Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • major depressive episode(s)
  • episode(s) of manic or mixed episodes
  • episode(s) of hypomania
  • inflated self-esteem or grandiosity
  • decreased need for sleep
  • more talkative than usual, or feels pressure to keep talking
  • flight of ideas, or subjective experience that thoughts are racing
  • distractibility
  • increase in goal-directed activity or psychomotor agitation
  • excessive involvement in pleasurable activities that have a high potential for adverse consequences
  • functional impairment
  • no substance abuse
  • no underlying medical cause
  • not due to somatic antidepressant treatment or other prescribed medication

Risk factors

  • FHx of bipolar disorder
  • onset of mood disorder prior to 20 years of age
  • stressful life events
  • previous hx of depression
  • lifetime hx of a substance abuse disorder
  • presence of an anxiety disorder
  • obesity
  • cardiovascular disease

Diagnostic investigations

1st investigations to order

  • Primary Care Evaluation of Mental Disorders (PRIME-MD)
  • Patient Health Questionnaire (PHQ-9)
  • Mood Disorder Questionnaire (MDQ)
  • Composite International Diagnostic Interview (CIDI)
  • Bipolarity Index
  • Young Mania Rating Scale (YMRS)
  • FBC
  • TFTs
  • serum vitamin D
  • toxicology screen
Full details

Investigations to consider

  • fasting lipid profile
  • fasting glucose
  • MRI brain
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Vice-Chair for Clinical Affairs

Associate Professor of Psychiatry

University of Texas Health Science Center

Houston

TX

Disclosures

PG has served on the speakers' bureau for Merck and Sunovion.

Dr Prashant Gajwani would like to gratefully acknowledge Dr David J. Muzina, a previous contributor to this monograph. DJM is an author of a number of references cited in this monograph. DJM has previously received honoraria for research support from Repligen Co. He has also previously received honoraria as a speaker and/or advisor from AstraZeneca, Pfizer, BMS, Wyeth, Sepracor, and GSK. DJM is a full-time employee of Medco.

Peer reviewers VIEW ALL

Head

Mood Disorders Psychopharmacology Unit

University Health Network

Associate Professor of Psychiatry and Pharmacology

University of Toronto

Ontario

Canada

Disclosures

RM has received research funds from Stanley Medical Research Institute and National Alliance for Research on Schizophrenia and Depression (NARSAD). RM is on the advisory boards for AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline Janssen-Ortho, Solvay/Wyeth, Eli Lilly, Organon, Lundbeck, Biovail, Pfizer, Shire, and Schering-Plough. RM is on the speakers' bureau for Janssen-Ortho, AstraZeneca, Eli Lilly, Lundbeck, Biovail, and Wyeth. RM has received research grants from Eli Lilly, Janssen-Ortho, and Shire.

Professor of Psychological Medicine

University of Newcastle

Honorary Professor

Psychological Treatments Research

Institute of Psychiatry

London

University Department of Psychiatry

Royal Victoria Infirmary

Newcastle upon Tyne

UK

Disclosures

JS has received remuneration for attending advisory boards for AstraZeneca, BSM-Otsuka, Eli Lilly, GSK, and Sanofi-Aventis.

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