Bipolar disorder in adults
Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- 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
Factores de riesgo
- 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
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- 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
Pruebas diagnósticas que deben considerarse
- fasting lipid profile
- fasting glucose
- MRI brain
- actigraphy
Algoritmo de tratamiento
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
Colaboradores
Autores
Adrian Preda, MD
Professor of Clinical Psychiatry
University of California, Irvine
Irvine
CA
Divulgaciones
AP has been compensated as an expert consultant by GLG, Atheneum, Guidepoint, and as the Editor-in-Chief of Psychiatric News.
Agradecimientos
Dr Adrian Preda would like to gratefully acknowledge Dr Sudhakar Selvaraj, Dr Prashant Gajwani, and Dr David J. Muzina, previous contributors to this topic.
Divulgaciones
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.
Revisores por pares
Stuart Watson, MD, MRCPsych, MBBS
Clinical Senior Lecturer
Newcastle University
Newcastle
UK
Divulgaciones
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
Divulgaciones
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
Divulgaciones
JS has received remuneration for attending advisory boards for AstraZeneca, BSM-Otsuka, Eli Lilly, GSK, and Sanofi-Aventis.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed, text revision (DSM-5-TR). Washington, DC: American Psychiatric Association; 2022.Texto completo
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. Resumen
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.Texto completo Resumen
National Institute for Health and Care Excellence. Bipolar disorder: assessment and management. Dec 2023 [internet publication].Texto completo
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.Texto completo Resumen
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.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Mood disorder due to general medical condition
- Substance-induced mood disorder
- Major depressive disorder
Más DiferencialesGuías de práctica clínica
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
- Bipolar disorder: assessment and management
Más Guías de práctica clínicaFolletos para el paciente
Bipolar disorder: what is it?
Bipolar disorder: what medications work?
Más Folletos para el paciente
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