Bipolar I disorder

Bipolar disorder that is characterized by at least one manic or mixed episode

Medical condition

Bipolar disorder

Specialty| Psychiatry
Symptoms| mood instability, psychosis in some cases
Complications| self harm, suicide
Usual onset| 25 years of age
Causes| Complex
Differential diagnosis| Other bipolar disorders, borderline personality disorder, antisocial personality disorder
Treatment| Therapy, mood stabilizing medication such as lithium
Medication| Lithium, anticonvulsants, antipsychotics
Deaths| 15-20% die by suicide [citation needed]

Bipolar I disorder (BD-I; pronounced "type one bipolar disorder") is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode, with or without mixed or psychotic features.[1] Most people also, at other times, have one or more depressive episodes.[2] Typically, these manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks.[3]

It is a type of bipolar disorder and conforms to the classic concept of manic-depressive illness, which can include psychosis during mood episodes.[4]

## Diagnosis

[edit]

The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes.[5] Often, individuals have had one or more major depressive episodes.[6] One episode of mania is sufficient to make the diagnosis of bipolar disorder; the person may or may not have a history of major depressive disorder.[6] Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, substance use disorder, or toxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. Bipolar I disorder requires confirmation of only 1 full manic episode for diagnosis, but may be associated with hypomanic and depressive episodes as well.[7] Diagnosis for bipolar II disorder does not include a full manic episode; instead, it requires the occurrence of both a hypomanic episode and a major depressive episode.[7] Serious aggression has been reported to occur in one out of every ten major, first-episode, BD-I patients with psychotic features, the prevalence in this group being particularly high in association with a recent suicide attempt, alcohol use disorder, learning disability, or manic polarity in the first episode.[8]

Bipolar I disorder often coexists with other disorders including PTSD, substance use disorders, and a variety of mood disorders.[9][10] Studies suggest that psychiatric comorbidities correlate with further impairment of day-to-day life.[11] Up to 40% of people with bipolar disorder also present with PTSD, with higher rates occurring in women and individuals with bipolar I disorder.[9] A diagnosis of bipolar 1 disorder is only given if bipolar episodes are not better accounted for by schizoaffective disorder or superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or a psychotic disorder not otherwise specified.[12]

### Medical assessment

[edit]

Regular medical assessments are performed to rule-out secondary causes of mania and depression.[13] These tests include complete blood count, glucose, serum chemistry/electrolyte panel, thyroid function test, liver function test, renal function test, urinalysis, vitamin B12 and folate levels, HIV screening, syphilis screening, and pregnancy test, and when clinically indicated, an electrocardiogram (ECG), an electroencephalogram (EEG), a computed tomography (CT scan), and/or a magnetic resonance imagining (MRI) may be ordered.[13] Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins.

### Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR)

[edit]

Dx code #  | Disorder  | Description

|
|

296.0x  | Bipolar I disorder  | Single manic episode
296.40  | Bipolar I disorder  | Most recent episode hypomanic
296.4x  | Bipolar I disorder  | Most recent episode manic
296.5x  | Bipolar I disorder  | Most recent episode depressed
296.6x  | Bipolar I disorder  | Most recent episode mixed
296.7  | Bipolar I disorder  | Most recent episode unspecified

### Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)

[edit]

In May 2013, American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are several proposed revisions to occur in the diagnostic criteria of Bipolar I Disorder and its subtypes. For Bipolar I Disorder 296.40 (most recent episode hypomanic) and 296.4x (most recent episode manic), the proposed revision includes the following specifiers: with psychotic features, with mixed features, with catatonic features, with rapid cycling, with anxiety (mild to severe), with suicide risk severity, with seasonal pattern, and with postpartum onset.[14] Bipolar I Disorder 296.5x (most recent episode depressed) will include all of the above specifiers plus the following: with melancholic features and with atypical features.[14] The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major depression of which one of the symptoms is depressed mood or anhedonia.[14] For Bipolar I Disorder 296.7 (most recent episode unspecified), the listed specifiers will be removed.[14]

The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include "and present most of the day, nearly every day", and criterion B will include "and represent a noticeable change from usual behavior". These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined.[15][16]

There have also been proposed revisions to criterion B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Criterion B lists "inflated self-esteem, flight of ideas, distractibility, and decreased need for sleep" as symptoms of a Hypomanic Episode. This has been confusing in the field of child psychiatry because these symptoms closely overlap with symptoms of attention deficit hyperactivity disorder (ADHD).[15]

### ICD-10

[edit]

* F31 Bipolar Affective Disorder
* F31.6 Bipolar Affective Disorder, Current Episode Mixed
* F30 Manic Episode
* F30.0 Hypomania
* F30.1 Mania Without Psychotic Symptoms
* F30.2 Mania With Psychotic Symptoms
* F32 Depressive Episode
* F32.0 Mild Depressive Episode
* F32.1 Moderate Depressive Episode
* F32.2 Severe Depressive Episode Without Psychotic Symptoms
* F32.3 Severe Depressive Episode With Psychotic Symptoms

## Treatment

[edit]

### Medication

[edit]

Mood stabilizers are often used as part of the treatment process.[17]

1. Lithium is the mainstay in the management of bipolar disorder but it has a narrow therapeutic range and typically requires monitoring[18]
2. Anticonvulsants, such as valproate,[19] carbamazepine, or lamotrigine
3. Atypical antipsychotics, such as quetiapine,[20][21] risperidone, olanzapine, or aripiprazole
4. Electroconvulsive therapy, a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect

Antidepressant-induced mania occurs in 20–40% of people with bipolar disorder. Mood stabilizers, especially lithium, may protect against this effect, but some research contradicts this.[22]

A frequent problem in these individuals is non-adherence to pharmacological treatment; long-acting injectable antipsychotics may contribute to solving this issue in some patients.[23]

A review of validated treatment guidelines for bipolar disorder by international bodies was published in 2020.[24]

## Prognosis

[edit]

Bipolar I usually has a poor prognosis, which is associated with substance abuse, psychotic features, depressive symptoms, and inter-episode depression.[25] A manic episode can be so severe that it requires hospitalization. An estimated 63% of all BP-I related mania results in hospitalization.[26] The natural course of BP-I, if left untreated, leads to episodes becoming more frequent or severe over time.[27] The absolute risk of suicide is highest for BP-I than all other mood and mental disorders.[28] Up to a quarter of individuals with BP-I die by suicide.[29] Individuals with BP-I typically have a shorter life expectancy compared to the general population, with estimates suggesting a reduction of 11 to 20 years.[30] With proper treatment, individuals with BP-I can, however, lead a healthy lifestyle.[31]

### Education

[edit]

Psychosocial interventions can be used for managing acute depressive episodes and for maintenance treatment to aid in relapse prevention.[32] This includes psychoeducation, cognitive behavioural therapy (CBT), family-focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT), and peer support.[32]

Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance of compliance with medication as prescribed. Behavior modification through counseling can have positive influence to help reduce the effects of risky behavior during the manic phase. Additionally, the lifetime prevalence for bipolar I disorder is estimated to be 1%.[33]

## See also

[edit]

* Psychiatry portal
* Psychology portal
* Medicine portal

* List of people with bipolar disorder
* Outline of bipolar disorder
* Bipolar disorder
* Bipolar disorders research
* Bipolar II disorder
* Cyclothymia
* Bipolar NOS
* Borderline personality disorder
* Creativity and bipolar disorder
* Detailed listing of DSM-IV-TR bipolar disorder diagnostics codes
* Emotional dysregulation
* International Society for Bipolar Disorders
* Kleine–Levin syndrome
* Major depressive disorder
* Racing thoughts
* Seasonal affective disorder

## References

[edit]

1. ^ "The Two Types of Bipolar Disorder". Psych Central.com. Archived from the original on 6 August 2013. Retrieved 25 November 2015.
2. ^ "Bipolar Disorder: Who's at Risk?". Retrieved 22 November 2011.
3. ^ "Bipolar Disorder - National Institute of Mental Health (NIMH)". www.nimh.nih.gov. Retrieved 16 March 2024.
4. ^ "What are the types of bipolar disorder?". Retrieved 22 November 2011.
5. ^ Phillips, Mary L; Kupfer, David J (11 May 2013). "Bipolar disorder diagnosis: challenges and future directions". Lancet. 381 (9878): 1663–1671\. doi:10.1016/S0140-6736(13)60989-7. ISSN 0140-6736. PMC 5858935. PMID 23663952.
6. ^ a b "Online Bipolar Tests: How Much Can You Trust Them?". DepressionD. Retrieved 7 January 2012.
7. ^ a b Diagnostic and statistical manual of mental disorders : DSM-5. American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. (Fifth ed.). Arlington, VA. 2013. ISBN 978-0-89042-559-6. OCLC 847226928.`{{cite book}}`: CS1 maint: location missing publisher (link) CS1 maint: others (link)
8. ^ Khalsa, Hari-Mandir K.; Baldessarini, Ross J.; Tohen, Mauricio; Salvatore, Paola (11 August 2018). "Aggression among 216 patients with a first-psychotic episode of bipolar I disorder". International Journal of Bipolar Disorders. 6 (1): 18. doi:10.1186/s40345-018-0126-8. ISSN 2194-7511. PMC 6161985. PMID 30097737.
9. ^ a b Cerimele, Joseph M.; Bauer, Amy M.; Fortney, John C.; Bauer, Mark S. (May 2017). "Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature". The Journal of Clinical Psychiatry. 78 (5): e506 – e514. doi:10.4088/JCP.16r10897. ISSN 1555-2101. PMID 28570791.
10. ^ Hunt, Glenn E.; Malhi, Gin S.; Cleary, Michelle; Lai, Harry Man Xiong; Sitharthan, Thiagarajan (December 2016). "Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis". Journal of Affective Disorders. 206: 331–349\. doi:10.1016/j.jad.2016.07.011. ISSN 1573-2517. PMID 27476137.
11. ^ Léda-Rêgo, Gabriela; Studart-Bottó, Paula; Sarmento, Stella; Cerqueira-Silva, Thiago; Bezerra-Filho, Severino; Miranda-Scippa, Ângela (1 February 2023). "Psychiatric comorbidity in individuals with bipolar disorder: relation with clinical outcomes and functioning". European Archives of Psychiatry and Clinical Neuroscience. 273 (5): 1175–1181\. doi:10.1007/s00406-023-01562-5. ISSN 0940-1334. PMID 36725737. S2CID 256501014.
12. ^ "Bipolar Disorder Residential Treatment Center Los Angeles". PCH Treatment. Retrieved 25 November 2015.
13. ^ a b Bobo, William V. (October 2017). "The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update". Mayo Clinic Proceedings. 92 (10): 1532–1551\. doi:10.1016/j.mayocp.2017.06.022. ISSN 0025-6196. PMID 28888714.
14. ^ a b c d American Psychiatric Association (22 May 2013). Diagnostic and Statistical Manual of Mental Disorders. American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN 978-0-89042-555-8.
15. ^ a b Issues pertinent to a developmental approach to bipolar disorder in DSM-5. American Psychiatric Association. 2010.
16. ^ Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision). Washington, DC: American Psychiatric Association. 2000. pp. 345–392.
17. ^ Schwartz, Jeremy (20 July 2017). "Can People Recover From Bipolar Disorder?". U.S. News & World Report.
18. ^ Burgess, Sally SA; Geddes, John; Hawton, Keith KE; Taylor, Matthew J.; Townsend, Ellen; Jamison, K.; Goodwin, Guy (2001). "Lithium for maintenance treatment of mood disorders | Cochrane". Cochrane Database of Systematic Reviews. 2001 (3): CD003013. doi:10.1002/14651858.CD003013. PMC 7005360.
19. ^ MacRitchie, Karine; Geddes, John; Scott, Jan; Haslam, D. R.; Silva De Lima, Mauricio; Goodwin, Guy (2003). "Valproate for acutre mood episodes in bipolar disorder | Cochrane". Cochrane Database of Systematic Reviews (1): CD004052. doi:10.1002/14651858.CD004052. PMID 12535506.
20. ^ Datto, Catherine (11 March 2016). "Bipolar II compared with bipolar I disorder: baseline characteristics and treatment response to quetiapine in a pooled analysis of five placebo-controlled clinical trials of acute bipolar depression". Annals of General Psychiatry. 15: 9. doi:10.1186/s12991-016-0096-0. PMC 4788818. PMID 26973704.
21. ^ Young, Allan (February 2014). "A Randomised, Placebo-Controlled 52-Week Trial of Continued Quetiapine Treatment in Recently Depressed Patients With Bipolar I And Bipolar II Disorder". World Journal of Biological Psychiatry. 15 (2): 96–112\. doi:10.3109/15622975.2012.665177. PMID 22404704. S2CID 2224996.
22. ^ Goldberg, Joseph F; Truman, Christine J (1 December 2003). "Antidepressant-induced mania: an overview of current controversies". Bipolar Disorders. 5 (6): 407–420\. doi:10.1046/j.1399-5618.2003.00067.x. ISSN 1399-5618. PMID 14636364.
23. ^ Tohen, Mauricio; Goldberg, Joseph F.; Hassoun, Youssef; Sureddi, Suresh (16 June 2020). "Identifying Profiles of Patients With Bipolar I Disorder Who Would Benefit From Maintenance Therapy With a Long-Acting Injectable Antipsychotic". The Journal of Clinical Psychiatry. 81 (4). doi:10.4088/JCP.OT19046AH1. ISSN 1555-2101. PMID 32558403. S2CID 219923839.
24. ^ Verdolini, Norma; Hidalgo-Mazzei, Diego; Del Matto, Laura; Muscas, Michele; Pacchiarotti, Isabella; Murru, Andrea; Samalin, Ludovic; Aedo, Alberto; Tohen, Mauricio; Grunze, Heinz; Young, Allan H. (22 December 2020). "Long-term treatment of bipolar disorder type I: A systematic and critical review of clinical guidelines with derived practice algorithms". Bipolar Disorders. 23 (4): 324–340\. doi:10.1111/bdi.13040. ISSN 1399-5618. PMID 33354842. S2CID 229693238.
25. ^ Jain, A.; Mitra, P. (2023). "Bipolar Disorder". StatPearls. PMID 32644424.
26. ^ De Zelicourt, M.; Dardennes, R.; Verdoux, H.; Gandhi, G.; Khoshnood, B.; Chomette, E.; Papatheodorou, M. L.; Edgell, E. T.; Even, C.; Fagnani, F. (2003). "Frequency of hospitalisations and inpatient care costs of manic episodes: In patients with bipolar I disorder in France". Pharmacoeconomics. 21 (15): 1081–1090\. doi:10.2165/00019053-200321150-00002. PMID 14596627. S2CID 41439636.
27. ^ "Bipolar Disorder – Fact Sheet".
28. ^ "Risk of suicide and all-cause death in patients with mental disorders: a nationwide cohort study".
29. ^ "Suicide Risk in Bipolar Disorder: A Brief Review".
30. ^ "Life expectancy in bipolar disorder".
31. ^ "Living Well with Bipolar Disorder". 7 May 2019.
32. ^ a b Yatham, Lakshmi N.; Kennedy, Sidney H.; Parikh, Sagar V.; Schaffer, Ayal; Bond, David J.; Frey, Benicio N.; Sharma, Verinder; Goldstein, Benjamin I.; Rej, Soham; Beaulieu, Serge; Alda, Martin (2018). "Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder". Bipolar Disorders. 20 (2): 97–170\. doi:10.1111/bdi.12609. ISSN 1399-5618. PMC 5947163. PMID 29536616.
33. ^ Merikangas, Kathleen R.; Akiskal, Hagop S.; Angst, Jules; Greenberg, Paul E.; Hirschfeld, Robert M.A.; Petukhova, Maria; Kessler, Ronald C. (1 May 2007). "Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication". Archives of General Psychiatry. 64 (5): 543–552\. doi:10.1001/archpsyc.64.5.543. ISSN 0003-990X. PMC 1931566. PMID 17485606.

Classification|

* ICD-11: 6A60
* ICD-10: F31.9
* ICD-9-CM: 296.7

|

* v
* t
* e

Mood disorder

Spectrum|

| Bipolar disorder|

* Bipolar I
* Bipolar II
* Cyclothymia
* Bipolar NOS
* Childhood
* Hypomania
* Mania
* Mixed affective state
* Rapid cycling

|

Depression|

* Major depressive disorder
* Dysthymia
* Seasonal affective disorder
* Atypical depression
* Melancholic depression
* Major depressive episode
* Depression in childhood and adolescence

Comorbidities|

* Schizoaffective disorder

Symptoms|

* Delusion
* Depression (differential diagnoses)
* Emotional dysregulation
* Anhedonia
* Dysphoria
* Suicidal ideation
* Episodic memory
* Hallucination
* Mood swing
* Sleep disorder
* Hypersomnia
* Insomnia
* Psychosis
* Psychotic depression
* Racing thoughts
* Reduced affect display

Diagnosis|

* Bipolar Spectrum Diagnostic Scale
* Child Mania Rating Scale
* General Behavior Inventory
* Hypomania Checklist
* Mood Disorder Questionnaire
* Rating scales for depression
* Young Mania Rating Scale

Treatment|

| Anticonvulsants|

* Carbamazepine
* Lamotrigine
* Oxcarbazepine
* Valproate
* Sodium valproate
* Valproate semisodium

|

Sympathomimetics,
SSRIs and similar|

* Bupropion
* Dextroamphetamine
* Escitalopram
* Fluoxetine
* Methylphenidate
* Sertraline

Other mood stabilizers|

* Antipsychotics
* Atypical antipsychotics
* Lithium
* Lithium carbonate
* Lithium citrate
* Lithium sulfate
* Lithium toxicity

Non-pharmaceutical|

* Clinical psychology
* Cognitive behavioral therapy
* Dialectical behavior therapy
* Electroconvulsive therapy
* Involuntary commitment
* Light therapy
* Psychotherapy
* Transcranial magnetic stimulation

History|

* Emil Kraepelin
* Frederick K. Goodwin
* John Cade
* Karl Leonhard
* Kay Redfield Jamison
* Mogens Schou

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