Bipolar I disorder

Bipolar I disorder is a mood disorder that is characterized by at least one manic or mixed episode. Bipolar I disorder sometimes occurs along with episodes of hypomania or major depression as well. It is a sub-diagnosis of bipolar disorder, and conforms to the classic concept of manic-depressive illness.

DSM-IV-TR diagnostic criteria
The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes (DSM-IV-TR, 2000). Often, individuals have had one or more major depressive episodes. Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, drug abuse, or toxin 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. In addition, the episodes must not be better accounted for by schizoaffective disorder or superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or a psychotic disorder not otherwise specified.

Medical assessment
Routine medical assessments are often prescribed to rule-out or identify a somatic cause for bipolar I symptoms. These tests can include ultrasounds of the head, x-ray computed tomography (CAT scan), electroencephalogram, HIV test, full blood count, thyroid function test, liver function test, urea and creatinine levels and if patient is on lithium, lithium levels are taken. Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins.

Medication
Mood stabilizers are often used as part of the treatment process.
 * 1) Lithium carbonate, the mainstay in the management of bipolar disorder, but it has a narrow therapeutic range and typically requires monitoring
 * 2) Anticonvulsants, such as sodium valproate, carbamazepine or lamotrigine
 * 3) Antipsychotics, such as quetiapine, risperidone, olanzapine or aripiprazole
 * 4) Electroconvulsive therapy, a psychiatric treatment in which seizures are electrically induced in anesthetized patients for therapeutic effect

Some antidepressants have been found to precipitate a manic episode.

Patient education
Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance of compliance with medication as prescribed. Behavior modification through counselling can have positive influence to help reduce the effects of risky behavior during the manic phase.

Proposed revisions in diagnostic criteria for DSM-5
The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is to be released in May 2013. 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: with Psychotic Features, with Mixed Features, with Catatonic Features, with Rapid Cycling, with Anxiety (mild to severe), with Suicide Risk Severity, with Seasonal Pattern, and with Postpartum Onset. Bipolar I Disorder 296.5x Most Recent Episode Depressed will include all of the above specifiers plus the following: with Melancholic Features and with Atypical Features. The categories for specifiers will be removed in DSM-5 and part A will add “or there are at least 3 symptoms of Major Depression of which one of the symptoms is depressed mood or anhedonia. For Bipolar I Disorder 296.7 Most Recent Episode Unspecified, the listed specifiers will be removed. The criteria for manic and hypomanic episodes in parts A & B will be edited. Part A will include “and present most of the day, nearly every day,” and part 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. There have also been proposed revisions to part B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Part 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 of ADHD (Attention Deficit Hyperactivity Disorder).

Note that many of the above changes are still under active consideration and are not definite. For more information regarding proposed revisions to the DSM-5, please visit their website at dsm5.org. For a helpful guide to understanding the DSM-IV, please visit their website at dsmiv.net.

ICD-10 diagnostic criteria

 * F31 Bipolar Affective Disorder
 * F31.6 Bipolar Affective Disorder, Current Episode Mixed
 * F30 Manic Episode
 * F30.0 Hypomania
 * F30.1 Mania Without Psychotic Symptoms
 * F30.2 Mania With Psychotic Symptoms
 * F32 Depressive Episode
 * F32.0 Mild Depressive Episode
 * F32.1 Moderate Depressive Episode
 * F32.2 Severe Depressive Episode Without Psychotic Symptoms
 * F32.3 Severe Depressive Episode With Psychotic Symptoms