Bipolar disorder in adults

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 11 Jun 2025

Last updated: 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 characterized 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 exam 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 stabilizers 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 individualized 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 characterized by manic, or hypomanic, and depressive episodes. Two subtypes are recognized: bipolar I disorder and bipolar II disorder.

Bipolar I disorder is characterized 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 characterized 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

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 age 20 years
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)
CBC
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): nonpregnant

not rapid cycling and without mixed features (with acute bipolar I depression): nonpregnant

not rapid cycling and without mixed features (with acute bipolar II depression): nonpregnant

not rapid cycling and with mixed features (with acute mania or hypomania predominant): nonpregnant

not rapid cycling and with mixed features (with acute depression predominant): nonpregnant

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

rapid cycling: nonpregnant

pregnant

持续性治疗

bipolar I after stabilization of acute episode (including rapid cycling but without mixed features): nonpregnant

bipolar II after stabilization of acute episode (including rapid cycling but without mixed features): nonpregnant

not rapid cycling and with mixed features (with mania or hypomania predominant) after stabilization of acute episode: nonpregnant

not rapid cycling and with mixed features (with depression predominant) after stabilization of acute episode: nonpregnant

not rapid cycling and with mixed features (with equally prominent concurrent manic and depressive symptoms) after stabilization of acute episode: nonpregnant

after stabilization 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.

鸣谢

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

利益声明

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.

同行评议者

Stuart Watson, MD, MRCPsych, MBBS

Clinical Senior Lecturer

Newcastle University

Newcastle

利益声明

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

利益声明

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

利益声明

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

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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

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. 摘要

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.全文摘要

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

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.全文摘要

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.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断
- Mood disorder due to general medical condition
- Substance-induced mood disorder
- Major depressive disorder
更多鉴别诊断
指南
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
- Bipolar disorder: assessment and management
更多指南
患者教育信息
Bipolar disorder: what is it?
Bipolar disorder: what medications work?
更多患者教育信息
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Bipolar disorder in adults

Summary

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): nonpregnant

not rapid cycling and without mixed features (with acute bipolar I depression): nonpregnant

not rapid cycling and without mixed features (with acute bipolar II depression): nonpregnant

not rapid cycling and with mixed features (with acute mania or hypomania predominant): nonpregnant

not rapid cycling and with mixed features (with acute depression predominant): nonpregnant

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

rapid cycling: nonpregnant

pregnant

bipolar I after stabilization of acute episode (including rapid cycling but without mixed features): nonpregnant

bipolar II after stabilization of acute episode (including rapid cycling but without mixed features): nonpregnant

not rapid cycling and with mixed features (with mania or hypomania predominant) after stabilization of acute episode: nonpregnant

not rapid cycling and with mixed features (with depression predominant) after stabilization of acute episode: nonpregnant

not rapid cycling and with mixed features (with equally prominent concurrent manic and depressive symptoms) after stabilization of acute episode: nonpregnant

after stabilization of acute episode: pregnant

撰稿人

作者

Adrian Preda, MD

利益声明

鸣谢

利益声明

同行评议者

Stuart Watson, MD, MRCPsych, MBBS

利益声明

Roger McIntyre, MD

利益声明

Jan Scott, MBBS

利益声明

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

鉴别诊断

指南

患者教育信息

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

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