psychiatric disorders
Bipolar Disorders
Key Points
Bipolar disorder is a cyclic condition that involves episodes of mania with or without depression (bipolar I) or hypomania plus depression (bipolar II). Bipolar disorder markedly impairs the ability to function at work and to interact socially, and risk of suicide is significant; however, mild manic states (hypomania) are sometimes adaptive because they can produce high energy, creativity, confidence, and supernormal social functioning. Length and frequency of cycles vary among patients; some patients have only a few over a lifetime, whereas others have≥4 episodes/year (rapid-cycling forms). Only a few patients alternate back and forth between mania and depression during each cycle; in most cycles, one or the other predominates. Diagnosis is based on clinical criteria, but stimulant use disorder and general medical disorders (such as hyperthyroidism or pheochromocytoma) must be ruled out by examination and testing. Treatment depends on the manifestations and their severity but typically involves mood stabilizers (eg,lithium, valproate,carbamazepine,lamotrigine) and/or second-generation antipsychotics (eg,aripiprazole,lurasidone,olanzapine,quetiapine,risperidone,ziprasidone,cariprazine). 