What are the facts of bipolar disorder?
- Bipolar disorder is a mood disorder, in which the patient experiences repeated episodes of mania, depression, or hypomania (a less severe form of mania), and may experience mixed episodes (concurrent symptoms of mania and depression).
- There are two major forms of bipolar disorder:
- bipolar I: the more serious form, with a lifetime prevalence of 0.4% to 1.6%; people experience one or more manic or mixed episodes, usually accompanied by major depressive episodes
- bipolar II: a less severe form, with a lifetime prevalence of approximately 0.5%; people experience one or more episodes of depression and at least one episode of hypomania
- People with bipolar disorder have a high rate of suicide.
- People with bipolar disorder often have comorbid psychiatric disorders, including alcohol or drug abuse.
- People with bipolar disorder may experience psychotic symptoms; psychotic symptoms may occur during manic or depressive states, but are more common during the manic state. Patients with psychotic symptoms are less likely to experience complete recovery between episodes, have worse functioning, and are more likely to be noncompliant with treatment.
- Bipolar disorder is a lifelong disorder that tends to recur; periods of relatively normal functioning may occur between mood episodes. The interval between episodes tends to decrease with age (i.e., episodes become more frequent).
- Rapid cycling, the occurrence of four or more episodes within a year, is associated with a poorer long-term prognosis.
- Long-term consequences of bipolar disorder include strained relationships, serious financial losses, and deterioration in occupational status.
- Bipolar disorder may involve a genetically transmitted vulnerability.
- Interactions between neurotransmitter systems, particularly those involving norepinephrine, dopamine, and serotonin, are believed to play a role in the etiology of bipolar disorder.
- Other theories regarding the etiology of bipolar disorder include kindling, electrolyte and neuronal membrane abnormalities, changes in neuroendocrine control, disruption of circadian rhythms, and seasonal changes.
- States of mania and depression may be viewed as a spectrum or a continuous range; both extremes may include psychosis.
- Manic states are typically characterized by heightened mood, excessive and rapid speech, quick thought, brisk physical and mental activity levels, increased energy, decreased need for sleep, irritability, perceptual acuity, paranoia, heightened sexuality, and impulsivity.
- Depressive states are usually characterized by a slowing or decrease in the following: rate of thought and speech, energy, sexuality, and ability to experience pleasure.
- Bipolar disorder is diagnosed based on the array of symptoms and course of the condition.
- Diagnosing bipolar disorder requires ruling out medical conditions, medications, and other psychiatric disorders that may cause symptoms of mania, depression, or psychosis.
- The DSM-IV-TR uses four major episodes as a basis for diagnosing mood disorders: manic, hypomanic, depressive, and mixed.
- Bipolar I is defined as one or more manic or mixed episodes, with patients often experiencing one or more major depressive episodes. People may be diagnosed as having bipolar I disorder after experiencing one manic episode, even they have not yet experienced a major depressive episode.
- Bipolar II is defined as at least one major depressive episode accompanied by at least one hypomanic episode.
- Clinicians may also use specifiers, such as “with psychotic features” and “with rapid cycling,” to make a more detailed diagnosis in terms of the severity or course of the disorder.
- The symptoms of bipolar disorder must be managed because affected individuals are at relatively high risk for suicide; in addition, untreated bipolar disorder tends to worsen with time and is associated with a shorter life expectancy (compared with treated cases).
- Therapy for bipolar disorder may be acute (i.e., treating the current episode) or long-term (i.e., to prevent future episodes) and involves medications, education, and psychotherapy.
- There are several challenges in treating bipolar disorder, including misdiagnosis, its irregular and unpredictable clinical course, the need for multiple medications, drug-induced side effects, and patient nonadherence.
- Nonadherence with therapy is one of the major causes of relapse in people with bipolar disorder. Factors that contribute to nonadherence relate to the person’s response (fear of social stigma), the illness (impaired cognitive ability or comorbid substance abuse), and medications (side effects and inconvenience of use). Some patients are not aware of their illness. Also, patients in the manic phase may feel more creative and productive, and are therefore reluctant to take medication.
- Pharmacologic therapy for bipolar disorder includes medications used as mood stabilizers (e.g., lithium, certain anticonvulsants), medications used to treat psychotic symptoms (antipsychotics), and medications used to treat other specific symptoms, such as anxiety and insomnia (benzodiazepines and sedative hypnotics).
- Although lithium is considered the mainstay of pharmacologic therapy for bipolar disorder, it is not effective for all subtypes and side effects may limit its use.
- Anticonvulsants, such as valproate, may offer improved effectiveness and tolerability relative to lithium. However, they have many disadvantages, including sedation, GI side effects, and the need for periodic monitoring.
- Antipsychotics have been successfully used as adjuncts to lithium and anticonvulsants. However, typical antipsychotics are associated with limiting CNS effects, including EPS and tardive dyskinesia. Bipolar patients may be at increased risk for tardive dyskinesia.
- Atypical antipsychotics offer a lower incidence of EPS and tardive dyskinesia. In addition, some agents have mood-stabilizing properties.
- Patient education, psychotherapy, and good patient follow-up are important in increasing adherence with drug therapy and optimizing clinical outcome.
- Many people with bipolar I disorder require hospitalization at some point during the course of illness for a number of reasons (e.g., to ensure safety, provide around-the-clock care and support, prevent access to drugs, or allow observation of the patient’s reaction to medications).
Bipolar Disorder Definition |
Bipolar Disorder Epidemiology |
Bipolar Disorder Facts |
General Longitudinal Features |
Long-Term Consequences |
Bipolar Disorder Among Children |
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