Bipolar disorder
A recurrent mood disorder defined by episodes of mania or hypomania, often with depression, requiring urgent risk assessment, polarity-specific treatment and long-term relapse prevention.
Definition
Bipolar disorder is a mood disorder characterised by episodes of mania or hypomania and often depression, separated by periods of euthymia or residual symptoms. Bipolar I includes mania; bipolar II includes hypomania with major depressive episodes.
First principles
The diagnostic pivot is a past elevated episode
Bipolar depression can look like unipolar depression, so the key diagnostic question is whether there has ever been a distinct episode of mania or hypomania with a clear change from baseline. Ask about reduced need for sleep, increased energy, pressured speech, racing thoughts, grandiosity, disinhibition and functional change, and obtain collateral history because insight and recall may be limited during episodes.
This page is exam revision material, not medical advice, and must not be used for patient care. Always check drug doses against the BNF and current guidance. Full disclaimer.