Bipolar disorder
Clinical Presentation and Diagnosis: – Bipolar disorder typically peaks in late adolescence and early adulthood. – It involves intermittent episodes of mania alternating with depression. […]
Clinical Presentation and Diagnosis:
– Bipolar disorder typically peaks in late adolescence and early adulthood.
– It involves intermittent episodes of mania alternating with depression.
– Symptoms include disruptions in mood, psychomotor activity, circadian rhythm, and cognition.
– Manic episodes are characterized by elevated mood, increased energy, racing thoughts, and impulsive behaviors.
– Diagnosis involves criteria from DSM-5 and ICD-10, self-reported experiences, and medical work-ups.
Classification and Subtypes:
– Bipolar I involves at least one manic episode, with or without depressive episodes.
– Bipolar II includes hypomanic episodes and major depressive episodes.
– Cyclothymia features hypomanic episodes with periods of depression.
– The concept of a bipolar spectrum includes subthreshold symptoms causing impairment.
– Specifiers like mild, moderate, severe, and with psychotic features indicate presentation and course.
Treatment Options and Management:
– Mood stabilizers like lithium and anticonvulsants are used for long-term management.
– Antipsychotics are prescribed during acute manic episodes.
– Psychotherapy can improve the disorder’s course.
– Controversy surrounds the use of antidepressants due to the risk of triggering manic episodes.
– Electroconvulsive therapy is effective in acute episodes, especially with psychosis.
Epidemiology and Impact:
– Global prevalence of bipolar disorder is around 2%.
– In the US, an estimated 3% of the population is affected at some point in life.
– Onset typically occurs between ages 20-25.
– Around one-quarter to one-third of individuals face financial, social, or work-related issues.
– Bipolar disorder ranks among the top 20 causes of disability worldwide with significant societal costs.
Comorbid Conditions and Causes:
– Common comorbid psychiatric conditions include anxiety and substance abuse.
– Individuals with bipolar disorder have higher rates of metabolic syndrome, obesity, and type 2 diabetes.
– Genetic influences, with a heritability estimated at 0.71, play a significant role in the disorder’s development.
– Environmental factors, psychosocial factors, and childhood traumatic experiences contribute to bipolar disorder.
– Neurological associations like stroke and traumatic brain injury may trigger bipolar-like symptoms.
Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks. If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe and does not significantly affect functioning, it is called hypomania. During mania, an individual behaves or feels abnormally energetic, happy or irritable, and they often make impulsive decisions with little regard for the consequences. There is usually also a reduced need for sleep during manic phases. During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others. The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm. Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.
| Bipolar disorder | |
|---|---|
| Other names | Bipolar affective disorder (BPAD), bipolar illness, manic depression, manic depressive disorder, manic–depressive illness (historical), manic–depressive psychosis, circular insanity (historical), bipolar disease |
 | |
| Bipolar disorder is characterized by episodes of depression and hypomania or mania. | |
| Specialty | Psychiatry |
| Symptoms | Periods of depression and elevated mood |
| Complications | Suicide, self-harm |
| Usual onset | 25 years old |
| Types | Bipolar I disorder, bipolar II disorder, others |
| Causes | Environmental and genetic |
| Risk factors | Family history, childhood abuse, long-term stress |
| Differential diagnosis | Attention deficit hyperactivity disorder, personality disorders, schizophrenia, substance use disorder |
| Treatment | Psychotherapy, medications |
| Medication | Lithium, antipsychotics, anticonvulsants |
| Frequency | 1–3% |
While the causes of this mood disorder are not clearly understood, both genetic and environmental factors are thought to play a role. Many genes, each with small effects, may contribute to the development of the disorder. Genetic factors account for about 70–90% of the risk of developing bipolar disorder. Environmental risk factors include a history of childhood abuse and long-term stress. The condition is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode (but no full manic episodes) and one major depressive episode. It is classified as cyclothymia if there are hypomanic episodes with periods of depression that do not meet the criteria for major depressive episodes. If these symptoms are due to drugs or medical problems, they are not diagnosed as bipolar disorder. Other conditions that have overlapping symptoms with bipolar disorder include attention deficit hyperactivity disorder, personality disorders, schizophrenia, and substance use disorder as well as many other medical conditions. Medical testing is not required for a diagnosis, though blood tests or medical imaging can rule out other problems.
Mood stabilizers—lithium and certain anticonvulsants such as valproate and carbamazepine as well as atypical antipsychotics such as aripiprazole—are the mainstay of long-term pharmacologic relapse prevention. Antipsychotics are additionally given during acute manic episodes as well as in cases where mood stabilizers are poorly tolerated or ineffective. In patients where compliance is of concern, long-acting injectable formulations are available. There is some evidence that psychotherapy improves the course of this disorder. The use of antidepressants in depressive episodes is controversial: they can be effective but have been implicated in triggering manic episodes. The treatment of depressive episodes, therefore, is often difficult. Electroconvulsive therapy (ECT) is effective in acute manic and depressive episodes, especially with psychosis or catatonia. Admission to a psychiatric hospital may be required if a person is a risk to themselves or others; involuntary treatment is sometimes necessary if the affected person refuses treatment.
Bipolar disorder occurs in approximately 2% of the global population. In the United States, about 3% are estimated to be affected at some point in their life; rates appear to be similar in females and males. Symptoms most commonly begin between the ages of 20 and 25 years old; an earlier onset in life is associated with a worse prognosis. Interest in functioning in the assessment of patients with bipolar disorder is growing, with an emphasis on specific domains such as work, education, social life, family, and cognition. Around one-quarter to one-third of people with bipolar disorder have financial, social or work-related problems due to the illness. Bipolar disorder is among the top 20 causes of disability worldwide and leads to substantial costs for society. Due to lifestyle choices and the side effects of medications, the risk of death from natural causes such as coronary heart disease in people with bipolar disorder is twice that of the general population.