The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update

Abstract

Bipolar disorders, including bipolar I disorder (BP-I) and bipolar II disorder (BP-II), are common, potentially disabling, and, in some cases, life-threatening conditions. Bipolar disorders are characterized by alternating episodes of mania or hypomania and depression, or mixtures of manic and depressive features. Bipolar disorders present many diagnostic and therapeutic challenges for busy clinicians. Adequate management of bipolar disorders requires pharmacotherapy and psychosocial interventions targeted to the specific phases of illness. Effective treatments are available for each illness phase, but mood episode relapses and incomplete responses to treatment are common, especially for the depressive phase. Mood symptoms, psychosocial functioning, and suicide risk must, therefore, be continually reevaluated, and, when necessary, the plan of care must be adjusted during long-term treatment. Many patients will require additional treatment of comorbid psychiatric and substance use disorders and management of a variety of commonly co-occurring chronic general medical conditions.

Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries

“…BD is not just one disorder but several, with the age at onset typically being late adolescence into young adulthood [66][67][68][69][70][71]. BP-I (Bipolar I) is characterized by episodes of mania.…”

<p>Comorbid Premenstrual Dysphoric Disorder in Women with Bipolar Disorder: Management Challenges</p>

“…10,11 BD is a serious psychiatric illness, defined by recurrent depressive, manic and mixed episodes, separated by periods of clinical remission, with an estimated lifetime prevalence of 3-7%. 12,13 In a large community sample, the prevalence of BD in women with PMDD was about 10%, seven-times higher than what observed in those without PMDD. 14 A systematic review conducted in 2014 reported that 15-27% of women with BD met an adjunctive diagnosis of PMDD, supporting the hypothesis that a subgroup of BD may have a hormonal sensitivity.…”

Pharmacogenomic Characterization in Bipolar Spectrum Disorders

“…One important and recent development in the area of mood disorders is the recognition that many patients initially suspected suffering from major depressive disorder suffer instead from a form of bipolar disorder (BD) [1]. Symptomatic bipolar disorder patients are more frequently in the depressive condition rather than in hypomanic, manic, or mixed states [1][2][3].…”

“…One important and recent development in the area of mood disorders is the recognition that many patients initially suspected suffering from major depressive disorder suffer instead from a form of bipolar disorder (BD) [1]. Symptomatic bipolar disorder patients are more frequently in the depressive condition rather than in hypomanic, manic, or mixed states [1][2][3]. As a consequence, such patients can be improperly diagnosed as suffering from major depression and prescribed antidepressants instead of the lithium, atypical antipsychotics, or antiepileptic-type mood stabilizers normally used to treat bipolar spectrum disorders [2,3].…”

“…As a consequence, such patients can be improperly diagnosed as suffering from major depression and prescribed antidepressants instead of the lithium, atypical antipsychotics, or antiepileptic-type mood stabilizers normally used to treat bipolar spectrum disorders [2,3]. Up to 50% of the patients once identified as suffering from unipolar depression are now recognized to be suffering from a bipolar spectrum disorder [1][2][3]. Antidepressant treatment of unrecognized bipolar patients can increase the cyclical nature of the mood disorder, mixed states, and conversion to hypomania and mania, and can also contribute to increase suicide in younger patients (<25 years) [4][5][6].…”