Bipolar disorder

Bipolar disorder is a common psychiatric disorder characterised by the presence of manic or hypomanic episodes, with or without depressive episodes as well. It's a chronic disorder in which the patient experiences periods of remission with occasional above-mentioned episodes.

One distinguishes two major types of bipolar disorder, bipolar I disorder and bipolar II disorder. Bipolar I is the most severe, characterised by episodes of mania, while bipolar II disorder is less severe, characterised by episodes of hypomania. Episodes of depression may occur in both types. One often uses the term "bipolar depression" to mean the depression occuring as a feature of bipolar disorder.

Clinical features

Mania and hypomania are the key features of bipolar disorder. These episodes may progress rapidly, the patient progressing from being in remission to being manic in only a few days. Hypomanic episodes usually progress slower.

Mania

Mania (or manic episode) is a state of severe mood disturbances and cognitive changes, including:

• Persistently and abnormally elevated or irritable mood
• Persistently and abnormally increased activity or energy
• Increased self-esteem or grandiosity
• Decreased need for sleep
• Increased talkativeness
• Quickly and erratically jumping between ideas and thoughts (flight of ideas)
• Distractability
• Increased goal-directed activity (at school, work, or sexually)
• Disinhibition (e.g. walking naked in public)
• Psychomotor agitation or hyperactivity
• Excessive involvement in activities which have painful consequences (sexual indescretion, unreasonable purchases)
• Disregard for social boundaries

For the episode to be defined as manic, the symptoms must be severe enough to necessitate hospitalisation. There may be features of psychosis as well (hallucinations, delusions).

Hypomania

Hypomania (or hypomanic episode) is a state similar to mania, but less severe. It includes the same features as described above, except the symptoms are not so severe as to necessitate hospitalisation, and there are no features of psychosis.

Hypomanic episodes can also occur in bipolar I disorder.

Major depression

See also: Major depressive disorder

Bipolar depression is similar to "unipolar" depression, including features like depressed mood, dminished interest or pleasure in activities, weight loss, sleep disturbance (too much or too little), and so on.

Mood episodes with mixed features

Some patients with bipolar disorder experience symptoms of both mania/hypomania and depression simultaneously.

Other types of bipolar disorder

Cyclothymic disorder

Cyclothymic disorder is characterised by periods of hypomanic symptoms and depressive symptoms where these symptoms are not severe enough to meet the diagnostic criteria for a hypomanic episode and depressive episode, respectively.

Substance/medication induced bipolar disorder

Substance/medication induced bipolar disorder is characterised by

Diagnosis

Diagnosis is based on clinical features, when the diagnostic criteria (according to DSM or ICD) for bipolar disorder are fulfilled.

For a diagnosis of bipolar I disorder, the patient must have experienced one or more manic episodes. Depressive episodes usually occur but are not required for the diagnosis.

For a diagnosis of bipolar II disorder, the patient must have experienced one or more hypomanic episodes, as well as one or more depressive episodes.

Management

Untreated, manic and hypomanic episodes may last weeks or months.