Bipolar disorder in adults

概述 
理论 
诊断 
治疗 
随访 
资源 

最后审阅： 6 Nov 2025

最后更新： 27 Sep 2024

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.

定义

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]

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]

病史和体格检查

关键诊断因素

presence of risk factors
major depressive episode(s)
episode(s) of mania
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 misuse
no underlying medical cause
not due to somatic antidepressant treatment or other prescribed medication

完整详情

危险因素

family history of bipolar disorder or schizophrenia
onset of mood disorder prior to 20 years of age
adverse life events
childhood trauma and/or adversity
previous history of depression
lifetime history of a substance use disorder
presence of an anxiety disorder
obesity
cardiovascular disease

完整详情

诊断性检查

首要检查

Primary Care Evaluation of Mental Disorders (PRIME-MD)
Patient Health Questionnaire (PHQ-9)
Rapid Mood Screener (RMS)
Mood Disorder Questionnaire (MDQ)
Bipolarity Index
Young Mania Rating Scale (YMRS)
FBC
thyroid function tests
serum vitamin D
toxicology screen

完整详情

需考虑的检查

fasting lipid profile
fasting glucose
MRI brain
actigraphy

完整详情

治疗流程

急症处理

not rapid cycling and without mixed features (with acute mania or hypomania): non-pregnant

not rapid cycling and without mixed features (with acute bipolar I depression): non-pregnant

not rapid cycling and without mixed features (with acute bipolar II depression): non-pregnant

not rapid cycling and with mixed features (with acute mania or hypomania predominant): non-pregnant

not rapid cycling and with mixed features (with acute depression predominant): non-pregnant

not rapid cycling and with mixed features (with equally prominent concurrent manic and depressive symptoms): non-pregnant

rapid cycling: non-pregnant

pregnant

持续性治疗

bipolar I after stabilisation of acute episode (including rapid cycling but without mixed features): non-pregnant

bipolar II after stabilisation of acute episode (including rapid cycling but without mixed features): non-pregnant

not rapid cycling and with mixed features (with mania or hypomania predominant) after stabilisation of acute episode: non-pregnant

not rapid cycling and with mixed features (with depression predominant) after stabilisation of acute episode: non-pregnant

not rapid cycling and with mixed features (with equally prominent concurrent manic and depressive symptoms) after stabilisation of acute episode: non-pregnant

after stabilisation of acute episode: pregnant

撰稿人

作者

Adrian Preda, MD

Professor of Clinical Psychiatry

University of California, Irvine

Irvine

利益声明

AP has been compensated as an expert consultant by GLG, Atheneum, Guidepoint, and as the Editor-in-Chief of Psychiatric News.

მადლიერება

Dr Adrian Preda would like to gratefully acknowledge Dr Sudhakar Selvaraj, Dr Prashant Gajwani, and Dr David J. Muzina, previous contributors to this topic.

გაფრთხილება:

SS has received speaking honoraria from Global Medical Education and honoraria from the British Medical Journal Publishing Group; owns convertible shares at Flow MedTech, Inc (a medical device start-up company); and has been involved in a treatment-resistant depression clinical trial and received research support from COMPASS pathways (a mental healthcare company). PG has served on the speakers' bureau for Merck and Sunovion. DJM is an author of a number of references cited in this topic; has previously received honoraria for research support from Repligen Co; has previously received honoraria as a speaker and/or advisor from AstraZeneca, Pfizer, BMS, Wyeth, Sepracor, and GSK; and is a full-time employee of Medco.

რეცენზენტები

Stuart Watson, MD, MRCPsych, MBBS

Clinical Senior Lecturer

Newcastle University

Newcastle

გაფრთხილება:

SW declares that he has no competing interests.

Roger McIntyre, MD

Head

Mood Disorders Psychopharmacology Unit

University Health Network

Associate Professor of Psychiatry and Pharmacology

University of Toronto

Ontario

Canada

გაფრთხილება:

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.

Jan Scott, MBBS

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

გაფრთხილება:

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

რეცენზენტების განცხადებები

BMJ Best Practice-ის თემების განახლება სხვადასხვა პერიოდულობით ხდება მტკიცებულებებისა და რეკომენდაციების განვითარების შესაბამისად. ქვემოთ ჩამოთვლილმა რეცენზენტებმა თემის არსებობის მანძილზე კონტენტს ერთხელ მაინც გადახედეს.

გაფრთხილება

რეცენზენტების აფილიაციები და გაფრთხილებები მოცემულია გადახედვის მომენტისთვის.

წყაროები

ჩვენი მტკიცებულებებისა და სარედაქციო ჯგუფები თანამშრომლობენ საერთაშორისო ექსპერტებსა და რეცენზენტებთან, რათა უზრუნველვყოთ თქვენი წვდომა კლინიკურად ყველაზე მნიშვნელოვან ინფორმაციაზე.

ძირითადი სტატიები

American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.სრული ტექსტი

Yatham LN, Chakrabarty T, Bond DJ, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) recommendations for the management of patients with bipolar disorder with mixed presentations. Bipolar Disord. 2021 Dec;23(8):767-88. აბსტრაქტი

National Institute for Health and Care Excellence. Bipolar disorder: assessment and management. Dec 2023 [internet publication].სრული ტექსტი

Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018 Mar;20(2):97-170.სრული ტექსტი აბსტრაქტი

Goodwin GM, Haddad PM, Ferrier IN, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2016 Jun;30(6):495-553.სრული ტექსტი აბსტრაქტი

Fountoulakis KN, Grunze H, Vieta E, et al. The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for bipolar disorder in adults (CINP-BD-2017), Part 3: the clinical guidelines. Int J Neuropsychopharmacol. 2017 Feb 1;20(2):180-95.სრული ტექსტი აბსტრაქტი

გამოყენებული სტატიები

ამ თემაში მოხსენიებული წყაროების სრული სია ხელმისაწვდომია მომხმარებლებისთვის, რომლებსაც აქვთ წვდომა BMJ Best Practice-ის ყველა ნაწილზე.

დიფერენციული დიაგნოზები
- Mood disorder due to general medical condition
- Substance-induced mood disorder
- Major depressive disorder
მეტი დიფერენციული დიაგნოზები
გაიდლაინები
- Bipolar disorder: assessment and management
- Treatment and management of mental health conditions during pregnancy and postpartum
მეტი გაიდლაინები
პაციენტის ბროშურები
Bipolar disorder: what is it?
Bipolar disorder: what medicines work?
მეტი პაციენტის ბროშურები
შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

ამ მასალის გამოყენება ექვემდებარება ჩვენს განცხადებას

Bipolar disorder in adults

小结

定义

病史和体格检查

关键诊断因素

危险因素

诊断性检查

首要检查

需考虑的检查

治疗流程

not rapid cycling and without mixed features (with acute mania or hypomania): non-pregnant

not rapid cycling and without mixed features (with acute bipolar I depression): non-pregnant

not rapid cycling and without mixed features (with acute bipolar II depression): non-pregnant

not rapid cycling and with mixed features (with acute mania or hypomania predominant): non-pregnant

not rapid cycling and with mixed features (with acute depression predominant): non-pregnant

not rapid cycling and with mixed features (with equally prominent concurrent manic and depressive symptoms): non-pregnant

rapid cycling: non-pregnant

pregnant

bipolar I after stabilisation of acute episode (including rapid cycling but without mixed features): non-pregnant

bipolar II after stabilisation of acute episode (including rapid cycling but without mixed features): non-pregnant

not rapid cycling and with mixed features (with mania or hypomania predominant) after stabilisation of acute episode: non-pregnant

not rapid cycling and with mixed features (with depression predominant) after stabilisation of acute episode: non-pregnant

not rapid cycling and with mixed features (with equally prominent concurrent manic and depressive symptoms) after stabilisation of acute episode: non-pregnant

after stabilisation of acute episode: pregnant

撰稿人

作者

Adrian Preda, MD

利益声明

მადლიერება

გაფრთხილება:

რეცენზენტები

Stuart Watson, MD, MRCPsych, MBBS

გაფრთხილება:

Roger McIntyre, MD

გაფრთხილება:

Jan Scott, MBBS

გაფრთხილება:

რეცენზენტების განცხადებები

გაფრთხილება

წყაროები

ძირითადი სტატიები

გამოყენებული სტატიები

დიფერენციული დიაგნოზები

გაიდლაინები

პაციენტის ბროშურები

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში ან გამოიწერეთ BMJ Best Practice

შედით სისტემაში BMJ Best Practice-ის მასალებზე სრული წვდომისთვის