Bipolar Disorder

05/12/2013 by admin | Psychiatry

Definition:the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood (known as mania, or if lesser if degree – hypomania) with or without one or more depressive episodes these usually are separated by periods of normal mood.

Classification / type of disease:

  1. Bipolar I disorder

One or more manic episodes.

  1. Bipolar II disorder

No manic episodes, but one or more hypomanic episodes and one or more major depressive episode

  1. Cyclothymia

A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. There is a low-grade cycling of mood which appears to the observer as a personality trait, and interferes with functioning.

  1. Bipolar Disorder NOS (Not Otherwise Specified)

This is a catchall category, diagnosed when the disorder does not fall within a specific subtype. Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.

Epidemiology: lifetime prevalence ~1%

Presenting symptoms / signs:  

Mania (hypomania): substantially elevated mood, irritability, excessive spending, pressurised speech, flight of ideas, hypersexuality, no need for sleep, reduced attention/judgement, grandiosity, anxiety delusions, hallucinations…hypomania is of a lesser extent and often just perceived as happiness and generally not a problem.

Depressions: same as clinical unipolar depressionsadnessanxietyguiltangerisolationhopelessness; disturbances in sleep and appetite; anhedonia, depersonalization; loss of interest in sexual activity; shyness or social anxiety; irritability, suicidal idealation, psychosis, hallucinations, delusions..

It is possible to have a mixed affective episode – where mania and depression occur simultaneously – this is a dangerous scenario where substance abuse and suicide is a high risk.

Diagnostic investigations: consider hypo- or hyperthyroidism, metabolic disturbance, a systemic infection or chronic disease, and syphilis or HIV infection. Do a CT head, FBC, TFT, EEG,

Aetiology: genetic, environmental, physiological.

Differentials: schizophrenia, schizoaffective disorder, drug intoxication, brief drug-induced psychosis, schizophreniform disorder and borderline personality disorder.




  • Requires accurate diagnosis, and good treatment. 1/3 = attempt suicide or complete it.
  • 4% of the popn suffer bipolar in their life.
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