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Source: Drayton S. Bipolar Disorder. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7989283. Accessed June 16, 2012.

  • Manic-depressive illness (or disorder)
  • Manic depression
  • Mood disorder
  • Mood swings
  • Rapid mood cycling

  • Cyclical, life-long disorder with recurrent extreme fluctuations in mood, energy, and behavior.

  • Theoretical causes:
    • Genetic factors
    • Perinatal insult
    • Head trauma
    • Environmental factors
    • Psychosocial or physical stressors
    • Nutritional factors
  • Medical conditions that can induce mania:
    • Central nervous system (CNS) disorders
    • Infections
    • Electrolyte or metabolic abnormalities
    • Endocrine or hormonal dysregulation
    • Drug withdrawal syndromes
  • Drugs that can induce mania:
    • Alcohol,
    • Antidepressants
    • Dopamine agonists
    • Hallucinogens
    • Norepinephrine-augmenting agents
    • Steroids
    • Thyroid preparations
    • Xanthines

  • Various theories:
    • Dysregulation between excitatory and inhibitory neurotransmitter systems
    • Excess of catecholamines (primarily norepinephrine and dopamine) causing mania
    • Deficiency of gamma aminobutyric acid (GABA) or excessive glutamate activity causing dysregulation of neurotransmitters (e.g., increased dopamine and norepinephrine activity)
    • Deficiency of acetylcholine causing imbalance in cholinergic-adrenergic activity

  • Lifetime prevalence: 0.4–1.6% for bipolar I disorder, 0.5% for bipolar II disorder.
  • Lifetime prevalence rate of manic episode: 1.6% for men, 1.7% for women in United States (~4 million people).
  • Bipolar I disorder occurs equally in men and women; bipolar II disorder more common in women.

  • 80–90% of patients have biologic relative with mood disorder.
  • First-degree relatives of bipolar patients have 15–35% lifetime risk of developing any mood disorder and 5–10% lifetime risk for developing bipolar disorder.

Signs and Symptoms

  • Manic episode
    • Usually begins abruptly; symptoms increase over several days.
    • Severe stages may include bizarre behavior, hallucinations, and paranoid or grandiose delusions.
    • Marked functional impairment or need for hospitalization.
    • May be precipitated by stressors, sleep deprivation, antidepressants, CNS stimulants, or bright light.
  • Hypomanic episode
    • Absence of marked impairment in social or occupational functioning, delusions, and hallucinations.
    • Patients may be more productive and creative than usual during episodes, but 5–15% rapidly switch to manic episode.
  • Major depressive episode
    • Patient in bipolar depression often has mood lability, hypersomnia, low energy, psychomotor retardation, cognitive impairments, anhedonia, decreased sexual activity, slowed speech, carbohydrate craving, and weight gain.
    • Delusions, hallucinations, and suicide attempts more common in bipolar depression than unipolar depression.
  • Mixed episode
    • Occurs in up to 40% of all episodes, often difficult to diagnose and treat, and more common in younger and older patients and women.

Means of Confirmation and Diagnosis

  • Classification of bipolar disorders:
    • Bipolar I: Manic episode with or without major depressive or mixed episode
    • Bipolar II: Major depressive episode with hypomanic episodes
    • Cyclothymic disorder: Chronic fluctuations between subsyndromal depressive and hypomanic episodes (2 years for adults and 1 year for children and adolescents)
    • Bipolar disorder not otherwise specified: Mood states do not meet criteria for any specific bipolar disorder.
  • Diagnosis requires occurrence of manic, hypomanic, or mixed episode (not caused by any other medical condition, substance, or ...

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