July 26th, 2020

Bipolar Disorder

Clinicals - History


Bipolar affective disorder (BPAD) is a mood disorder, and its symptoms overlap with a range of related diagnoses in the DSM-V. Within this group, Bipolar I disorder (BP I) and Bipolar II disorder (BP II) are the main diagnoses seen in clinical practice.


BP affects 1-2% of the general population with similar prevalence across all racial and gender groups. Within this prevalence statistic, BP I has been found to be slightly higher than BP II.


BPAD appears to carry a genetic component. However, a lack of complete concordance with monozygotic twins and development of unipolar depression rather than BPAD in relatives, suggests that environmental factors may influence disease development, including substance abuse.


Mania is characterized by elevated mood, exaggerated self-confidence, easy distractibility, disinhibited behaviour including reckless spending and indiscriminant hypersexuality, grandiose thinking, a history of sleeplessness – both insomnia and a lack of need for sleep and lasts at least 7 days. Hypomanic episodes present with similar features, but symptoms are not severe enough to warrant hospitalization, as is often the case in mania.


Depressive episodes in Bipolar disorder are characterized by low mood, anhedonia, thoughts of hopelessness or helplessness, guilt, low self-worth and suicidal thoughts. This occurs in both BP I and BP II and are of variable duration.

Mixed states

Mixed states are those in which the patient displays features of both mania and depression.

Psychotic features

Bipolar disorder can be, but is not always associated with psychotic features. Features of psychosis include hallucinations, delusions, disorganized speech or behaviour.


Bipolar disorder is associated with increased suicidality. The rate of suicide has been found to be 10-30 times higher compared to the general population.

Chronic illness

Bipolar disorder is associated with chronic ill health. Patients with bipolar disorder experience a greater reduction in life expectancy due to medical comorbidities compared to the general population.

Psychiatric co-morbidities

Bipolar disorder is associated with multiple psychiatric conditions. These include drug, alcohol and substance abuse, anxiety disorders, attention deficit disorder (ADHD), post traumatic stress disorder (PTSD) and borderline personality disorder (BPD).

Substance abuse

For patients who have already been diagnosed with Bipolar disorder and present with symptoms of psychiatric decompensation such as in mania or psychotic features, the most common culprits are medical non-compliance or concurrent drug use.


This is usually a period of milder mood disturbance consisting of episodic mood changes including mood lability, anxiety, depression and subthreshold manic symptoms. These precedes the first presentation of BPAD and are strong indicators of future BPAD development. A prodromal period may also precede a relapse.

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