Bipolar I disorder

Regular medical assessments are performed to rule-out secondary causes of mania and depression.[9] These tests include complete blood count, glucose, serum chemistry/electrolyte panel, thyroid function test, liver function test, renal function test, urinalysis, vitamin B12 and folate levels, HIV screening, syphilis screening, and pregnancy test, and when clinically indicated, an electrocardiogram (ECG), an electroencephalogram (EEG), a computed tomography (CT scan), and/or a magnetic resonance imagining (MRI) may be ordered.[9] Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins.

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.[10] 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.[10] The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major depression of which one of the symptoms is depressed mood or anhedonia.[10] For Bipolar I Disorder 296.7 (most recent episode unspecified), the listed specifiers will be removed.[10]

The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include “and present most of the day, nearly every day,” and criterion 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.[11][12]

There have also been proposed revisions to criterion B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Criterion 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 attention deficit hyperactivity disorder (ADHD).[11]

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.

• F31 Bipolar Affective Disorder
• F31.6 Bipolar Affective Disorder, Current Episode Mixed
• F30 Manic Episode
• F30.0 Hypomania
• F30.1 Mania Without Psychotic Symptoms
• F30.2 Mania With Psychotic Symptoms
• F32 Depressive Episode
• F32.0 Mild Depressive Episode
• F32.1 Moderate Depressive Episode
• F32.2 Severe Depressive Episode Without Psychotic Symptoms
• F32.3 Severe Depressive Episode With Psychotic Symptoms

Mood stabilizers are often used as part of the treatment process.[13]

1. Lithium is the mainstay in the management of bipolar disorder but it has a narrow therapeutic range and typically requires monitoring[14]
2. Anticonvulsants, such as valproate,[15] carbamazepine, or lamotrigine
3. Atypical antipsychotics, such as quetiapine,[16][17] risperidone, olanzapine, or aripiprazole
4. Electroconvulsive therapy, a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect

Antidepressant-induced mania occurs in 20–40% of people with bipolar disorder. Mood stabilizers, especially lithium, may protect against this effect, but some research contradicts this.[18]

Psychosocial interventions can be used for managing acute depressive episodes and for maintenance treatment to aid in relapse prevention.[19] This includes psycho education, cognitive behavioural therapy (CBT), family-focused therapy (FFT), interpersonal and social-rhythm therapy (IPSRT), and peer support.[19]

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%.[20]