Bipolar Disorder



  • Mania:
    • Presentation is diverse and may be difficult to recognize as mania:
      • Simple irritability
      • Cheerfulness
      • Psychosis
      • Delirium
      • Agitation
    • Full extent of pathology often revealed only by outside informants
    • Onset gradual or acute, duration several weeks or months; rarely may be chronic
  • Hypomania:
    • Milder symptoms without marked impairment
  • Mixed mood:
    • Simultaneous symptoms of mania and depression
    • Treat in ED as for mania
  • Bipolar disorder:
    • Formerly manic depressive disorder
    • Defined as one or more episodes of hypomanic, manic, or mixed mood
    • Possibly with episodes of depressed mood
    • Bipolar II is used to denote cases where hypomania has occurred in the course of the disorder but never mania
    • Typically begins in the teens or 20s
    • Episodes of abnormal mood may be mild or severe, brief or prolonged, infrequent or chronic, chiefly elevated or chiefly depressed in character
    • Bipolar disorder may be readily responsive to treatment or nearly intractable
  • Schizoaffective disorder:
    • Characterized by episodes of altered mood, but psychotic features present even when mood is normal


  • Typically, a primary psychiatric disorder, with genetic association
  • May be secondary to medical disorder (e.g., drug toxicity, endocrine, neurologic process)
  • Particularly likely to be secondary if:
    • First episode
    • Patient >40 yr
    • Atypical or mixed presentation
    • Abnormal sensorium

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