Bipolar I disorder

Bipolar I disorder is characterized by severe, recurrent mood changes and behavioral changes. A manic episode is a key feature of bipolar I disorder and is required for diagnosis of bipolar I disorder. Hypomanic episodes, major depressive episodes, and psychotic features may also be present but are not necessary for diagnosis. Hypomanic episodes Similar to mania, hypomanic episodes involve distinct periods of time where an individual experiences persistent, increased energy, euphoria, elation, or irritable mood that is disproportionately out of norm. Symptoms of psychosis include delusions, hallucinations, or both. Delusions are more common than hallucinations in bipolar disorder. Psychotic symptoms occur more frequently during manic or mixed episodes. Having psychotic episodes indicates a more severe illness. People with psychosis have poor insight and more agitation, anxiety, and hostility. Psychotic symptoms are more common in bipolar type I compared to bipolar type II. == Risk Factors ==

Currently, there are no single, clear causes of bipolar disorder. However, there are evidence that suggest there may be a genetic component that contribute to the development of bipolar disorder. Studies from identical twins suggest that there is a 5-10% lifetime risk (about seven times greater compared to the general population) of developing bipolar disorder if there is a first-degree relative diagnosed with bipolar disorder. Bipolar disorder appears to be more common in high-income countries compared to low-income countries, and higher rates of bipolar I disorder are seen in individuals that are separated, divorced, or widowed compared to those who are married or never married. ==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. One episode of mania is sufficient to make the diagnosis of bipolar disorder. Often, individuals have had one or more major depressive episodes and may or may not have a history of major depressive disorder. Because depression is typically one of the first symptoms of bipolar disorders, the initial diagnosis of bipolar disorder may be delayed. In contrast, diagnosis for bipolar II disorder does not include a full manic episode; instead, it requires the occurrence of both a hypomanic episode and a major depressive episode. Bipolar I disorder often coexists with other disorders including PTSD, substance use disorders, and a variety of mood disorders. Studies suggest that psychiatric comorbidities correlate with further impairment of day-to-day life. Up to 40% of people with bipolar disorder also present with PTSD, with higher rates occurring in women and individuals with bipolar I disorder. Medical assessment Regular medical assessments are performed to rule-out secondary causes of mania and depression. Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins. Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) In May 2013, American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are several proposed revisions to occur in the diagnostic criteria of Bipolar I Disorder and its subtypes. For Bipolar I Disorder 296.40 (most recent episode hypomanic) and 296.4x (most recent episode manic), the proposed revision includes the following specifiers: with psychotic features, with mixed features, with catatonic features, with rapid cycling, with anxiety (mild to severe), with suicide risk severity, with seasonal pattern, and with postpartum onset. 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. 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). 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 Differential diagnosis When evaluating an individual for bipolar I disorder, other psychiatric conditions that mimic or present with similar symptoms to bipolar I disorder must be considered. It is possible that some of these may be co-occurring with bipolar I disorder. • Other bipolar disorders, such as bipolar II or bipolar disorder due to another medical condition • Major depressive disorder with hypomanic or manic symptoms • Anxiety disorders including Generalized Anxiety Disorder (GAD), panic disorder, post-traumatic stress disorder (PTSD) • Attention-deficit/hyperactivity disorder (ADHD) • Substance or medication-induced bipolar disorder • Personality disorders such as borderline personality disorder == Management ==

Medication Pharmacotherapy is the primary method of managing bipolar disorder, with multiple medications and combinations available. Medications used may vary depending on the side effect profile and patient preference as well as the phase of bipolar disorder being managed (acute mania, bipolar depression, mixed states, or maintenance relapse prevention). It has suicide-protective effects, with an 87% reduction in suicide risk compared to placebos in mood disorders. • Anticonvulsants, such as valproate, carbamazepine, or lamotrigine • Atypical antipsychotics, such as quetiapine, risperidone, olanzapine, lurasidone, or aripiprazole • Combination therapies such as lithium or valproate with antipsychotics Usage of antidepressants alone in the treatment of bipolar disorders is not recommended. However, antidepressants may be used to supplement mood stabilizers or second-generation antipsychotics (adjuvant therapy). There has been concerns that usage of antidepressants may cause individuals to switch to mania (sometimes referred to as antidepressant-induced mania). They act quickly to block NMDA receptors and treat depression, with effects lasting up to a week. However, it is unknown exactly why it works. In severe cases, Electroconvulsive therapy (ECT), a type of brain stimulation therapy where seizures are electrically induced in anesthetized patients for therapeutic effect may be used for bipolar depression Patients with bipolar disorder may benefit from supplemental psychotherapy (such as cognitive behavioral therapy) in reducing recurrences and stabilizing depressive phases. Interventions that target sleep regulation and mood monitoring, as well as efforts to reduce stigma, are beneficial in improving their quality of life. ==Prognosis==

Bipolar I usually has a poor prognosis, which is associated with substance abuse, psychotic features, depressive symptoms, and inter-episode depression. A manic episode can be so severe that it requires hospitalization. An estimated 63% of all BP-I related mania results in hospitalization. The natural course of BP-I, if left untreated, leads to episodes becoming more frequent or severe over time. The absolute risk of suicide is highest for BP-I than all other mood and mental disorders. Approximately 15-20% of people with bipolar disorder die by suicide, with 30-60% making at least one attempt. The attempts use more lethal means than those among the general population. Individuals with BP-I typically have a shorter life expectancy compared to the general population, with estimates suggesting a reduction of 11 to 20 years. With proper treatment, individuals with BP-I can, however, lead a healthy lifestyle. Education Psychosocial interventions can be used for managing acute depressive episodes and for maintenance treatment to aid in relapse prevention. 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%, while bipolar spectrum disorder has been estimated to affect as much as 6% of people. == See also ==