Bipolar I Disorder - DSM V Facts

Characteristics of Bipolar Disorder

• Excessive involvement in high-risk activities, such as buying sprees, sexual indiscretions, or foolish business investments, with a potential for painful consequences.
• Observable mood disturbances and changes in functioning by others.

Etiology of Bipolar Disorder

• Genetic factors: 10-fold increased risk among adult relatives of individuals with bipolar I and bipolar II disorders.
• Shared genetic origin with schizophrenia and major depressive disorder.
• Affects both females and males equally.

Neuroscience

• Disturbances in the brain reward-system.
• Changes in brain activity during episode swings.
• Neurotransmitters involved in episode switching: dopamine, norepinephrine, serotonin, GABA, glutamate, and acetylcholine.

Treatment

• Pharmacotherapy: valproic acid and lithium, with over 60 years of experience in treating bipolar disorder.
• Challenges in treatment: monitoring Li levels, overdose risk, and risk of medication interactions.

Bipolar I Disorder

• 12-month prevalence: 0% to 0.6% across 11 countries, with the highest in the US.
• Gender difference: lifetime male-to-female ratio is 1.1:1.
• Females are more likely to experience rapid cycling and mixed states, and have a higher lifetime risk of alcohol use disorder.
• Mean age at onset: early adulthood, around 18 years old, but late onsets are also possible.

Social Factors

• More common in high-income countries.
• Marital status: separated, divorced, or widowed individuals are more at risk.
• 15 times higher risk of suicidal behavior compared to the general population.
• 30% severe impairment in work functioning.

Bipolar II Disorder

• Lifetime and recurrent, with at least 1 episode of major depression and at least 1 hypomanic episode.
• No manic episodes.
• Creativity may be present in milder cases during hypomanic episodes.
• Worldwide 12-month prevalence: 0.3%.
• Onset in mid 20s, with earlier onset indicating a more severe course.
• Gender differences: slightly more commonly diagnosed in women due to depressive episodes.

Cyclothymic Disorder

• Chronic, fluctuating mood disturbance for at least 2 years.
• Numerous periods of hypomanic and depressive symptoms.
• Symptoms are insufficient to meet full criteria for a hypomanic or major depressive episode.
• Symptoms-free periods do not last longer than 2 months at a time.
• Not caused by a substance or medical condition.
• Leading to distress or impairment in social, occupational, or other important areas of functioning.