Chapter 3

This chapter discusses bipolar disorders, characterized by extreme mood fluctuations, requiring at least one manic episode. BIPOLAR I DISORDER (296) has been recognized as a mental illness since the 19th century, initially termed "manic-depressive psychosis". Patients with bipolar I experience mood extremes, with at least one manic episode. It differs from bipolar II disorder (must have depressive episodes alongside hypomania). The DSM-V replaced the NOS category with an unspecified category for unclear diagnoses and recognizes that anxiety can exacerbate bipolar disorders. Manic episodes last a week, featuring elevated or irritable moods, grandiosity, increased energy, decreased sleep, and impulsivity, but no hallucinations are present. Depressive episodes can lead to psychosis. Patients may experience hypomania, characterized by optimistic moods and productivity, without hallucinations, unlike true mania. Mixed episodes share features of both mania and depression, where suicidality is common. According to DSM-V, manic episodes require an irritable mood with increased activity lasting a week and must meet certain symptom criteria. A lifetime prevalence of bipolar I is about 2%, with genetic components influencing its occurrence. BIPOLAR II DISORDER (296.89) comprises depressive episodes and hypomania, where patients can function better than those with bipolar I. Hypomania does not require hospitalization. Treatment involves a combination of medications and therapies, with psychotherapy often preferred. CYCLOTHYMIC DISORDER (301.13) involves mood cycling over two years without meeting criteria for bipolar I or II disorder (15-50% develop bipolar disorder later). It is characterized by hypomanic and depressive episodes lasting more than half the time and causing functional impairment. Treatments often include mood stabilizers and therapy. MEDICATION OR SUBSTANCE-INDUCED BIPOLAR DISORDER describes mood episodes caused by medications, requiring substantial evidence of temporal relationships between substance use and symptoms. Typical drugs include alcohol and hallucinogens. KEY TAKEAWAYS: Bipolar disorders are distinct categories of mental illness. Strategies for treatment vary based on the disorder type.