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Bipolar I Disorder

It is a disorder in which at least one manic or mixed episode clearly is or has been present.

  1. DSM-IV Criteria
  2. One or more Manic or Mixed episodes.
  3. Commonly accompanied by a history of one or more major depressive episodes, but not required for the diagnosis.
  4. Mixed episodes cannot be due to a medical condition, medication, drugs of abuse, toxins or treatment for depression.
  5. Symptoms cannot be accounted for by a psychotic disorder.
  1. Clinical Features
    1. Greater than 90% of patients who have a mania single episode will have a recurrence.
    2. Mixed episodes are more likely in younger patients.
    3. Episodes occur more frequently with age.
    4. Social and occupational consequences of episodes can be severe (e.g.; violence, child abuse, excessive debt, job loss, divorce).
    5. Manic episodes are more likely to receive clinical attention compared to Depressive episodes.
    6. The suicide rate of bipolar patients is 10-15%
    7. Common co-morbid diagnoses include disorder, mania, manic disorder substance- related disorders, eating disorders, attention deficit hyperactivity disorder bipolar
    8. Rapid cycling pattern carries a poor prognosis and may effect up to 20% of bipolar patients.
  1. Epidemiology
    1. The lifetime prevalence is approximately 0.5-1.5%
    2. Male: female ratio-- 1:1
    3. The first episode in males tends to be a manic episode, while the first episode in Manic females tends to be a depressive episode.
    4. First degree relatives have higher rates of mood disorder.
    5. disorder has a 70% concordance rate among monozygotic twins.
  1. Classification
    1. Classification of involves describing the current or most recent mood episode - Manic, Hypomanic, Mixed or Depressive. (e.g. Most recent episode Mixed)
    2. The most recent episode can be further classified as follows:
      1. Without psychotic features
      2. With psychotic features
      3. With catatonic features
      4. With postpartum onset
    4. Rapid Cycling
      1. Diagnosis requires the presence of at least 4 mood episodes within 1 year.
      2. Rapid cycling mood episodes may include
      3. The patient must be symptom-free for at least 2 months between episodes or the patient must switch to an opposite episode.
  1. Differential Diagnosis
    1. Cyclothymic Disorder: Mood episodes never meet criteria for full manic episode or full major depressive episode.
    2. Psychotic Disorders
      1. The clinical presentation of a patient at the height of a manic episode may be indistinguishable from an acute exacerbation of paranoid schizophrenia, making accurate diagnosis difficult unless clear history is available.
      2. If history is unavailable or the patient is having an initial episode, it may be necessary to observe the patient over time to make an
      3. Family history of mood disorder or psychotic disorder may be suggestive of diagnosis.
    4. Substance-Induced Mood Disorder: Rule out the effects of medication or drugs of abuse. Common organic causes of mania include sympathomimetics, amphetamines, steroids and H2 blockers such as
    5. Mood Disorder Due to a General Medical Condition (see page 124).
  1. Treatment
    1. Assessment of suicidality is essential, ask about suicidal ideation as well as intent.
    2. Hospitalization may be necessary for either Manic or Depressive mood episodes.
    3. Pharmacotherapy
      1. Mood stabilizers such as lithium and the anticonvulsants have proven effective in the acute treatment as well as the prophylaxis of mood episodes, bipolar 1.