Bipolar I disorder

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Bipolar disorder
SpecialtyPsychiatry Edit this on Wikidata
Symptomsmood instability, psychosis in some cases.
Complicationssuicide
Usual onset25 years of age
CausesComplex
Differential diagnosisOther bipolar disorders, borderline personality disorder, antisocial personality disorder
TreatmentTherapy, mood stabilizing medication such as lithium
MedicationLithium, anticonvulsants, antipsychotics
Deaths6% die by suicide

Bipolar I disorder (BD-I; pronounced "type one bipolar disorder") is a type of

manic episode, with or without mixed or psychotic features.[1] Most people also, at other times, have one or more depressive episodes.[2] Typically, these manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention. Also, the depressive episodes will be approximately 2 weeks long.[3]

It is a type of bipolar disorder and conforms to the classic concept of manic-depressive illness, which can include psychosis during mood episodes.[4]

Diagnosis

The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes.

alcohol use disorder, learning disability, or manic polarity in the first episode.[8]

Bipolar I disorder often coexists with other disorders including

psychotic disorder not otherwise specified.[12]

Medical assessment

Regular medical assessments are performed to rule-out secondary causes of mania and depression.

synthetic cannabinoids
, and exposure to toxins.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR)

Dx Code # Disorder Description
296.0x Bipolar I disorder Single manic episode
296.40 Bipolar I disorder Most recent episode hypomanic
296.4x Bipolar I disorder Most recent episode manic
296.5x Bipolar I disorder Most recent episode depressed
296.6x Bipolar I disorder Most recent episode mixed
296.7 Bipolar I disorder Most recent episode unspecified

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)

In May 2013,

suicide risk severity, with seasonal pattern, and with postpartum onset.[14] Bipolar I Disorder 296.5x (most recent episode depressed) will include all of the above specifiers plus the following: with melancholic features and with atypical features.[14] The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major depression of which one of the symptoms is depressed mood or anhedonia.[14] For Bipolar I Disorder 296.7 (most recent episode unspecified), the listed specifiers will be removed.[14]

The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include "and present most of the day, nearly every day", and criterion B will include "and represent a noticeable change from usual behavior". These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined.[15][16]

There have also been proposed revisions to criterion B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Criterion B lists "inflated self-esteem, flight of ideas, distractibility, and decreased need for sleep" as symptoms of a Hypomanic Episode. This has been confusing in the field of child psychiatry because these symptoms closely overlap with symptoms of attention deficit hyperactivity disorder (ADHD).[15]

ICD-10

  • F31 Bipolar Affective Disorder
  • F31.6 Bipolar Affective Disorder, Current Episode Mixed
  • F30 Manic Episode
  • F30.0 Hypomania
  • F30.1 Mania Without Psychotic Symptoms
  • F30.2 Mania With Psychotic Symptoms
  • F32 Depressive Episode
  • F32.0 Mild Depressive Episode
  • F32.1 Moderate Depressive Episode
  • F32.2 Severe Depressive Episode Without Psychotic Symptoms
  • F32.3 Severe Depressive Episode With Psychotic Symptoms

Treatment

Medication

Mood stabilizers are often used as part of the treatment process.[17]

  1. therapeutic range and typically requires monitoring[18]
  2. Anticonvulsants, such as valproate,[19] carbamazepine, or lamotrigine
  3. Atypical antipsychotics, such as quetiapine,[20][21] risperidone, olanzapine, or aripiprazole
  4. electrically induced in anesthetized patients for therapeutic effect

Antidepressant-induced mania occurs in 20–40% of people with bipolar disorder. Mood stabilizers, especially lithium, may protect against this effect, but some research contradicts this.[22]

A frequent problem in these individuals is non-adherence to pharmacological treatment; long-acting injectable antipsychotics may contribute to solving this issue in some patients.[23]

A review of validated treatment guidelines for bipolar disorder by international bodies was published in 2020.[24]

Prognosis

Bipolar I usually has a poor prognosis, which is associated with substance abuse, psychotic features, depressive symptoms, and inter-episode depression.[25] A manic episode can be so severe that it requires hospitalization. An estimated 63% of all BP-I related mania results in hospitalization.[26] The natural course of BP-I, if left untreated, leads to episodes becoming more frequent or severe over time.[27] But with proper treatment, individuals with BP-I can lead a healthy lifestyle.[28]

Education

Psychosocial interventions can be used for managing acute depressive episodes and for maintenance treatment to aid in relapse prevention.[29] This includes psychoeducation, cognitive behavioural therapy (CBT), family-focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT), and peer support.[29]

Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance of

compliance with medication as prescribed. Behavior modification through counseling can have positive influence to help reduce the effects of risky behavior during the manic phase. Additionally, the lifetime prevalence for bipolar I disorder is estimated to be 1%.[30]

See also

References

  1. ^ "The Two Types of Bipolar Disorder". Psych Central.com. Archived from the original on 6 August 2013. Retrieved 25 November 2015.
  2. ^ "Bipolar Disorder: Who's at Risk?". Retrieved 22 November 2011.
  3. ^ "Bipolar Disorder - National Institute of Mental Health (NIMH)". www.nimh.nih.gov. Retrieved 16 March 2024.
  4. ^ "What are the types of bipolar disorder?". Retrieved 22 November 2011.
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  6. ^ a b "Online Bipolar Tests: How Much Can You Trust Them?". DepressionD. Retrieved 7 January 2012.
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    OCLC 847226928.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link
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  9. ^
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  12. ^ "Bipolar Disorder Residential Treatment Center Los Angeles". PCH Treatment. Retrieved 25 November 2015.
  13. ^
    PMID 28888714
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  14. ^
    ISBN 978-0-89042-555-8
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  15. ^ a b Issues pertinent to a developmental approach to bipolar disorder in DSM-5. American Psychiatric Association. 2010.
  16. ^ Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision). Washington, DC: American Psychiatric Association. 2000. pp. 345–392.
  17. ^ Schwartz, Jeremy (20 July 2017). "Can People Recover From Bipolar Disorder?". U.S. News & World Report.
  18. PMC 7005360
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  19. PMID 12535506
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  20. PMID 26973704
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  21. S2CID 2224996
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  22. PMID 14636364
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  23. S2CID 219923839
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  24. S2CID 229693238
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  25. PMID 32644424
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  26. S2CID 41439636
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  27. ^ "Bipolar Disorder – Fact Sheet".
  28. ^ "Living Well with Bipolar Disorder". 7 May 2019.
  29. ^
    PMID 29536616
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  30. PMID 17485606
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