Bipolar I Disorder         Bipolar II Disorder
Bipolar I Disorder
Sometimes individuals experience severe mood swings from periods of extreme depression to periods of exaggerated happiness. This is known as bipolar disorder or manic-depressive illness, an illness that involves episodes of serious mania and depression. The individual's mood usually swings from overly "high" and irritable (mania) to sad and hopeless (depression) and then back again, with periods of normal moods interspersed.

Bipolar I Disorder, Single Manic Episode

The patient has had just one Manic Episode and no Major Depressive Episodes.

Schizoaffective disorder doesn't explain the Manic Episode better, and it isn't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

Specify Mixed: If a single episode meets the criteria for Mixed Episode, it would be recorded, for example:

Bipolar I Disorder, Single Manic Episode, Mixed, Moderate

Include any specifiers that apply to this Manic Episode.

Bipolar I Disorder, Most Recent Episode Manic

The patient's most recent episode is of mania.

The patient has had at least one Major Depressive, Manic or Mixed Episode.

Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

Include any specifiers that apply to this Manic Episode or to the overall course of the disorder.

Bipolar I Disorder, Most Recent Episode Hypomanic

The patient's most recent episode is hypomanic.

The patient has previously had one or more Manic or Mixed Episodes.

The symptoms cause clinically important distress or impair work, social or personal functioning.

Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

Include any specifiers that apply to the overall course of the disorder.

Bipolar I Disorder, Most Recent Episode Mixed

The patient's most recent episode is of mixed mania and depression.

The patient has had at least one Major Depressive, Manic or Mixed Episode.

Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

Include any specifiers that apply to this Mixed Episode or to the overall course of the disorder.

Bipolar I Disorder, Most Recent Episode Depressed

The patient's most recent episode is Major Depressive.

The patient has had at least one previous Manic or Mixed Episode.

Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

Include any specifiers that apply to this Major Depressive Episode or to the overall course of the disorder.

Bipolar I Disorder, Most Recent Episode Unspecified

Other than duration, the patient currently or recently meets criteria for Major Depressive,  Manic, Mixed, or Hypomanic episode.

The patient has had at least one previous Manic or Mixed Episode.

These symptoms cause clinically important distress or impair work, social or personal functioning.

Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

The symptoms are not directly caused by a general medical condition or the use substances, including prescription medications.

Include any specifiers that apply to the overall course of the disorder.

Evaluation:

History: Interviews with family or friends are essential. Often a family history of affective disorders and alcoholism is present in first-degree relatives. If patient is >40 years of age and has first manic episode, look for medical causes.

Examination: Evaluate for medical cause, such as drug abuse or intoxication.

Laboratory Tests: Tests are needed before starting lithium carbonate, carbamazepine, or valproate (see below under specific medications). They should also be performed to rule out certain causes of secondary mania, such as megaloblastic anemia, hyperglycemia and hypoglycemia, hyperthyroidism and hypothyroidism, systemic lupus erythematosus, syphilis, HIV, and liver disease induced by alcohol or other substances.

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Bipolar II Disorder

The patient has had at least one Major Depressive Episode.

The patient has had at least one Hypomanic Episode.

There have been no Manic or Mixed Episodes.

Schizoaffective disorder doesn't explain the above episodes better, and they aren't superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder or Psychotic Disorder Not Otherwise Specified.

These symptoms cause clinically important distress or impair work, social or personal functioning.

Specify Current or Most Recent Episode:

Hypomanic
Depressed

Include any specifiers that apply to the most recent episode, if it is depressive, or to the overall course of the disorder.

Differential Diagnosis: 

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Mood Disorder Due to a General Medical Condition;
Substance-Induced Mood Disorder;
Major Depressive Disorder;
Dysthymic Disorder;
Bipolar I Disorder;
Cyclothymic Disorder;
Psychotic Disorders (e.g., Schizoaffective Disorder, Schizophrenia, and Delusional Disorder

Cause:

The cause of this disorder is still not established. Many bipolars have a family history of manic depression while it appears 50% are unable to find this family background.

Treatment:

There is no known cure for the bipolar disorder but it is treatable with medication and therapy. However manic depression is a chronic and recurring disorder in spite of medications used. Many factors can play into this. For example, for those who have been diagnosed early and treated early on seem to be more successful regarding relapse. Rapid cyclers and people with mixed episodes also seem harder to treat.

Other important treatment involves exercise, a regulated sleep and meal plan, avoiding stress, caffeine, alcohol and illicit drugs. Again, more information in the site.

Hospitalization is usually indicated for full manic syndromes, since the patient's well-being is at risk because of impaired judgment. This includes a risk of death from exhaustion. Consider ECT in medication nonresponders and pregnant women.

Pharmacotherapy

Treatment for the bipolar disorder involves the use of psychotropic medications that may include:  lithium, antidepressants, neuroleptics, ECT etc.

Antipsychotics:

Haloperidol.
Benzodiazepines may be a useful adjunct for sedation.

Antimanic drugs:

Lithium Carbonate.
Carbamazepine (Tegretol).
Valproic Acid (Depakene, Depakote).
Verapamil (Calan).