Transcript:
Hello. I’m Dr Andrew Cutler. I’m a Clinical Associate Professor of Psychiatry at SUNY Upstate Medical University in Syracuse, New York, and the chief medical officer at the Neuroscience Education Institute in Carlsbad, California.
I welcome you to this patient case video that will illustrate the moderate manic episode severity specifier, as defined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), released in March of 2022. Understanding how to apply this severity specifier can lead to an accurate diagnosis and help you make informed and appropriate treatment decisions for your patients with bipolar I disorder.
Let’s get started.
This case depicts a patient experiencing a moderate manic episode. The patient’s chief complaint is manic symptoms in the setting of stopping mood stabilizing medication, which she says she ran out of.
The patient is a 46-year-old female with non-rapid cycling bipolar I disorder who presents with her husband. She exhibits rapid speech, is flirtatious, and endorses euphoric mood. Her husband reports the patient is only sleeping 3 to 4 hours per night and has expressed a desire to go to a bar “to see if anyone notices how good I look in this dress.” He is concerned the patient’s judgment is declining.
Here, it’s important to note that patient non-adherence is common and can result in emergence or aggravation of mood episodes.1
Also of note, she was initially diagnosed with MDD at age 26 before being correctly diagnosed with bipolar I disorder at age 33 after her psychiatrist recognized a manic episode.
Recall from our previous case that earlier age at symptom onset is associated with greater delays in diagnosis.2
So, the impression for this patient is as follows:
This patient is a 46-year-old married female with bipolar I disorder, non-rapid cycling, who presents with a moderate manic episode in the context of self-discontinuing her medication.
The treatment plan for this patient is to attempt outpatient management and to consider admitting her to inpatient psychiatry if her condition worsens or treatment nonadherence persists.
This case illustrates how moderate mania differs from mild mania. Mild manic episodes meet the minimum symptom criteria for mania. Moderate manic episodes cause a very significant increase in activity or impairment in judgment.3 The patient experiencing mild mania had manic symptoms that affected his ability to function but were of lesser intensity. This patient exhibited very significant increase in activity and impairment in judgment, characteristic of moderate mania.
Impaired judgment may be associated with treatment nonadherence.
In closing, it is vital that healthcare providers recognize manic episodes early to help support their patient’s adherence to treatment and prevent adverse consequences and health outcomes.
I hope this case has been informative for you and helps you better understand how a moderate manic episode presents. Following the DSM-5-TR severity specifier criteria for manic episodes leads to a more precise diagnosis and helps you make informed and appropriate treatment decisions for your patients with bipolar I disorder.
Thank you for joining me today, and I look forward to seeing you next time.
