Bipolar II disorder

Recognize the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for bipolar disorder as well as the subtypes of bipolar I disorder, bipolar II disorder, and cyclothymic disorder. 

Bipolar disorders have been categorized into bipolar I disorder, bipolar II disorder, and bipolar disorder, not otherwise specified (NOS). Bipolar I disorder is characterized by one or more manic or mixed mood episodes. Bipolar II disorder is characterized by one or more major depressive episodes and at least one hypomanic episode. Hypomania is an abnormally and persistently elevated, expansive, or irritable mood, but not of sufficient severity to cause significant impairment in social or occupational function and does not require hospitalization. Most epidemiologic studies have looked at bipolar disorder of all types (bipolar I and bipolar II), or the bipolar spectrum, which includes all clinical conditions thought to be closely related to bipolar disorder. The lifetime prevalence of bipolar I disorder is estimated to be between 0.3% and 2.4%. The lifetime prevalence of bipolar II disorder ranges from 0.2% to 5%. When including the bipolar spectrum, the lifetime prevalence is between 3% and 6.5%.1... 

The distinguishing feature of bipolar II disorder is depression with past hypomanic episodes that often are not recalled by the individual as being unusual. Irritability and anger episodes are also common. Collateral information is essential to obtain the entire history (i.e., there cannot have been a prior full manic episode).1,14... 

Suppes T, Dennehy EB. Evidence-based long-term treatment of bipolar II disorder. J Clin Psychiatry 2002 63(Supplement 10) 29-33. 

Hauser, P., Matochik, J., Altshuler, L.L., et al. (2000) MRI-based measurements of temporal lobe and ventricular structures in patients with bipolar I and bipolar II disorders. J Affect Disord 60 25-32. 

The treatment of children with bipolar II disorder, depressed phase, has been studied by Geller and colleagues (1998b) who hypothesized that lithium would be efficacious for the treatment of prepubertal major... 

Greil, W., and Kleindienst, N. (1999b) Lithium versus carbamazepine in the maintenance treatment of bipolar II disorder and bipolar disorder not otherwise specified. Int Clin Psychopharmacol 14 283-285. 

T. Kato, S. Takahashi, T. Shioiri, J. Murashita, H. Hamakawa and T. Inubushi, Reduction of brain phosphocreatine in bipolar II disorder detected by phosphorus-31 magnetic resonance spectroscopy. /. Affect. Disord., 1994, 31,125-133. 

Reports vary as to the predominant picture, which ranges from one quite similar to melancholia to one more consistent with an atypical depressive disorder or a bipolar II disorder (Table 6-5). Complaints usually involve a diminution in energy, followed by an increased need for sleep, increased appetite and weight, and a lack of involvement or interest in one s activities. Only toward the end of the episode onset does the patient become aware of the depressed mood and such classic symptoms as poor concentration, feelings of self-worthlessness, and multiple somatic complaints. Insomnia often develops over the next 1 to 2 months. Whereas this atypical picture is more characteristic of the early phases of the illness, reminiscent of certain bipolar subtypes, the affective episode appears to evolve toward a more classic depressive syndrome as it progresses over multiple seasons. 

A 42-year-old woman with bipolar II disorder who had taken olanzapine 5 mg/day for 5 weeks began to have severe enduring panic-like anxiety and serious obsessive-compulsive symptoms (150). 

Jonkers F, De Haan L. Olanzapine-induced obsessive-compulsive symptoms in a patient with bipolar II disorder. Psychopharmacology (Berl) 2002 162(l) 87-8. 

A 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation was treated as an out-patient with lamotrigine 400 mg/day, clonazepam 0.5 mg tds, and quetiapine 100 mg/day. She gained 9 kg in 6 months and was advised to reduce the dose of quetiapine to 50 mg/day. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude normal daily activities. She was instructed to take quetiapine 75 mg/day, but her symptoms continued and only resolved when she took 100 mg/day. Slower reduction in the dose of quetiapine (by 12.5 mg/day every 5 days) with an antiemetic, ondansetron, also failed. On a third attempt, prochlorperazine successfully reduced her withdrawal symptoms, although moderate nausea persisted for 2 days after complete withdrawal. 

A 38-year-old man with bipolar II disorder took chromium polynicotinate 400 micrograms/day. Shortly after the first dose his mood started to improve, but he had unusually vivid intense dreams. The dose of chromium was increased to 600 micrograms/day. He then developed intermittent brief dizzy spells due to orthostatic hypotension. After switching to chromium picolinate his dizzy spells did not recur. 

Approximately 5-15% of patients with bipolar II disorder will develop a manic episode over a 5-year period. If a manic or mixed episode develops in a patient with bipolar II disorder, the diagnosis is changed to bipolar I disorder,... 

Favorable tolerability profile leading to off-label uses for many indications other than schizophrenia (e.g., acute bipolar mania bipolar II disorder, including hypomanic, mixed, rapid cycling, and depressed phases treatment-resistant depression anxiety disorders)... 

May decrease suicide and suicide attempts not only in bipolar I disorder but also in bipolar II disorder and in unipolar depression... 

Persons who experience manic episodes are classified as having Bipolar I Disorder, while those who experience only hypomanic episodes are classified as having Bipolar II Disorder. 

The lifedme populadon prevalence of Bipolar I disorder in the United States is about 1% (Kessler et al., 1994). There is no gender prevalence, with women as likely as men to develop the illness. The prevalence of bipolar I disorder does not appear to be influenced by race, ethnicity, or geography. Similar prevalence rates are reported in most coundies, although large scale cross nadonal and cross-cultural studies are needed. The prevalence of bipolar II disorder is less well understood, but is estimated to be about 3-5% (Berk and Dodd, 2005). Needless to say, padents with bipolar II disorder may be less likely to come to medical attendon. 

Berk M, Dodd S (2005) Bipolar II disorder A review. Bipolar Disord 7 11-21. 

Bipolar II disorder—manic-depressive illness characterized by a depressive episode and a hypo-manic episode. 

Bipolar II disorder is defined as one or more depressive episodes and at least one episode of hypomania. It has been postulated that bipolar II is difficult to differentiate from major depression, for several reasons. First, many patients subjectively do not recognize periods of elevated mood as dysfunctional—or may even deny the existence of such periods because of the predominate depressive element. Second, the patient may primarily manifest irritability rather than classic mood and behavior symptoms of hypomania. Finally, there is considerable variation between individual clinicians ability to reliably assess for hypomania. 

Course specifiers for bipolar I or bipolar II disorder are as follows ... 

Fluctuations in hormones and neurotransmitters during the luteal phase of the menstrual cycle, postpartum period, and during peri-menopause (starting approximately 10 years before menopause) may precipitate mood changes and increase cycling that resembles bipolar II disorder. Women with bipolar I disorder are at greater risk for relapse into mania, depression, or psychosis during the... 

Predictors of a positive response with valproate include rapid cycling, mixed episodes, comorbid panic disorder, organic mental disorders (e.g., head trauma), and mental retardation. " Low-dose valproate (125 to 500 mg/day) has been reported to be effective in reducing mood cycling in bipolar II disorder and cyclothymia. Oral loading with divalproex sodium, 20 mg/kg per day, may produce a rapid reduction in manic and psychotic symptoms within 4 days without causing major side effects, although there may be a lag time to obtain full antimanic efficacy. Development of tolerance and loss of efficacy with valproate occurs in some patients after several years of treatment." ... 

---