Bipolar I Disorder: A Comprehensive Guide

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 TypeDurationKey Features
Manic≥1 weekEuphoria/irritability, psychosis risk
Depressive≥2 weeksSimilar to MDD but often more severe
MixedVariableSimultaneous manic + depressive symptoms (high suicide risk)

High-Risk Signs:
• Psychotic symptoms during mania
• Suicidal ideation during mixed/depressive episodes


3. Causes & Risk Factors

CategoryContributors
Genetic80% heritability (stronger than MDD)
NeurobiologicalDopamine dysregulation, circadian rhythm disruptions
EnvironmentalChildhood 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

MedicationNotes
LithiumGold standard (requires blood monitoring)
ValproateFaster onset than lithium
Atypical AntipsychoticsOlanzapine, 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

GroupClinical Pearls
ChildrenOften misdiagnosed as ADHD
ElderlyHigher lithium toxicity risk
Peripartum50% relapse risk postpartum