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Schizoaffective disorder
7%
15/212
Major depressive disorder
2%
4/212
Bipolar I disorder
65%
138/212
Bipolar II disorder
17%
37/212
Dysthymic disorder
6%
12/212
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This patient meets criteria for a manic episode with her grandiosity, flight of ideas, increase in activity, decreased need for sleep, and talkativeness. These symptoms have also lasted for more than 7 days; this would lead to a diagnosis of bipolar I disorder. A manic episode is defined as a distinct period of abnormally elevated/irritated mood and persistently elevated energy levels. A manic episode must last at least one week. A diagnosis of a manic episode requires a need for hospitalization or 3 of the following DIGFAST symptoms: distractibility, irresponsibility, grandiosity, flight of ideas, activity/agitation increase, sleep requirement decreased, talkativeness or pressured speech. Presence of a manic episode automatically assigns the diagnosis of Bipolar I. Bipolar II requires a hypomanic episode and a depressive episode. Incorrect Answers: Answer 1: Schizoaffective disorder is characterized by features of both schizophrenia and a mood disorder. Specifically, DSM-V requires two separate episodes of psychosis: one lasting > 2 weeks without a major mood episode and the other requires conspicuous overlap between the mood symptoms and psychotic symptoms and last for the greater portion of the disorder. This patient does not have any psychotic symptoms, making schizoaffective disorder unlikely. Answer 2: Major depressive disorder is defined by depressed mood with 5 of the following 9 symptoms: sleep disturbance, loss of interest, guilt, energy loss, concentration issues, appetite changes, psychomotor retardation or agitation, and suicidal ideation. This patient may have suffered from depression in the past, but her current episode is more consistent with mania. Answer 4: Bipolar II disorder is diagnosed in a patient with hypomanic episodes and at least one major depressive episode. The presence of a manic episode makes the diagnosis bipolar I. Answer 5: Dysthymia is mild depression lasting at least 2 years. This patient has an acute manic episode of several days. Bullet summary: Bipolar I disorder is defined by at least one manic episode with or without a hypomanic or depressive episode.
4.4
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