Bipolar I disorder (BD-I; pronounced "type one bipolar disorder") is a type ofbipolar spectrum disorder characterized by the occurrence of at least onemanic episode, with or without mixed or psychotic features.[1] Most people also, at other times, have one or moredepressive episodes.[2] Typically, these manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks.[3]
It is a type of bipolar disorder and conforms to the classic concept of manic-depressive illness, which can includepsychosis during mood episodes.[4]
The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes.[5] Often, individuals have had one or moremajor depressive episodes.[6] One episode of mania is sufficient to make the diagnosis of bipolar disorder; the person may or may not have a history ofmajor depressive disorder.[6] Episodes of substance-induced mood disorder due to the direct effects of amedication, or othersomatic treatments for depression,substance use disorder, ortoxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. Bipolar I disorder requires confirmation of only 1 full manic episode for diagnosis, but may be associated with hypomanic and depressive episodes as well.[7] Diagnosis for bipolar II disorder does not include a full manic episode; instead, it requires the occurrence of both a hypomanic episode and a major depressive episode.[7] Serious aggression has been reported to occur in one out of every ten major, first-episode, BD-I patients with psychotic features, the prevalence in this group being particularly high in association with a recent suicide attempt,alcohol use disorder, learning disability, or manic polarity in the first episode.[8]
Bipolar I disorder often coexists with other disorders includingPTSD, substance use disorders, and a variety of mood disorders.[9][10] Studies suggest that psychiatric comorbidities correlate with further impairment of day-to-day life.[11] Up to 40% of people with bipolar disorder also present with PTSD, with higher rates occurring in women and individuals with bipolar I disorder.[9] A diagnosis of bipolar 1 disorder is only given if bipolar episodes are not better accounted for byschizoaffective disorder or superimposed onschizophrenia,schizophreniform disorder,delusional disorder, or apsychotic disorder not otherwise specified.[12]
In May 2013,American Psychiatric Association released the fifth edition of theDiagnostic and Statistical Manual of Mental Disorders (DSM-5). 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: withpsychotic features, withmixed features, withcatatonic features, with rapid cycling, withanxiety (mild to severe), withsuicide risk severity, withseasonal pattern, and withpostpartum onset.[14] Bipolar I Disorder 296.5x (most recent episode depressed) will include all of the above specifiers plus the following: withmelancholic features and with atypical features.[14] The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of majordepression of which one of the symptoms isdepressed mood oranhedonia.[14] For Bipolar I Disorder 296.7 (most recent episode unspecified), the listed specifiers will be removed.[14]
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.[15][16]
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 ofattention deficit hyperactivity disorder (ADHD).[15]
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.[22]
A frequent problem in these individuals is non-adherence to pharmacological treatment; long-acting injectable antipsychotics may contribute to solving this issue in some patients.[23]
A review of validated treatment guidelines for bipolar disorder by international bodies was published in 2020.[24]
Bipolar I usually has a poor prognosis, which is associated with substance abuse, psychotic features, depressive symptoms, and inter-episode depression.[25] A manic episode can be so severe that it requires hospitalization. An estimated 63% of all BP-I related mania results in hospitalization.[26] The natural course of BP-I, if left untreated, leads to episodes becoming more frequent or severe over time.[27] The absolute risk of suicide is highest for BP-I than all other mood and mental disorders.[28] Up to a quarter of individuals with BP-I die by suicide.[29] Individuals with BP-I typically have a shorter life expectancy compared to the general population, with estimates suggesting a reduction of 11 to 20 years.[30] With proper treatment, individuals with BP-I can, however, lead a healthy lifestyle.[31]
Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance ofcompliance with medication asprescribed.Behavior modification throughcounseling 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%.[33]
^abCerimele, Joseph M.; Bauer, Amy M.; Fortney, John C.; Bauer, Mark S. (May 2017). "Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature".The Journal of Clinical Psychiatry.78 (5):e506 –e514.doi:10.4088/JCP.16r10897.ISSN1555-2101.PMID28570791.
^Hunt, Glenn E.; Malhi, Gin S.; Cleary, Michelle; Lai, Harry Man Xiong; Sitharthan, Thiagarajan (December 2016). "Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis".Journal of Affective Disorders.206:331–349.doi:10.1016/j.jad.2016.07.011.ISSN1573-2517.PMID27476137.
^Léda-Rêgo, Gabriela; Studart-Bottó, Paula; Sarmento, Stella; Cerqueira-Silva, Thiago; Bezerra-Filho, Severino; Miranda-Scippa, Ângela (1 February 2023). "Psychiatric comorbidity in individuals with bipolar disorder: relation with clinical outcomes and functioning".European Archives of Psychiatry and Clinical Neuroscience.273 (5):1175–1181.doi:10.1007/s00406-023-01562-5.ISSN0940-1334.PMID36725737.S2CID256501014.
^Young, Allan (February 2014). "A Randomised, Placebo-Controlled 52-Week Trial of Continued Quetiapine Treatment in Recently Depressed Patients With Bipolar I And Bipolar II Disorder".World Journal of Biological Psychiatry.15 (2):96–112.doi:10.3109/15622975.2012.665177.PMID22404704.S2CID2224996.
^Verdolini, Norma; Hidalgo-Mazzei, Diego; Del Matto, Laura; Muscas, Michele; Pacchiarotti, Isabella; Murru, Andrea; Samalin, Ludovic; Aedo, Alberto; Tohen, Mauricio; Grunze, Heinz; Young, Allan H. (22 December 2020). "Long-term treatment of bipolar disorder type I: A systematic and critical review of clinical guidelines with derived practice algorithms".Bipolar Disorders.23 (4):324–340.doi:10.1111/bdi.13040.ISSN1399-5618.PMID33354842.S2CID229693238.
^De Zelicourt, M.; Dardennes, R.; Verdoux, H.; Gandhi, G.; Khoshnood, B.; Chomette, E.; Papatheodorou, M. L.; Edgell, E. T.; Even, C.; Fagnani, F. (2003). "Frequency of hospitalisations and inpatient care costs of manic episodes: In patients with bipolar I disorder in France".Pharmacoeconomics.21 (15):1081–1090.doi:10.2165/00019053-200321150-00002.PMID14596627.S2CID41439636.
^Kessing, L. V.; Vradi, E.; Andersen, P. K. (2015). "Life expectancy in bipolar disorder".Bipolar Disorders.17 (5):543–548.doi:10.1111/bdi.12296.PMID25846854.
