Bipolar I disorder

Bipolar disorder
Classification and external resources
Specialty psychiatry
ICD-9-CM 296.7

Bipolar I disorder (BP-I; pronounced "type one bipolar disorder") is a bipolar spectrum disorder characterized by the occurrence of at least one manic or mixed episode.[1] Most patients also, at other times, have one or more depressive episodes, and all experience a hypomanic stage before progressing to full mania.[2]

It is a type of bipolar disorder, and conforms to the classic concept of manic-depressive illness, which can include psychosis during mood episodes.[3] The difference with bipolar II disorder is that the latter requires that the individual must never have experienced a full manic or mixed-manic episode - only less severe hypomanic episode(s).[4]

Diagnostic criteria

The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes (DSM-IV-TR, 2000). Often, individuals have had one or more major depressive episodes.[5] One episode of mania is sufficient to make the diagnosis of bipolar disorder; the patient may or may not have history of major depressive disorder.[5] Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, drug abuse, or toxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. In addition, the episodes must not be better accounted for by schizoaffective disorder or superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or a psychotic disorder not otherwise specified.[6]

Treatment

Medical assessment

Routine medical assessments are often prescribed to rule-out or identify a somatic cause for bipolar I symptoms. These tests can include ultrasounds of the head, x-ray computed tomography (CAT scan), electroencephalogram, HIV test, full blood count, thyroid function test, liver function test, urea and creatinine levels and if patient is on lithium, lithium levels are taken. Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins.

[7][8]

Medication

Mood stabilizers are often used as part of the treatment process.[9]

  1. Lithium is the mainstay in the management of bipolar disorder but it has a narrow therapeutic range and typically requires monitoring[10]
  2. Anticonvulsants, such as sodium valproate, carbamazepine or lamotrigine[11]
  3. Antipsychotics, such as quetiapine, risperidone, olanzapine or aripiprazole
  4. Electroconvulsive therapy, a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect

Some antidepressants, like venlafaxine, have been found to precipitate a manic episode.

Patient education

Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance of compliance with medication as prescribed. Behavior modification through counseling can have positive influence to help reduce the effects of risky behavior during the manic phase. Additionally, the lifetime prevalence for bipolar I disorder is estimated to be 1%.[12]

DSM-IV-TR General diagnosis codes

Dx Code # Disorder Description
296.0x Bipolar I disorder Single manic episode
296.40 Bipolar I disorder Most recent episode hypomanic
296.4x Bipolar I disorder Most recent episode manic
296.5x Bipolar I disorder Most recent episode depressed
296.6x Bipolar I disorder Most recent episode mixed
296.7 Bipolar I disorder Most recent episode unspecified

Proposed revisions in diagnostic criteria for DSM-5

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was released in May 2013. There are several proposed revisions to occur in the diagnostic criteria of Bipolar I Disorder and its subtypes. For Bipolar I Disorder 296.40 Most Recent Episode Hypomanic and 296.4x Most Recent Episode Manic, the proposed revision includes the following specifiers: with Psychotic Features, with Mixed Features, with Catatonic Features, with Rapid Cycling, with Anxiety (mild to severe), with Suicide Risk Severity, with Seasonal Pattern, and with Postpartum Onset. Bipolar I Disorder 296.5x Most Recent Episode Depressed will include all of the above specifiers plus the following: with Melancholic Features and with Atypical Features. The categories for specifiers will be removed in DSM-5 and part A will add “or there are at least 3 symptoms of Major Depression of which one of the symptoms is depressed mood or anhedonia. For Bipolar I Disorder 296.7 Most Recent Episode Unspecified, the listed specifiers will be removed.[13]

The criteria for manic and hypomanic episodes in parts A & B will be edited. Part A will include “and present most of the day, nearly every day,” and part B will include “and represent a noticeable change from usual behavior.” These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined.[14][15]

There have also been proposed revisions to part B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Part B lists "inflated self-esteem, flight of ideas, distractibility, and decreased need for sleep" as symptoms of a Hypomanic Episode. This has been confusing in the field of child psychiatry because these symptoms closely overlap with symptoms of ADHD (Attention Deficit Hyperactivity Disorder).[14]

Note that many of the above changes are still under active consideration and are not definite. For more information regarding proposed revisions to the DSM-5, please visit their website at dsm5.org. For a helpful guide to understanding the DSM-IV, please visit their website at

ICD-10 diagnostic criteria

See also

References

  1. ↑ "The Two Types of Bipolar Disorder". Psych Central.com. Retrieved 25 November 2015.
  2. ↑ "Bipolar Disorder: Who’s at Risk?". Retrieved 22 November 2011.
  3. ↑ "What are the types of bipolar disorder?". Retrieved 22 November 2011.
  4. ↑ Berk M., Dodd S. (2005). "Bipolar II disorder: a review". Bipolar Disorders. 7: 11–21. doi:10.1111/j.1399-5618.2004.00152.x.
  5. 1 2 "Online Bipolar Tests: How Much Can You Trust Them?". DepressionD. Retrieved 7 January 2012.
  6. ↑ "Bipolar Disorder Residential Treatment Center Los Angeles". PCH Treatment. Retrieved 25 November 2015.
  7. ↑ Datto, Catherine (11 March 2016). "Bipolar II compared with bipolar I disorder: baseline characteristics and treatment response to quetiapine in a pooled analysis of five placebo-controlled clinical trials of acute bipolar depression". Annals of General Psychiatry. 15: 1–12. PMC 4788818 Freely accessible. PMID 26973704. doi:10.1186/s12991-016-0096-0.
  8. ↑ Young, Allan (February 2014). "A Randomised, Placebo-Controlled 52-Week Trial of Continued Quetiapine Treatment in Recently Depressed Patients With Bipolar I And Bipolar II Disorder". World Journal of Biological Psychiatry. 15 (2): 96–112. PMID 22404704. doi:10.3109/15622975.2012.665177.
  9. ↑ http://health.usnews.com/health-care/for-better/articles/2017-07-20/can-people-recover-from-bipolar-disorder
  10. ↑ "Lithium for maintenance treatment of mood disorders | Cochrane". www.cochrane.org. Retrieved 9 March 2016.
  11. ↑ "Valproate for acutre mood episodes in bipolar disorder | Cochrane". www.cochrane.org. Retrieved 9 March 2016.
  12. ↑ Merikangas, Kathleen R.; Akiskal, Hagop S.; Angst, Jules; Greenberg, Paul E.; Hirschfeld, Robert M.A.; Petukhova, Maria; Kessler, Ronald C. (1 May 2007). "Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication". Archives of General Psychiatry. 64 (5): 543–552. ISSN 0003-990X. PMC 1931566 Freely accessible. PMID 17485606. doi:10.1001/archpsyc.64.5.543.
  13. ↑ "DSM-5 Development". American Psychiatric Association. Archived from the original on 19 November 2008. Retrieved 12 February 2012.
  14. 1 2 "Issues pertinent to a developmental approach to bipolar disorder in DSM-5". American Psychiatric Association. 2010.
  15. ↑ Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision). Washington, DC: American Psychiatric Association. 2000. pp. 345–392.
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