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Bipolar disorder

"Bipolar disorders" and "Manic depression" redirect here. For the medical journal, see Bipolar Disorders (journal). For the song, see Manic Depression (song).

Bipolar disorder
Other namesBipolar affective disorder (BPAD),[1] bipolar illness, manic depression, manic depressive disorder, manic–depressive illness (historical),[2] manic–depressive psychosis, circular insanity (historical),[2] bipolar disease[3]
Bipolar disorder is characterized by episodes of depression and hypomania or mania.
SpecialtyPsychiatry
SymptomsPeriods of depression and elevated mood[4][5]
ComplicationsSuicide, self-harm[4]
Usual onset25 years old[4]
TypesBipolar I disorder, bipolar II disorder, others[5]
CausesEnvironmental and genetic[4]
Risk factorsFamily history, childhood abuse, long-term stress[4]
Differential diagnosisAttention deficit hyperactivity disorder, personality disorders, schizophrenia, substance use disorder[4]
TreatmentPsychotherapy, medications[4]
MedicationLithium, antipsychotics, anticonvulsants[4]
Frequency1–3%[4][6]

Bipolar disorder, previously known as manic depression, is a mental disorder characterized by periods of depression and periods of abnormally elevated mood that each last from days to weeks.[4][5] If the elevated mood is severe or associated with psychosis, it is called mania; if it is less severe and does not significantly affect functioning, it is called hypomania.[4] During mania, an individual behaves or feels abnormally energetic, happy or irritable,[4] and they often make impulsive decisions with little regard for the consequences.[5] There is usually also a reduced need for sleep during manic phases.[5] During periods of depression, the individual may experience crying and have a negative outlook on life and poor eye contact with others.[4] The risk of suicide is high; over a period of 20 years, 6% of those with bipolar disorder died by suicide, while 30–40% engaged in self-harm.[4] Other mental health issues, such as anxiety disorders and substance use disorders, are commonly associated with bipolar disorder.[4]

While the causes of this mood disorder are not clearly understood, both genetic and environmental factors are thought to play a role.[4] Many genes, each with small effects, may contribute to the development of the disorder.[4][7] Genetic factors account for about 70–90% of the risk of developing bipolar disorder.[8][9] Environmental risk factors include a history of childhood abuse and long-term stress.[4] The condition is classified as bipolar I disorder if there has been at least one manic episode, with or without depressive episodes, and as bipolar II disorder if there has been at least one hypomanic episode (but no full manic episodes) and one major depressive episode.[5] It is classified as cyclothymia if there are hypomanic episodes with periods of depression that do not meet the criteria for major depressive episodes.[10] If these symptoms are due to drugs or medical problems, they are not diagnosed as bipolar disorder.[5] Other conditions that have overlapping symptoms with bipolar disorder include attention deficit hyperactivity disorder, personality disorders, schizophrenia, and substance use disorder as well as many other medical conditions.[4] Medical testing is not required for a diagnosis, though blood tests or medical imaging can rule out other problems.[11]

Mood stabilizers—lithium and certain anticonvulsants such as valproate and carbamazepine as well as atypical antipsychotics such as aripiprazole—are the mainstay of long-term pharmacologic relapse prevention.[12] Antipsychotics are additionally given during acute manic episodes as well as in cases where mood stabilizers are poorly tolerated or ineffective. In patients where compliance is of concern, long-acting injectable formulations are available.[12] There is some evidence that psychotherapy improves the course of this disorder.[13] The use of antidepressants in depressive episodes is controversial: they can be effective but have been implicated in triggering manic episodes.[14] The treatment of depressive episodes, therefore, is often difficult.[12] Electroconvulsive therapy (ECT) is effective in acute manic and depressive episodes, especially with psychosis or catatonia.[a][12] Admission to a psychiatric hospital may be required if a person is a risk to themselves or others; involuntary treatment is sometimes necessary if the affected person refuses treatment.[4]

Bipolar disorder occurs in approximately 2% of the global population.[16] In the United States, about 3% are estimated to be affected at some point in their life; rates appear to be similar in females and males.[6][17] Symptoms most commonly begin between the ages of 20 and 25 years old; an earlier onset in life is associated with a worse prognosis.[18] Interest in functioning in the assessment of patients with bipolar disorder is growing, with an emphasis on specific domains such as work, education, social life, family, and cognition.[19] Around one-quarter to one-third of people with bipolar disorder have financial, social or work-related problems due to the illness.[4] Bipolar disorder is among the top 20 causes of disability worldwide and leads to substantial costs for society.[20] Due to lifestyle choices and the side effects of medications, the risk of death from natural causes such as coronary heart disease in people with bipolar disorder is twice that of the general population.[4]

  1. ^ Gautam S, Jain A, Gautam M, Gautam A, Jagawat T (January 2019). "Clinical Practice Guidelines for Bipolar Affective Disorder (BPAD) in Children and Adolescents". Indian Journal of Psychiatry. 61 (Suppl 2): 294–305. doi:10.4103/psychiatry.IndianJPsychiatry_570_18. PMC 6345130. PMID 30745704.
  2. ^ a b Cite error: The named reference Shorter2005 was invoked but never defined (see the help page).
  3. ^ Coyle N, Paice JA (2015). Oxford Textbook of Palliative Nursing. Oxford University Press, Incorporated. p. 623. ISBN 978-0-19-933234-2.
  4. ^ a b c d e f g h i j k l m n o p q r s t u v Anderson IM, Haddad PM, Scott J (December 27, 2012). "Bipolar disorder". BMJ (Clinical Research Ed.). 345: e8508. doi:10.1136/bmj.e8508. PMID 23271744. S2CID 22156246.
  5. ^ a b c d e f g American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 123–154. ISBN 978-0-89042-555-8.
  6. ^ a b Schmitt A, Malchow B, Hasan A, Falkai P (February 2014). "The impact of environmental factors in severe psychiatric disorders". Frontiers in Neuroscience. 8 (19): 19. doi:10.3389/fnins.2014.00019. PMC 3920481. PMID 24574956.
  7. ^ Goodwin GM (2012). "Bipolar disorder". Medicine. 40 (11): 596–598. doi:10.1016/j.mpmed.2012.08.011.
  8. ^ Charney A, Sklar P (2018). "Genetics of Schizophrenia and Bipolar Disorder". In Charney D, Nestler E, Sklar P, Buxbaum J (eds.). Charney & Nestler's Neurobiology of Mental Illness (5th ed.). New York: Oxford University Press. p. 162. ISBN 978-0-19-068142-5.
  9. ^ Cite error: The named reference Bobo2017 was invoked but never defined (see the help page).
  10. ^ Cite error: The named reference Van Meter 2012 was invoked but never defined (see the help page).
  11. ^ NIMH (April 2016). "Bipolar Disorder". National Institutes of Health. Archived from the original on July 27, 2016. Retrieved August 13, 2016.
  12. ^ a b c d Grande I, Berk M, Birmaher B, Vieta E (April 2016). "Bipolar disorder". Lancet. 387 (10027): 1561–1572. doi:10.1016/S0140-6736(15)00241-X. PMID 26388529. S2CID 205976059.
  13. ^ Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes T, Cipriani A, Coghill DR, Fazel S, Geddes JR, Grunze H, Holmes EA, Howes O, Hudson S, Hunt N, Jones I, Macmillan IC, McAllister-Williams H, Miklowitz DR, Morriss R, Munafò M, Paton C, Saharkian BJ, Saunders K, Sinclair J, Taylor D, Vieta E, Young AH (June 2016). "Evidence-based guidelines for treating bipolar disorder: Revised third edition recommendations from the British Association for Psychopharmacology". Journal of Psychopharmacology. 30 (6): 495–553. doi:10.1177/0269881116636545. PMC 4922419. PMID 26979387. Currently, medication remains the key to successful practice for most patients in the long term. ... At present the preferred strategy is for continuous rather than intermittent treatment with oral medicines to prevent new mood episodes.
  14. ^ Cheniaux E, Nardi AE (October 2019). "Evaluating the efficacy and safety of antidepressants in patients with bipolar disorder". Expert Opinion on Drug Safety. 18 (10): 893–913. doi:10.1080/14740338.2019.1651291. PMID 31364895. S2CID 198997808.
  15. ^ American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.). Arlington, VA: American Psychiatric Publishing. pp. 119–121. ISBN 978-0-89042-555-8.
  16. ^ Nierenberg AA, Agustini B, Köhler-Forsberg O, Cusin C, Katz D, Sylvia LG, Peters A, Berk M (October 10, 2023). "Diagnosis and Treatment of Bipolar Disorder: A Review". JAMA. 330 (14): 1370–1380. doi:10.1001/jama.2023.18588. PMID 37815563. S2CID 263801832.
  17. ^ Diflorio A, Jones I (2010). "Is sex important? Gender differences in bipolar disorder". International Review of Psychiatry. 22 (5): 437–452. doi:10.3109/09540261.2010.514601. PMID 21047158. S2CID 45781872.
  18. ^ Cite error: The named reference Carvalho was invoked but never defined (see the help page).
  19. ^ Chen M, Fitzgerald HM, Madera JJ, Tohen M (May 2019). "Functional outcome assessment in bipolar disorder: A systematic literature review". Bipolar Disorders. 21 (3): 194–214. doi:10.1111/bdi.12775. PMC 6593429. PMID 30887632.
  20. ^ Ferrari AJ, Stockings E, Khoo JP, Erskine HE, Degenhardt L, Vos T, Whiteford HA (August 2016). "The prevalence and burden of bipolar disorder: findings from the Global Burden of Disease Study 2013". Bipolar Disorders (Review). 18 (5): 440–450. doi:10.1111/bdi.12423. hdl:11343/291577. PMID 27566286. S2CID 46097223.


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