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Bipolar II Disorder

DSM-IV Diagnostic Criteria

One or more major depressive episodes and at least one hypomanic episode

Mood episodes cannot be due to a medical condition, medication, drugs of abuse, toxins or treatment for depression.

Symptoms cannot be accounted for by a psychotic disorder.

Clinical Features

  1. Hypomanic episodes tend to occur in close proximity to depressive episodes
  2. Episodes occur more frequently with age.
  3. Social and occupational consequences of Bipolar II can be severe (e.g. job loss and divorce).
  4. These patients have a suicide rate of 10-15%
  5. Common co-morbid diagnoses includes substance-related disorders, eating disorders, attention deficit hyperactivity disorder, borderline personality disorder.
  6. Rapid cycling pattern carries a poor prognosis.
Epidemiology
  1. The lifetime prevalence of II is 0.5%
  2. Possibly more common in women
Classification

Classification involve, describing the current or most recent mood episode which can be Hypomanic, or Depressive.

The most recent episode can be further classified as follows

  1. Episodes without Psychotic Features
  2. Episodes with Psychotic Features
  3. Episodes with Catatonic Features
  4. Episodes with Post partum Onset
Bipolar II Disorder with Rapid Cycling
  1. Diagnosis requires the presence of at least 4 mood episodes within 1 year.
  2. Episodes may include major depressive, manic, mania hypomanic or mixed.
  3. The patient must be symptom-free for at least 2 months between episodes or the patient must display a change in mood to an opposite type of episode.

Differential Diagnosis

Cyclothymic Disorder: Mood episodes never meet criteria for full manic episode or full major depressive episode.
Substance - Induced Mood Disorder: Rule out the effects of medication, drugs of abuse, toxin exposure.

Mood Disorder Due to a General Medical Condition.

Treatment

The treatment of Bipolar II disorder involves lithium and/or anticonvulsants, and is similar to the treatment.