Bipolar Disorder

Basics

Description

  • Mood disorder characterized by recurrent episodes of mania, hypomania, or depression
  • Characterized by episodes of altered mood, but psychotic features present even when mood is normal
  • Bipolar I Disorder: At least 1 manic episode, with or without depressive or hypomanic episodes.
  • Bipolar II Disorder: At least 1 hypomanic and 1 major depressive episode, without manic episodes
  • Mixed episode:
    • Simultaneous symptoms of mania and depression
    • Defined as one or more manic episodes
  • Cyclothymia is a syndrome of less severe episodes of hypomania and depression over years
  • Atypical and residual forms: manifestations that do not fit standard diagnostic criteria
  • Bipolar disorder affects over 1% of the global population
  • Lifetime prevalence: 0.6% bipolar I, 0.4% bipolar II.
  • Typically begins in the teens or 20s
  • Earlier-onset linked to greater comorbidities, depressive onset
  • Diagnosis often delayed by 5 yr from symptom onset

Etiology

  • Genetically complex with multifactorial genesis
  • Heritability estimated up to 85%
  • May be secondary to medical disorder (eg, drug toxicity, endocrine, neurologic process)
  • Medications can trigger or reveal bipolar-like symptoms:
    • Classically mania after initiation of an antidepressant

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