6.95: Bipolar II Disorder (296.89)

DSM-IV-TR criteria

• A. Presence (or history) of one or more Major Depressive Episodes.
• B. Presence (or history) of at least one Hypomanic Episode.
• C. There has never been a Manic Episode or a Mixed Episode.
• D. The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorder and are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Specify current or most recent episode:
  • Hypomanic: if currently (or most recently) in a Hypomanic Episode
  • Depressed: if currently (or most recently) in a Major Depressive Episode
• If the full criteria are currently met for a Major Depressive Episode, specify its current clinical status and/or features:
  • Mild, Moderate, Severe Without Psychotic Features/Severe With Psychotic Features
    • NOTE: Fifth-digit codes cannot be used here because the code for Bipolar II Disorder already uses the fifth digit.
  • Chronic
  • With Catatonic Features
  • With Melancholic Features
  • With Atypical Features
  • With Postpartum Onset
• If the full criteria are not currently met for a Hypomanic or Major Depressive Episode, specify the clinical status of the Bipolar II Disorder and/or features of the most recent Major Depressive Episode (only if it is the most recent type of mood episode):
  • In partial remission, In Full Remission
    • NOTE: Fifth-digit codes cannot be used here because the code for Bipolar II Disorder already uses the fifth digit.
  • Chronic
  • With Catatonic Features
  • With Melancholic Features
  • With Atypical Features
  • With Postpartum Onset
• Specify:
  • Longitudinal Course Specifiers (With and Without Interepisode Recovery)
  • With Seasonal Pattern (applies only to the pattern of Major Depressive Episodes)
  • With Rapid Cycling

Associated features

Suicide is also a risk for individuals with bipolar II disorder. Completion rates are somewhere between 10 and 15 percent, although many more may attempt it. Like bipolar I, issues with school and careers are also present. Truancy or failure in school and occupational failure are common. Divorce is also very common in bipolar individuals. Bipolar II is often comorbid with Substance Abuse or Dependence, Anorexia Nervosa, Bulimia Nervosa, Attention Deficit/Hyperactivity Disorder, Panic Disorder, Social Phobia, and Borderline Personality Disorder.

Individuals with bipolar 2 disorders tend to have some creativity. A large number of people with bipolar 2 are well involved in art. Also individuals with bipolar 2 disorders are characterized as outgoing and more daring that people without bipolar 2 disorders.

Child vs. adult presentation

Bipolar 2 disorder is often more severe, more chronic, and more rapid cyclers in children versus adults. Bipolar 2 is very uncommon late in life. However, neurologic impairment can be associated with some older adults. Furthermore, adolescents are confined more to substance abuse with bipolar 2 than with their counterparts.

Gender and cultural differences in presentation

• In general, bipolar disorders are equally in both men and women. However, women may actually be more at risk than men. Women are known to have more rapid episodes than males. The average age for bipolar 2 disorder is age 22 and it is uncommon after the age of 40. Also with bipolar disorders, in general, women tend to report experiences of depression first whereas men report experiencing mania.
• Men have predominately Hypomanic Episodes, and women have mainly Major Depressive Episodes.
• Women with Bipolar II Disorder may have an increased risk of developing episodes in the postpartum period.

Epidemiology

• The average lifetime prevalence rate for Bipolar II Disorder is approximately 0.5 percent.
• The average age for children with bipolar 2 disorder is 10 which is found in 0.3%-0.5% of patients. Bipolar 2 disorder is less common in older adults.

Etiology

Genetics play a big factor of people with bipolar 2 disorder. Individuals with family members that have bipolar 2 disorders have a big risk of bipolar 2. Antidepressants may be a potential risk for bipolar patients in that it could trigger more rapid cycling and antidepressants can induce hypomania. There are also brain abnormalities in that the neurotransmitters dopamine, serotonin, and nor epinephrine can be associated with mood disturbances.

Empirically supported treatments

There seem to be different alternatives methods in treating bipolar 2 disorders. However, in treating all bipolar disorders, lithium is the desired treatment. Therapy also tend to play a vital role in the treatment of bipolar disorders in that it helps the client to understand the importance of the illness and helps them to recognize when a hypomanic or a depressive episode is occurring.

DSM-V Revisions

Draft Criteria for Bipolar II Disorder

• A.Presence (or history) of one or more Major Depressive Episodes (see Criteria for Major Depressive Episode).
• B.Presence (or history) of at least one Hypomanic Episode (see Criteria for Hypomanic Episode).
• C.There has never been a Manic Episode (see
• D.The mood symptoms in Criteria A and B are not better accounted for by Schizoaffective Disorderand are not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder Not Otherwise Specified.
• E.The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• Specify current or most recent episode:
  • Hypomanic: if currently (or most recently) in a Hypomanic Episode
  • Depressed: if currently (or most recently) in a Major Depressive Episode

Specifiers and/or current features have not yet been reviewed by the Workgroup for bipolar disorder. It is anticipated that specifiers and/or features that apply across the mood disorders will be consistent across major depression and bipolar disorder. The bipolar specific rapid cycling specifier is under review to consider whether to keep as is, eliminate, or modify

Additional Information

Patients with Bipolar Disorder are at a higher risk than any other disorder on the listed on the axis I. 25-56% of patients are at risk of attempting suicide; this is a major problem in bipolar disorder (Valtonen, Suominen, Haukka, Mantere, Leppämäki, Arvilommi, et al, 2008). The suicidal behavior is related to the depressive aspects of the illness. The highest levels of suicide ideation were at the point when individuals had mixed phases of the illness and then peaking off into the more depressive stages (Valtonen, et al., 2008). The suicide thoughts were more likely to occur in Bipolar Disorder II rather than Bipolar Disorder I. The reason for this is because the bipolar II disorder patients spend more time during the mixed phases of depression. However both bipolar I and II are at high risk for suicide (Valtonen, et al., 2008). Individuals with bipolar disorders are prone to substance abuse such as: nicotine dependence, and alcohol abuse. Nicotine is the highest drug used in bipolar disorder followed by alcohol. For illegal substances, marijuana was the highest found to be abused (Leventhal & Zimmerman, 2010).

Cognitive impairment exists in both subtypes of Bipolar I and II disorders. Research has found that performance levels in verbal memory, working memory, psychomotor speed, and executive function were reduced in bipolar I disorder patients, but that performance levels only in working memory and psychomotor speed were reduced in bipolar II disorder patients (Yih-Lynn, H., Yi-Syuan, W., Jo Yung-Wei, W., Min-Hsien, H., Hui-Chun, C., Sheng-Yu, L., et al., 2009). Bipolar I patients impaired across cognitive domains (except for visual memory), while Bipolar II patients were unimpaired on verbal memory measures (Yih-Lynn, et al., 2009). Two possible factors involved in bipolar I patients having more severe neuropsychological deficits than Bipolar II patients might be the presence of psychotic symptoms and the effect of medication. Bipolar I patients generally have a history of frequent psychotic symptoms; however, one recent study reported no correlation between a history of psychotic symptoms and cognitive impairment (Yih-Lynn, et al., 2009). Moreover, the presence of psychotic symptoms is one of the DSM-IV criteria for diagnosing bipolar I. Antipsychotic treatments are used more frequently in patients with Bipolar I (Yih-Lynn, et al., 2009). Some studies have associated cognitive deficits with antipsychotic medication rather than with psychotic symptoms; however, the effect of medication is difficult to control for and to evaluate in a clinical setting (Yih-Lynn, et al., 2009). Other studies have reported cognitive deficits in the first-degree relatives of bipolar disorder patients; thus, people have questioned whether the neuropsychological functional impairments found in the patients were due to the antipsychotics or to other medication (Yih-Lynn, et al., 2009). Further studies are needed to provide additional evidence (Yih-Lynn, et al., 2009).

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