Overview
Definition
A mood disorder characterized by the presence of at least one full manic episode, typically interspersed with major depressive episodes.
Epidemiology
Lifetime prevalence ~1%. Strong genetic component (highest heritability of all psychiatric disorders).
Etiology & Risk Factors
- Unknown exact cause; dysregulation of monoamines and altered neuroplasticity. Extremely strong family history.
Clinical Symptoms
- Manic Episode (DIG FAST, lasting ≥ 1 week or requiring hospitalization):
- Distractibility
- Irresponsibility/Impulsivity (reckless spending, hypersexuality)
- Grandiosity (inflated self-esteem)
- Flight of ideas (racing thoughts)
- Activity increase (goal-directed)
- Sleep deficit (decreased NEED for sleep, feels rested after 2 hours)
- Talkativeness (pressured speech)
Clinical Approach
Diagnosis
- Clinical diagnosis based on DSM-5 criteria (requires ≥ 1 lifetime Manic episode)
- Depressive episodes are NOT required for the diagnosis of Bipolar I (though they almost always occur)
- Rule out substance-induced mania (e.g., Cocaine, Amphetamines) or medical causes (e.g., Hyperthyroidism)
Management
- Mood Stabilizers (First-line): Lithium (Gold standard, proven anti-suicidal properties) or Valproic Acid
- Atypical Antipsychotics (Quetiapine, Olanzapine, Aripiprazole) for acute mania and maintenance
- DO NOT use antidepressant monotherapy (SSRIs can trigger a manic switch)
Complications
- High risk of suicide (up to 15-20%)
- Substance abuse (highly comorbid)
- Financial/legal ruin due to impulsive manic behavior