and it’s not severe enough to cause
marked impairment in social or occupational functioning, or to necessitate
hospitalisation. If there is any psychotic features it’s manic
ICD-10
, - Hypomania: A disorder characterized by a persistent mild elevation of mood,
increased energy and activity, and usually marked feelings of well-being and both
physical and mental efficiency. Increased sociability, talkativeness, over-familiarity,
increased sexual energy, and a decreased need for sleep are often present but not to
the extent that they lead to severe disruption of work or result in social rejection.
Irritability, conceit, and boorish behaviour may take the place of the more usual
euphoric sociability. The disturbances of mood and behaviour are not accompanied
by hallucinations or delusions.
- Mania without psychotic symptoms: Mood is elevated out of keeping with the
patient's circumstances and may vary from carefree joviality to almost
uncontrollable excitement. Elation is accompanied by increased energy, resulting in
overactivity, pressure of speech, and a decreased need for sleep. Attention cannot
be sustained, and there is often marked distractibility. Self-esteem is often inflated
with grandiose ideas and overconfidence. Loss of normal social inhibitions may result
in behaviour that is reckless, foolhardy, or inappropriate to the circumstances, and
out of character.
- Mania with psychotic symptoms: In addition to the clinical picture described in
F30.1, delusions (usually grandiose) or hallucinations (usually of voices speaking
directly to the patient) are present, or the excitement, excessive motor activity, and
flight of ideas are so extreme that the subject is incomprehensible or inaccessible to
ordinary communication.
- Depressive episode: In typical mild, moderate, or severe depressive episodes, the
patient suffers from lowering of mood, reduction of energy, and decrease in activity.
Capacity for enjoyment, interest, and concentration is reduced, and marked
tiredness after even minimum effort is common. Sleep is usually disturbed and
appetite diminished. Self-esteem and self-confidence are almost always reduced
and, even in the mild form, some ideas of guilt or worthlessness are often present.
The lowered mood varies little from day to day, is unresponsive to circumstances
and may be accompanied by so-called "somatic" symptoms, such as loss of interest
and pleasurable feelings, waking in the morning several hours before the usual time,
depression worst in the morning, marked psychomotor retardation, agitation, loss of
appetite, weight loss, and loss of libido. Depending upon the number and severity of
the symptoms, a depressive episode may be specified as mild, moderate or severe.
Bipolar and Crime;
