Bipolar disorder in adults

Bipolar disorder is a recurrent and sometimes chronic mental illness marked by alternating periods of abnormal mood elevation and depression associated with a change or impairment in functioning.

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 a bipolar disorder.

Diagnosis is based on interviews with the patient and family, using diagnostic criteria for bipolar disorder.

Misdiagnosis of bipolar disorder is common, with unipolar major depressive disorder the most frequent diagnostic error made.

The management of acute mania requires mood stabilisers or atypical antipsychotics, as monotherapy or in combination. There are fewer approved treatment options for acute bipolar depression; traditional antidepressants 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.

Bipolar disorder, previously termed manic depression, is a psychiatric diagnosis characterised by abnormally elevated or irritable mood episode(s) accompanied by disruptive symptoms of distractibility, indiscretions, grandiosity, flight of ideas, hyperactivity, decreased need for sleep, and talkativeness.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. (DSM-5). Washington, DC: American Psychiatric Publishing; 2013. It is marked by alternating mood elevation (mania or hypomania) and depression. Manic episodes include a clustering of these symptoms over at least a period of 1 week, and are more disruptive than hypomania (milder symptoms, >4 days' duration).

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