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INTRODUCTION

  • Bipolar disorder is a common, lifelong, often severe cyclic mood disorder characterized by recurrent fluctuations in mood, energy, and behavior. The mania or hypomania is not substance-related or caused by other medical or psychiatric disorders.

PATHOPHYSIOLOGY

  • Table 67-1 lists medical conditions, medications, and treatments that may induce mania.

  • Bipolar disorder is influenced by developmental, genetic, neurobiological, and psychological factors. Multiple gene loci are likely involved in the heredity of mood disorders.

TABLE 67-1Secondary Causes of Mania

CLINICAL PRESENTATION

  • Different types of episodes may occur sequentially with or without a period of normal mood (euthymia) between them. There can be mood fluctuations that continue for months or after one episode, and there can be years without recurrence of any type of mood episode.

DIAGNOSIS

  • The Diagnostic and Statistical Manual of Mental Disorders, 5th edition classifies bipolar disorders into five subtypes:

    • (1) Bipolar I disorder: At least one manic episode, which may have been preceded by and may be followed by hypomanic or major depressive episode(s).

    • (2) Bipolar II disorder: At least one hypomanic episode and a current or past major depressive episode.

    • (3) Cyclothymic disorder: Chronic fluctuations between subsyndromal depressive and hypomanic episodes.

    • (4) Other specified bipolar and related disorder.

    • (5) Unspecified bipolar and related disorder.

  • See Table 67-2 for diagnostic criteria for major depressive episode, manic episode, and hypomanic episode.

  • A medical, psychiatric, and medication history; physical examination; and laboratory testing are necessary to rule out organic causes of mania or depression.

  • Delusions, hallucinations, and suicide attempts are more common in bipolar depression than in unipolar depression.

  • Acute mania ...

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