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Bipolar disorder in adults

Last reviewed: 11 Jun 2025
Last updated: 27 Sep 2024

Summary

定义

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
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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
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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
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需考虑的检查

  • fasting lipid profile
  • fasting glucose
  • MRI brain
  • actigraphy
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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

CA

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

UK

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

UK

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.
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