A severe mood disorder characterized by manic episodes that may alternate with depressive episodes
1. Definition & Diagnostic Criteria (DSM-5)
Bipolar I requires:
✅ At least one manic episode (lasting ≥1 week or requiring hospitalization)
✅ May include depressive/hypomanic episodes (but not required for diagnosis)
Manic Episode Features:
- Abnormally elevated/irritable mood
- ≥3 of these symptoms:
• Grandiosity
• Decreased need for sleep
• Pressured speech
• Racing thoughts
• Distractibility
• Increased goal-directed activity
• Risky behaviors (spending sprees, reckless driving)
Key Distinction from Bipolar II:
- Bipolar I has full mania (not just hypomania)
- Psychotic features are common during mania
2. Clinical Presentations
| Episode Type | Duration | Key Features |
|---|---|---|
| Manic | ≥1 week | Euphoria/irritability, psychosis risk |
| Depressive | ≥2 weeks | Similar to MDD but often more severe |
| Mixed | Variable | Simultaneous manic + depressive symptoms (high suicide risk) |
High-Risk Signs:
• Psychotic symptoms during mania
• Suicidal ideation during mixed/depressive episodes
3. Causes & Risk Factors
| Category | Contributors |
|---|---|
| Genetic | 80% heritability (stronger than MDD) |
| Neurobiological | Dopamine dysregulation, circadian rhythm disruptions |
| Environmental | Childhood trauma, substance use, sleep deprivation |
Myth Buster:
❌ “Mania is fun/productive” → Often leads to hospitalization, financial ruin, or legal trouble
4. Diagnosis Process
Differential Diagnosis:
• Schizophrenia (if psychotic symptoms persist beyond mood episodes)
• ADHD (shared hyperactivity but episodic in bipolar)
• Substance-induced mania
Assessment Tools:
• Mood Disorder Questionnaire (MDQ)
• Young Mania Rating Scale
5. Treatment Approach
A. Acute Mania Management
| Medication | Notes |
|---|---|
| Lithium | Gold standard (requires blood monitoring) |
| Valproate | Faster onset than lithium |
| Atypical Antipsychotics | Olanzapine, Risperidone (for psychosis) |
B. Maintenance Therapy
• Mood stabilizers + psychotherapy (CBT, IPSRT)
• Avoid antidepressants alone (risk of manic switch)
C. Hospitalization Criteria
• Psychotic features
• Risk of harm to self/others
• Severe functional impairment
6. Prognosis & Course
• High relapse rate (90% without treatment)
• Average 8-10 episodes across lifespan
• Good outcomes with:
- Early intervention
- Medication adherence
- Regular sleep schedule
7. Special Populations
| Group | Clinical Pearls |
|---|---|
| Children | Often misdiagnosed as ADHD |
| Elderly | Higher lithium toxicity risk |
| Peripartum | 50% relapse risk postpartum |