Bipolar disorder in adults

Bipolar disorder is a recurrent and often chronic mental illness marked by episodes of hypomania or mania and depression, associated with a change or impairment in functioning. It is associated with a reduction in life expectancy of around 10-20 years (primarily attributable to cardiovascular disease and suicide).

The long-term course of illness is characterised by a predominance of depression, although a history of at least one manic, hypomanic, or mixed episode is required to make the diagnosis of bipolar disorder.

Diagnosis is based on a comprehensive clinical assessment, encompassing the mental status examination at the time of the evaluation and the longitudinal history from the patient and family, using diagnostic criteria for bipolar disorder.

Misdiagnosis and delayed diagnosis of bipolar disorder are common, with depressive disorders, including unipolar major depressive disorder, accounting for the most frequent diagnostic errors.

The management of acute mania, as well as maintenance treatment, requires mood stabilisers or antipsychotics, as monotherapy or in combination. There are fewer approved treatment options for acute bipolar depression; traditional antidepressants alone are not indicated.

Bipolar disorder requires an individualised long-term management plan that includes maintenance medication(s), adjunctive psychosocial therapies, careful monitoring for any treatment-emergent complications, and promotion of a healthy lifestyle including sleep hygiene, exercise, and stress management.

Bipolar disorder, previously termed manic depression, is an episodic mood disorder characterised by manic, or hypomanic, and depressive episodes. Two subtypes are recognised: bipolar I disorder and bipolar II disorder.

Bipolar I disorder is characterised by manic episodes, which are distinct periods of abnormally and persistently elevated, expansive, or irritable mood, with abnormally and persistently increased energy or activity, lasting for at least 1 week. Although the lifetime occurrence of a major depressive episode is not a requirement for diagnosis, most people with bipolar I disorder experience a major depressive episode at some point during their lives.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr

Bipolar II disorder is characterised by a current or past hypomanic episode and a current or past major depressive episode. Hypomanic episodes present with similar symptoms as mania but cause less impairment and are of shorter duration, lasting for at least 4 consecutive days.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022. https://ebooks.appi.org/product/diagnostic-statistical-manual-mental-disorders-fifth-edition-text-revision-dsm5tr