Bipolar I Disorder

Descriptive text is not available for this image Basics

Description

  • A chronic disorder of at least one manic or mixed (mania and depression) episode that causes marked impairment, psychosis, and/or hospitalization
  • Symptoms are not caused by a substance or general medical condition.

Geriatric Considerations
In new onset in older patients (>50 years of age), a workup for organic or chemically induced pathology is recommended.Pediatric Considerations
Need for clarity of symptoms is critical to differentiate between attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), disruptive mood dysregulation, and other diagnoses with overlapping symptoms that can occur in childhood.Pregnancy Considerations

  • Pregnancy does not reduce risk of mood episodes.
  • Need to weigh risk of fetal and maternal exposure to mood episode to that of medication
  • Avoid divalproex (Depakote) due to high teratogenicity risk.
  • Postpartum carries high risk of severe acute episode with psychosis and/or infanticidal ideation.

Epidemiology

Onset usually between 15 and 30 years of age, average prior to age 25 years.

Incidence

1% of the world’s population

Prevalence

  • 0.5–1% lifetime prevalence
  • Manic episodes more common in men; depressive episodes more common in women

Etiology and Pathophysiology

  • Dysregulation of biogenic amines or neurotransmitters (particularly serotonin, norepinephrine, and dopamine)
  • MRI findings suggest abnormalities in prefrontal cortical areas, striatum, and amygdala that predate illness onset.

Genetics

  • Monozygotic twin concordance 40–70%; dizygotic 5–25%
  • 50% have at least one parent with a mood disorder.

General Prevention

Treatment adherence and education help to prevent relapses.

Commonly Associated Conditions

Substance abuse (60%), ADHD, anxiety disorders (~50%), and eating disorders

There's more to see -- the rest of this topic is available only to subscribers.