Bipolar disorder, which in the ICD-10 is classified as bipolar disorder, or manic-depressive illness (MDI), is a common, severe, and persistent mental illness. This condition is a serious lifelong struggle and challenge.
Signs and symptoms
Bipolar disorder is characterized by periods of deep, prolonged, and profound depression that alternate with periods of an excessively elevated or irritable mood known as mania.
Manic episodes are feature at least 1 week of profound mood disturbance, characterized by elation, irritability, or expansiveness (referred to as gateway criteria). At least 3 of the following symptoms must also be present
Diminished need for sleep
Excessive talking or pressured speech
Racing thoughts or flight of ideas
Clear evidence of distractibility
Increased level of goal-focused activity at home, at work, or sexually
Excessive pleasurable activities, often with painful consequences
Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4 consecutive days’ duration. The diagnosis of hypomania requires at least three of the symptoms above. The difference being that in hypomania these symptoms are not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization and are not associated with psychosis.
Major depressive episodes are characterized as, for the same 2 weeks, the person experiences 5 or more of the following symptoms, with at least 1 of the symptoms being either a depressed mood or characterized by a loss of pleasure or interest:
Markedly diminished pleasure or interest in nearly all activities
Significant weight loss or gain or significant loss or increase in appetite
Hypersomnia or insomnia
Psychomotor retardation or agitation
Loss of energy or fatigue
Feelings of worthlessness or excessive guilt
Decreased concentration ability or marked indecisiveness
Preoccupation with death or suicide; patient has a plan or has attempted suicide
See Clinical Presentation for more detail.
Examination of patients with suspected bipolar disorder includes evaluation using the Mental Status Examination as well as assessment of the following:
Although bipolar disorder is diagnosed based on the patient’s history and clinical course, laboratory studies may be necessary to rule out other potential causes of the patient’s signs and symptoms as well as to have baseline results before administering certain medications.
Laboratory tests that may be helpful include the following:
Fasting glucose levels
Thyroid hormone levels
Creatinine and blood urea nitrogen levels
Liver and lipid panel
Substance and alcohol screening
Depending on the patient’s presentation, other laboratory tests may be indicated, which may include the following:
Urinary copper levels
Antinuclear antibody testing
Electrocardiography is important in elderly patients and before antidepressant therapy. Electroencephalography and/or MRI may be appropriate for selected patients.
See Workup for more detail.
The treatment of bipolar disorder is directly related to the phase of the episode (ie, depression or mania) and the severity of that phase, and it may involve a combination of psychotherapy and medication. Always evaluate patients with mania, hypomania, or mixed episode, and those with bipolar depression, for suicidality, homicidality, acute or chronic psychosis, or other unstable or dangerous conditions.
Medications used to manage patients with bipolar disorder include the following:
Benzodiazepines – for acute agitation (eg, lorazepam, clonazepam)
Antimanic agents (eg, lithium)
Anticonvulsants (eg, carbamazepine, valproate sodium, valproic acid, divalproex sodium, lamotrigine)
First-generation antipsychotics (eg, inhaled loxapine, haloperidol)
Second-generation antipsychotics (eg, asenapine, ziprasidone, quetiapine, risperidone, aripiprazole, olanzapine, olanzapine and fluoxetine, cariprazine, clozapine, paliperidone, lurasidone)
Phenothiazine antipsychotics (eg, chlorpromazine)
Dopamine agonists (eg, pramipexole)
Psychotherapy may help to decrease relapse rates, improve quality of life, and/or increase functioning, or more favorable symptom improvement.
Electroconvulsive therapy may be useful in selected patients with bipolar disorder.
What is bipolar disorder? Bipolar disorder, sometimes known as manic depression, is a type of mental disorder where people experience periods of extreme lows, known as depression, as well as periods of extreme highs, or manic episodes. Courtesy of Osmosis.org (https://www.osmosis.org/).