Bipolar DisorderAssessment
B. Anthony Lindsey, MD
Professor and Vice Chair
UNC Department of Psychiatry
Bipolar Disorder
Characteristics of a Manic Episode
 A distinct period of abnormally and persistently elevated,
expansive or irritable mood
 During the period of mood disturbance, at least three of
the following symptoms have persisted (four if the mood
is only irritable) and have been persistent to a significant
degree
– Inflated self esteem or grandiosity
– Decreased need for sleep
– More talkative than usual or pressure to keep talking
– Flight of ideas or subjective experience that thoughts
are racing
Characteristics (Cont.)
– Distractability, i.e. attention too easily drawn to
unimportant or irrelevant external stimuli
– Increase in goal-directed activity or psychomotor
agitation
– Excessive involvement in pleasurable activities
which have a high potential for painful
consequences, e.g. unrestrained buying sprees,
sexual indiscretions, or foolish business
investments
Characteristics (Cont.)




Mood disturbance sufficiently severe to cause marked
impairment in occupational functioning or in usual
social activities or relations with others, or to
necessitate hospitalization to prevent harm to self or
others
At no time during the disturbance have there been
delusions or hallucinations for as long as two weeks
in the absence of prominent mood symptoms
Not superimposed on schizophrenia,
schizophreniform disorder, or delusional disorder or
psychotic disorder NOS
The disturbance is not due to the physiologic effects
of a substance or general medical disorder
Presentations of Bipolar Disorder

Manic

Depressed

Mixed
Types


Type I - manic/mixed episode +/major depressive episode
Type II - hypomanic episode + major
depressive episode
Epidemiology
Lifetime prevalence
 Type I - 0.7 - 0.8%
 Type II - 0.4 - 0.5%
– Equal in males and females
– Increased prevalence in upper
socioeconomic classes

Age of Onset
– Usually late adolescence or early
adulthood. However some after age 50.
Late onset is more commonly Type II.
Genetics



Greater risk in first degree relatives
(4-14 times risk)
Concordance in monozygotic twins
>85%
Concordance in dizygotic twins – 20%
Secondary Causes of Mania
Toxins

Drugs of Abuse
– Stimulants (amphetamines, cocaine)
– Hallucinogens (LCD, PCP)

Prescription Medications
– Common: antidepressants, L-dopa,
corticosteroids
Neurologic




Nondominant frontal CVA
Nondominant frontal tumors
Huntington’s Disease
Multiple Sclerosis
Secondary Causes of Mania
(Cont.)
Infectious


Neurosyphilis
HIV
Endocrine


Hyperthyroidism
Cushing’s Disease
Treatment


Education and Support
Medication
Acute mania
Lithium, Carbamazepine, Valproate,
Lamotrigine, antipsychotics,
benzodiazepines
Long Term Mood Stabilization
Lithium, Carbamazepine, Valproate,
Lamotrigine, possibly atypical
antipsychotics
Course

Acute Episode
– Manic - 5 weeks
– Depressed - 9 weeks
– Mixed - 14 weeks

Long Term
– Variable - most cover fully
– Mean number of lifetime episodes 8-9
Cyclothymic Disorder
Characteristics


For at least two years (one for children and
adolescents) presence of numerous
Hypomanic Episodes and numerous periods
with depressed mood or loss of interest or
pleasure that did not meet criterion A of a
Major Depressive Episode
During a two year period (one year in
children and adolescents) of the
disturbance, never without hypomanic or
depressive symptoms for more than a two
month time
Characteristics (Cont.)



No clear evidence of a Major Depressive
Disorder, or Manic Episode during the first
two years of the disturbance (or one year
for children and adolescents)
Not superimposed on a chronic psychotic
disorder, such as schizophrenia or Delusional
Disorder
Not due to the direct physiologic affects of a
substance or a general medical condition
Epidemiology


Lifetime prevalence 0.4 – 1.0 %
same for males and females
Age of onset
– Usually in adolescence or early adulthood

Genetics
– Major Depression and Bipolar Disorder
more common in first degree relatives
Cyclothymic Disorder
Secondary causes of cyclothymic
disorder


Bipolar Disorder
Mood disorders due to a general medical
condition
Treatment


Initiation of biologic treatment is dependent
on the degree of impairment
If treatment is indicated, it is similar to that