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Bipolar%20disorder Signs and Symptoms
Introduction
- Mood disorder characterized by episodic, recurrent and frequently progressive condition of mania, hypomania and major depression
- Age of onset is between 15 and 30 years old with overall average of 25 years old
- An estimated 2.4% total lifetime prevalence reported by the World Mental Health Survey across bipolar I, bipolar II and subthreshold bipolar disorder subtypes
- Associated with increased comorbidity with substance abuse, anxiety disorder, personality disorders and attention-deficit hyperactivity disorder (ADHD)
- Comorbidity with axis I or axis II may be associated with an earlier age at onset and a worse course of illness
Bipolar Subtypes
Bipolar I
- Primarily defined by manic or mixed episodes that last for at least 7 days, or very severe manic symptoms needing immediate hospital care
- Patient also has depressive episodes that may last for at least 2 weeks
Bipolar II
- Usually misdiagnosed; characterized by occurrence of ≥1 major depressive episodes with at least 1 hypomanic episode
Other Specified Bipolar and Related Disorder or Unspecified Bipolar and Related Disorder
- Patient has symptoms that do not meet the criteria for either bipolar I or II
- Symptoms may not last long or are very few
Bipolar Spectrum Disorders
Cyclothymic Disorder or Cyclothymia
- A mild form of bipolar disorder
- Patients have episodes of hypomania alternating with mild depression that lasts for 2 years
Rapid-Cycling Bipolar Disorder
- Patients have ≥ 4 episodes of major depression, mania, hypomania or mixed symptoms within a year
- More common in patients with severe bipolar disorder, in people who had the disease at an earlier age and in female patients
Signs and Symptoms
Clinical Course
- Patient may present with bipolar disorder in a manic, hypomanic, depressive or mixed state
- More common for 1st episode to present as depression
- Often, the patient will suffer from a number of depressive episodes before a manic episode occurs
- Features of bipolar disorder vary and can be traced by recording using daily mood chart
- Patients with bipolar disorder have the highest risk for suicide
- Knowing risk factors (eg younger age, male, unemployed, early onset of mood disorder, 1st-degree family history of suicide) can help in detection of patients who are at risk for suicide
Depression
- Depressive symptoms occur more commonly than manic symptoms throughout the course of illness
- Bipolar I patients have depression 3 times more frequent than mania
- Bipolar II patients experience depression 37 times more commonly than hypomania
- Episodes of depression are similar to unipolar major depression
- Bipolar depression occurs more commonly in patients with family history of bipolar disorder and in patients with early onset of depression
- Subsyndromal episodes associated with loss of interpersonal skills and occupational ability are common in patients with bipolar disorder
Mania
- Extreme behaviors associated with manic episodes often require hospital admission to prevent harm to self and others
- Acute phase of mania may involve extreme affect, often euphoric or irritable
- Causes impairment in perception, somatic and social functioning
Hypomania
- Also have features of mania but at a lesser extent, where insight is preserved
- Usually accompanied by mild functional impairment
- Can be assessed using the Hypomania Symptom Checklist (HCL-32), Mood Disorders Questionnaire (MDQ),Young Mania Rating Scale (YMRS)
