Bipolar [affective] disorder (aka manic-depressive illness) is a mental disorder involving periods of mania (severely elevated mood, that may involve psychosis) or hypomania (significantly elevated mood), and periods of depression.

• Manic episodes, where there is a distinct period of at least 1 week of elevated or irritable mood, which can be euphoria, and 3+ of the following behaviors (4 if irritable), including pressured speech (speak in a rapid, uninterruptible manner), are easily distracted, have racing thoughts, display an increase in goal-oriented activities or feel agitated, or exhibit behaviors characterized as impulse or high risk e.g. hypersexuality or excessive money spending. The behaviors must impair the patient's ability to socialize or work. It includes:
  • Feels/acts abnormally happy, energetic, or irritable
  • Often make poorly thought out decisions w/ little regard to the consequences
  • The need for sleep is usually reduced
• Hypomanic episodes, a milder form of mania defined as at least 4 days of the same criteria as mania, but doesn't cause a significant decrease in the patient's ability to socialize or work, lacks psychotic features (i.e. delusions or hallucinations), and does not require psychiatric hospitalization. Overall functioning may actually increase during episodes of hypomania, and may serve as a defense mechanism against depression. It rarely progresses to manic episodes. Some patients show increased creativity, whilst others are irritable or demonstrate poor judgment. Patient's generally have increased energy and increased activity levels
• Depressive episodes, which are a phase including persistent feelings of sadness, anxiety, guilt, anger, isolation, hopelessness, disturbances in sleep and appetite, fatigue and loss in interest in usually enjoyable activities, problems concentrating, loneliness, self-loathing, apathy or indifference, depersonalization, loss of interest in sexual activity, shyness or social anxiety, irritability, chronic pain (with or without a known cause), lack of motivation, and morbid suicidal thoughts. In severe cases, the patient may become psychotic, which causes delusions, or less commonly, hallucinations, which are usually frightening or intimidating. It includes:
  • Crying
  • Poor eye contact w/ others
  • Negative outlook on life
• Mixed affective episodes, where Sx of both mania and depression occur at the same time. Patients may have manic Sx such as grandiose thoughts while at the same time experiencing depressive Sx such as excessive guilt or feeling suicidal. Mixed states are considered to be high risk for suicidal behavior since depressive emotions such as hopelessness, are often paired with mood swings or impulsivity (difficulties with impulse control)

• Many genes of small effect, contribute to risk
• Environmental factors, including:
  • Long term stress
  • Hx of childhood abuse

• Bipolar 1 disorder, if there is at least 1 manic episode
• Bipolar 2 disorder, if there are at least 1 hypomanic episode and 1 major depressive episode
• Cyclothymic disorder, in Pt's w/ less severe Sx of a prolonged duration
• Classified separately, if due to drugs or medical conditions

• Substance use disorder
• Personality disorders
• ADHD
• Schizophrenia
• Numerous medical conditions

• Psychotherapy
  • ECT, for Pt's who don't respond to other Tx
• Drugs, which if stopped should only be done slowly. This includes:
  • Mood stabilizers, including lithium and anticonvulsants. Antidepressants, can be used for periods of depression, used in conjunction w/ mood stabilizers
  • Antipsychotics, for severe behavioral problems
  • Short term benzodiazepines, for severe behavioral problems

• Anxiety disorder
• Substance use disorder

• Pt's often have social, financial or work-related problems due to the disorder, occurring for 33% of the time
• Risk of suicide is higher, at >6% over 20 years
• Self harm occurs in 35%
• Risk of death from natural causes (e.g. heart disease) is twice that of the general population, due to poor lifestyle choices, and side effects from drugs
• Often face problems w/ social stigma

• Tx in hospital against a Pt's wishes may be required at times, as they may be a risk to themselves, or others refuse Tx
• 3% of people in the USA have bipolar disorder at some point in their life. Lower rates of 1% are found in other countries
• The most common age of onset is 25yo
• Rates are similar in males and females
• Economic cost is $45bn per annum in the USA, largely due to missed work days (50 per year)