Introduction
Bipolar disorder is a chronic mental health disorder characterised by periods of mania/hypomania alongside episodes of depression.
Classification
Two types of bipolar disorder are recognised:
- type I disorder: mania and depression (most common)
- type II disorder: hypomania and depression
Epidemiology
- Incidence: 25.00 cases per 100,000 person-years
- Peak incidence: 20-30 years
- Sex ratio: 1:1
| <1 | 1-5 | 6+ | 16+ | 30+ | 40+ | 50+ | 60+ | 70+ | 80+ |
Clinical features
What is mania/hypomania?
- both terms relate to abnormally elevated mood or irritability
- with mania there is severe functional impairment or psychotic symptoms for 7 days or more
- hypomania describes decreased or increased function for 4 days or more
- from an exam point of view the key differentiation is psychotic symptoms (e.g.delusions of grandeur or auditory hallucinations) which suggest mania
Management
Management
- psychological interventions specifically designed for bipolar disorder may be helpful
- lithium remains the mood stabilizer of choice. An alternative is valproate
- management of mania: consider stopping antidepressant if the patient takes one; antipsychotic therapy e.g. olanzapine or haloperidol
- management of depression: talking therapies (see above); fluoxetine is the antidepressant of choice
- address co-morbidities - there is a 2-3 times increased risk of diabetes, cardiovascular disease and COPD
Prognosis
Primary care referral
- if symptoms suggest hypomania then NICE recommend routine referral to the community mental health team (CMHT)
- if there are features of mania or severe depression then an urgent referral to the CMHT should be made