The patients with bipolar disorder present with manic episodes characterized by diminished need for sleep, irritability, excessive talking, pressured speech, racing thoughts, excessive pleasurable activities and evidence of distractibility.

Major depressive episodes are characterized by depressed mood, hypersomnia or insomnia, psychomotor retardation, loss of energy, decreased ability to concentrate and even suicidal attempts.

In mixed episodes, the patient experiences both manic disorders and major depression. Depressive events last for at least 1 week. Mood disturbances are unrelated to substance abuse or medical conditions and result in marked depression and disruption of social activities.

• Fatigue

  Individuals with bipolar disorder can quickly swing from extremes of happiness, energy and clarity to sadness, fatigue and confusion. These shifts can be so devastating that individuals may choose suicide. [apa.org]

  Fatigue Fatigue is a common experience for individuals with bipolar disorder. The extreme shifts in mood and energy are exhausting on the body. Fatigue also often results depression or insomnia. [tuck.com]

  Possible benzodiazepine side effects include: Drowsiness or dizziness Lightheadedness Fatigue Blurred vision Slurred speech Memory loss Muscle weakness Benzodiazepines can be habit-forming and addictive. [webmd.com]

  During periods of depression, patients may: Lose interest in regular activities Feel tormented Become bored easily Feel fatigued Be pessimistic Some may even develop suicidal thoughts, which may lead to attempted suicide. [bumrungrad.com]

• Weight Gain

  Mean weight gain with placebo was 0.4 kg, and for both quetiapine groups was 1.7 kg. The rates of clinically significant (≥7%) weight gain were 12.2% with quetiapine and 0% with placebo, resulting in an NNH for ≥7% weight gain of 8.2. [ncbi.nlm.nih.gov]

• Weight Loss

  Participants of the intensive weight loss program lost 7 pounds more weight. What’s more, they didn’t gain the weight back, even one year later. [bpkids.org]

  Although the data on weight loss were not analysed formally, weight loss was marked in the topiramate treated group. Several unpublished trials have been identified and data from these trials may be included in future reviews. [ncbi.nlm.nih.gov]

  Weight loss was reported in each of the treatment groups. The mean weight loss was 5.8 kilograms (kg) in the topiramate treated group and 1.2 kg in the bupropion SR treated group. [doi.org]

  […] sex Decreased energy, a feeling of fatigue or of being "slowed down" Difficulty concentrating, remembering, making decisions Restlessness or irritability Sleeping too much, or having trouble sleeping Change in appetite or unintended weight loss or gain [adaa.org]

• Hypersomnia

  Hypersomnia presents as excessive daytime sleepiness with a prevalence of 7.1% in general population. Hypersomnia has serious negative effects on persons functioning. [ncbi.nlm.nih.gov]

  Hypersomnia Hypersomnia is the opposite of insomnia. It describes over-sleeping, and it affects one-third of individuals with bipolar disorder. By contrast, it only affects 4 to 6% of the general population. [tuck.com]

  Major depressive episodes are characterized by depressed mood, hypersomnia or insomnia, psychomotor retardation, loss of energy, decreased ability to concentrate and even suicidal attempts. [symptoma.com]

  Other potential symptoms include: Significant weight loss when not dieting or weight gain and changes in appetite Insomnia or hypersomnia nearly every day Psychomotor agitation or retardation nearly every day Fatigue or loss of energy nearly every day [psycom.net]

• Anorexia

  While in many cases bipolar disorder can be treated very effectively in an outpatient setting, it can also pose a grave challenge for suffers who also have symptoms of drug addiction, alcohol abuse or eating disorders, such as anorexia or bulimia. [timberlineknolls.com]

  Show less Web Resource When she was only 18, Emma began filming her own struggle with anorexia all the way to her death. [kcls.bibliocommons.com]

  Anorexia nervosa is an eating disorder characterized by an extreme fear of gaining weight or getting fat. Those with this disorder often have a body weight of less than 85 percent of that which is considered normal. [verywellmind.com]

  Patients will also often have considerable anxiety and sometimes an eating disorder (such as anorexia). [healthengine.com.au]

  Anorexia nervosa. Cerebrovascular event. Dementia. Other psychiatric disorders - eg, schizophrenia, schizoaffective disorder, cyclothymia. Medications - eg, steroids, isoniazid, L-dopa, sympathomimetic amines. Chronic kidney disease. [patient.info]

• Overeating

  A patient presenting with bipolar I disorder and comorbid anxiety, ADHD, and dyslexia was taught deep touch pressure strategies to alleviate severe symptoms of sensory over-responsivity and anxiety. [ncbi.nlm.nih.gov]

  Osmani gave smartphones to 12 patients with bipolar disorder and monitored their activity over a period of 12 weeks in 2012 and 2013. [technologyreview.com]

  Differences in methodology contribute to the perception that rates of BD have increased over time. Rates varied markedly by geographic region, even after controlling for all other predictors. [doi.org]

  There are several types of bipolar disorder, in which the states of mania and depression may alternate cyclically, one mood state may predominate over the other, or they may be mixed or combined with each other. [britannica.com]

• Increased Appetite

  AgRP regulates energy metabolism by increasing appetite and decreasing energy expenditure. The resting energy expenditures of patients with manic bipolar disorder are higher than those of controls. [ncbi.nlm.nih.gov]

  The most frequently reported adverse events were somnolence, weight gain, dry mouth, increased appetite, and headache. At endpoint, there were no clinically meaningful changes in vital signs, laboratory analytes, or electrocardiography. [biopsychiatry.com]

  appetite Loss of interest in activities once considered enjoyable Problems concentrating Chronic pain without a known cause If you or someone you love is suffering from these symptoms, please call 1-888-319-2606 Who Answers?. [recovery.org]

  Add to this the fact that bipolar disorder medications increase appetite in people, and we have a problem in our hands that is almost unsolvable. [bpkids.org]

  Tips Report any symptoms of increased thirst, increased urination, increased appetite or weakness to your doctor. May be administered with or without food. Olanzapine is available as orally-disintegrating tablets (Zyprexa Zydis). [drugs.com]

• Constipation

  […] reduced ability to think clearly or make decisions difficulties in concentrating or with short-term memory loss constantly feeling tired noticeable lack of motivation anxiety and restlessness, sometimes leading to panic attacks muscle and joint pain constipation [canada.ca]

  Feeling restless and agitated Loss of self-confidence Feeling useless, inadequate and hopeless Feeling more irritable than usual Thinking of suicide Physical Symptoms: Loss of appetite and weight Difficulty in getting to sleep Waking earlier than usual Constipation [heretohelp.bc.ca]

  […] inhibitors (SNRIs) include: Tricyclic antidepressants are an older class of antidepressants that while effective for some people do carry a large side effect profile including heart arrhythmias and anticholinergic side effects like dry mouth, sedation, and constipation [verywellmind.com]

  Downsides If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include: Dizziness, a drop in blood pressure on standing, inner restlessness, constipation [drugs.com]

  Common side effects of clozapine include tachycardia (rapid heart rate), hypotension, constipation, and weight gain. [medical-dictionary.thefreedictionary.com]

• Abdominal Pain

  However, the patient complained of severe abdominal pain. Blood amylase was found to be markedly high, and computed tomography revealed pancreatomegaly and an increased amount of peripancreatic fat. [ncbi.nlm.nih.gov]

  His life was also made miserable by chronic diarrhea, abdominal pain, chronic respiratory illness, depression, and alcohol abuse. [nejm.org]

  Some of these effects include: abdominal pain diarrhea nausea vomiting Such symptoms are often accompanied with feelings of panic, or a sense of impending doom. You might also sweat and breathe rapidly. [healthline.com]

• Motor Restlessness

  Extrapyramidal effects often manifest early and can include akathisia (i.e., subjective sense of motor restlessness); parkinsonism (i.e., cogwheel rigidity of tendons, masked facies, or muscle stiffness or rigidity); and other movement disorders, such [aafp.org]

• Mood Swings

  Usually medication can help control the mood swings. [baltimorepsych.com]

  Bipolar I Disorder Symptoms of Bipolar I Disorder Bipolar I disorder can cause dramatic mood swings. [psychiatry.org]

  The most prominent signs of bipolar disorder in children and teenagers may include severe mood swings that are different from their usual mood swings. [mayoclinic.org]

  The list goes on, but the gist remains the same – you’ve got mood swings that are more severe and disruptive than normal mood swings, yet not characterized by total manic breaks as in a bipolar II diagnosis. [vantagepointrecovery.com]

  The physician will also ask about any mood swings experienced recently, and take a history of the mood swings including when they began. [psychguides.com]

• Anxiety Disorder

  These people may be suffering from an anxiety disorder, bipolar disorder, or both. It is not uncommon for someone with an anxiety disorder to also suffer from bipolar disorder. [adaa.org]

  […] a current anxiety disorder reached 30.5%; comorbid anxiety tended to be more common in patients with bipolar I disorder compared with bipolar II. 11 Anxiety may be interwoven into the fabric of syndromic bipolarity, may occur alongside it as a comorbid [web.archive.org]

  Myths and Facts Recovery Is Possible What To Look For Anxiety Disorders Behavioral Disorders Eating Disorders Mental Health and Substance Use Disorders Mood Disorders Obsessive-Compulsive Disorder Personality Disorders Psychotic Disorders Suicidal Behavior [mentalhealth.gov]

  Bipolar disorder is a developing disorder; its early stages are sometimes misdiagnosed as anxiety or depressive disorders. At the same time, these disorders are often in comorbidity with bipolar disorder. [ncbi.nlm.nih.gov]

• Impulsivity

  Regression analysis showed that hemodynamic changes were significantly correlated with verbal memory and impulsivity in both disorders. [ncbi.nlm.nih.gov]

  […] high-risk behaviors, such as spending sprees, impulsive sex, drug or alcohol use, and impulsive business investments suicide attempts When a person suffering with bipolar disorder enters a depressive phase, the signs and symptoms create a stark contrast [timberlineknolls.com]

• Distractibility

  Mania is a mood disturbance that is characterized by abnormally intense excitement, elation, expansiveness, boisterousness, talkativeness, distractibility, and irritability. [britannica.com]

  Mania is a state in which you have abnormally high energy and confidence, are easily distracted, and make risky decisions. [msdmanuals.com]

  […] degree. 1. inflated self-esteem or grandiosity 2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep) 3. more talkative than usual or pressure to keep talking 4. flight of ideas or subjective experience that thoughts are racing 5. distractibility [web.archive.org]

  […] significant degree: inflated self-esteem or grandiosity decreased need for sleep (e.g., feels rested after only 3 hours of sleep) more talkative than usual or pressure to keep talking flight of ideas or subjective experience that thoughts are racing distractibility [med.stanford.edu]

• Delusion

  Delusions Two types of delusions can occur during a manic episode: grandiose or persecutory delusions. [blackdoginstitute.org.au]

  Two common types of delusions are: Grandiose delusions--People with delusions of grandeur may exhibit a drastically exaggerated sense of self-importance or may believe that they are a famous person or religious figure. [suicide.org]

  A review of case reports suggests a possible relationship between somatic delusions and affective disorders. [ncbi.nlm.nih.gov]

• Sexual Dysfunction

  Study investigators conclude, “These analyses support the findings that switching SSRI antidepressant therapy to vortioxetine in well-treated adult MDD patients experiencing treatment-emergent sexual dysfunction can improve sexual dysfunction regardless [psychiatryadvisor.com]

  Increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation 7. [aafp.org]

  Other sexual problems are described in this article, as are possible treatment options for sexual dysfunction. [rockwellsband.com]

• Irritability

  With an irritable mood, four additional symptoms must be present for a diagnosis. [adaa.org]

  It's still a distinct period (at least four consecutive days) of abnormally and persistently elevated or irritated mood and increased energy and activity. [blackdoginstitute.org.au]

  If the mood of the patient is irritable and not elevated, four of the symptoms are required. [medical-dictionary.thefreedictionary.com]

  This condition is marked by irritability and sudden mood swings, and has no specific diagnostic criteria. Disagreement is even greater for bipolar disorder in preschool age. [ncbi.nlm.nih.gov]

• Hyperactivity

  At one end of this spectrum, patients experience extreme highs and hyperactivity, while at the other they feel devastatingly low and lethargic. [technologyreview.com]

  Bipolar children are easily distracted, impulsive, and hyperactive, which can lead to a misdiagnosis of ADHD. Furthermore, their aggression often leads to violence, which may be misdiagnosed as a conduct disorder. [medical-dictionary.thefreedictionary.com]

  Keywords Attention Deficit Hyperactivity Disorder Bipolar Disorder Attention Deficit Hyperactivity Disorder Conduct Disorder Oppositional Defiant Disorder These keywords were added by machine and not by the authors. [doi.org]

  While the Greeks did indeed speak of mania and melancholia, these terms covered all sorts of hyperactive deliriums and lethargic stupors, the majority of which were probably caused by infectious or post-infectious states, or perhaps by Parkinson’s disease [web.archive.org]

  Converseley, an understanding of the common mechanisms of sensitisation (such as regionally selective alterations in brain derived neurotrophic factor (BDNF) and hyperactivity of striatally based habit memories), could also result in single therapies [ncbi.nlm.nih.gov]

• Agitation

  He was psychiatrically hospitalized for agitation, aggression, and manic symptoms including insomnia, rapid and pressured speech, and hyperactivity. After multiple medication trials, ECT was recommended. [ncbi.nlm.nih.gov]

  They have all of the negative feelings that come with depression, but they also feel agitated, restless and activated, or "wired." Those who have had a mixed state often describe it as the very worst part of bipolar disorder. [dbsalliance.org]

  Agitation. Agitation, prominent in depressive, manic, and mixed states, includes two basic disturbances ( 35 ). [doi.org]

  Aside from depressed mood, depression episodes may also be accompanied by sleep problems, apathy or agitation, loss of energy, suicidal thoughts and more, according to the NIMH. [livescience.com]

  Note: in children, consider failure to make expected weight gains. insomnia or hypersomnia nearly every day psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down [med.stanford.edu]

• Insomnia

  […] with insomnia ( Erman et al., 2008 ). [ncbi.nlm.nih.gov]

  Many experience vivid dreams and nightmares, coupled with either insomnia or too much sleep, depending on whether they're in a manic or depressive episode. [bipolar.about.com]

  Psychotherapy for Bipolar Insomnia The primary psychotherapeutic treatment of insomnia is cognitive-behavioral therapy for insomnia (CBT-I). [ajp.psychiatryonline.org]

  Insomnia Insomnia describes difficulty falling or staying asleep. A person with insomnia may take an hour or more to fall asleep. Once they finally do fall asleep, the sleep they experience is low-quality. [tuck.com]

• Excitement

  Depressive, positive, negative, excitement and disorganised domains were detected in SCH sample, whereas depressive, excitement and psychotic appeared for BD [ 14, 15, 16, 17, 18 ]. [doi.org]

  An anxious mood may shift into an excited mood with a simple change of perspective, and a depressed mood may shift into a happier one upon hearing pleasing news. [mentalhelp.net]

  In bipolar disorder, periods of intense elation and excitation (mania) alternate with periods of depression and despair. Mood may be normal in between these periods. [msdmanuals.com]

  Bipolar used to be known as 'manic depression', because people tend to experience extreme moods – both low (depressed), and high or excited (manic). [beyondblue.org.au]

The diagnosis of bipolar disorder is mainly clinical. The following investigations may be helpful in the diagnosis.

Laboratory investigations:

• The level of thyroid hormones should be evaluated to rule out hypothyroidism (which causes depression) and hyperthyroidism (which causes mania).
• Erythrocyte sedimentation rate should also be measured to rule out any infection.
• Drug and alcohol screening should also be done.
• Liver function tests and tests for rapid plasma reagent (RPR) are also important.

Imaging studies:

Brain imaging via CT scan (computerized tomography) or MRI (magnetic resonance imaging) should also be done to rule out infections, stroke or tumor.

Procedures:

Electroencephalography should be done if temporal lobe epilepsy is suspected.

The treatment of bipolar disorder directly depends upon severity of disease. In severe disease, the patient should be hospitalized. Less severe cases can be treated on an outpatient basis.

A number of drugs are used to reduce anxiety and depression in these patients. These including antipsychotics, valproate and benzodiazepines.

Manic episodes are usually treated with lithium, which may also have a neuro-protective role [10].

Certain lifestyle changes are also associated with a better prognosis. Patients with bipolar depressive illness are advised to have adequate levels of omega-3 in their diet [11]. Salt intake should be reduced. They should also be encouraged to plan a proper exercise schedule.

Bipolar disorder is a severely impairing illness and has a deep impact on many aspects of the life of the patient [7]. A typical patient with bipolar disorder has an average of 8 to 10 manic episodes over a lifetime. It is not yet clear how frequently childhood disorder persists into adulthood or as future illness.

Patients suffering from bipolar disorder also have an increased risk for the development of respiratory and circulatory disorders [8]. Owing to these co-morbidities, the patients suffering from bipolar disorder die an average of 9 years earlier as compared to the normal population [9].

Genetic predisposition plays a key role in the development of this disease. Major life stressors and external factors can trigger the initial and subsequent episodes.

Genetic factors

Bipolar disorder has a well-documented genetic predisposition. The concordance of this disease in monozygotic twins is around 40 to 70% whereas in dizygotic twins, it is 5 to 25%. 50% of the patients have atleast one parent with a mood disorder.

The major genes involved in the development of bipolar disorder are the ANK3, CACNA1C and CLOCK genes [1] [2].

Biochemical factors

Drugs that increase the levels of monoamine neurotransmitters (such as serotonin, norepinephrine and dopamine) can cause bipolar disorder. High glutamate level are also known to have an association. Calcium channel blockers and hormonal imbalances may also contribute to bipolar disorder.

Environmental factors

External pressure and work load may also be a cause of increased stress in these patients. Pregnancy, for example, is a particular stress for women with a manic-depressive illness history.

Bipolar disorder is one of the most common mental illnesses. The age of onset is usually 15 to 30 years. The incidence is greater in the higher socioeconomic classes.

In the United States, the prevalence of bipolar disease varies from 1 to 1.6%. Studies indicate differences in prevalence of bipolar disease to be 1.0% for bipolar I disease and 1.1% for bipolar II disease [3].

Worldwide, the prevalence rate is 0.3-1.5%. The lifetime prevalence for bipolar disorder (BP-I) is 0.6%. For bipolar II disorder (BP-II), the prevalence is 0.4% whereas for sub-threshold bipolar disorder, it is 1.4% [4].

Patients suffering from bipolar disorder also commonly suffer from other disorders such as cardiovascular disease, diabetes mellitus, obesity and mental disorders [5]. These disorders are the major source of mortality and morbidity in these patients.

The pathophysiology of bipolar disorder is not fully understood.

The role of genetic factors in predisposing the patient to this disease is well-documented. The underlying dysregulation of biogenic amines or neurotransmitters (especially serotonin, norepinephrine and dopamine) is also well known.

Magnetic resonance imaging (MRI) findings suggest abnormalities in the prefrontal cortical areas, striatum and amygdala.

Functional neuroimaging studies also reveal the presence of hyperactivity and hypoactivity in certain regions of the brain in this illness [6].

Bipolar disorder cannot be prevented; however, the mood swings can be controlled by medication.

Bipolar disorder is a group of mood disorders that are characterized by episodes of mania and depression. Bipolar disorder has two common types; bipolar I (BP-I) and bipolar II (BP-II).

Bipolar I disorder is the more severe of the two and is characterized by at least one manic or mixed episode alternating with episodes of major depression. It causes marked impairment and requires hospitalization.

In contrast, bipolar II disorder is characterized by at least one episode of major depression and at least one episode of a mild form of mania (hypomania).

Bipolar disorder is a common severe and persistent mental illness which is characterized by episodes of depression and irritability. The disease is commonly diagnosed around the age of 21 years. The severity of the disease varies from patient to patient. Medications can be used to control depression and mood swings in these patients.

1. Sklar P, Smoller JW, Fan J, et al. Whole-genome association study of bipolar disorder. Molecular psychiatry. Jun 2008;13(6):558-569.
2. Baum AE, Akula N, Cabanero M, et al. A genome-wide association study implicates diacylglycerol kinase eta (DGKH) and several other genes in the etiology of bipolar disorder. Molecular psychiatry. Feb 2008;13(2):197-207.
3. Calabrese JR. Overview of patient care issues and treatment in bipolar spectrum and bipolar II disorder. The Journal of clinical psychiatry. Jun 2008;69(6):e18.
4. Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of general psychiatry. Mar 2011;68(3):241-251.
5. Price AL, Marzani-Nissen GR. Bipolar disorders: a review. American family physician. Mar 1 2012;85(5):483-493.
6. Houenou J, Frommberger J, Carde S, et al. Neuroimaging-based markers of bipolar disorder: evidence from two meta-analyses. Journal of affective disorders. Aug 2011;132(3):344-355.
7. Ketter TA. Diagnostic features, prevalence, and impact of bipolar disorder. The Journal of clinical psychiatry. Jun 2010;71(6):e14.
8. Hoang U, Stewart R, Goldacre MJ. Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006. Bmj. 2011;343:d5422.
9. Crump C, Sundquist K, Winkleby MA, Sundquist J. Comorbidities and mortality in bipolar disorder: a Swedish national cohort study. JAMA psychiatry. Sep 2013;70(9):931-939.
10. Bauer M, Alda M, Priller J, Young LT, International Group For The Study Of Lithium Treated P. Implications of the neuroprotective effects of lithium for the treatment of bipolar and neurodegenerative disorders. Pharmacopsychiatry. Nov 2003;36 Suppl 3:S250-254.
11. Sarris J, Mischoulon D, Schweitzer I. Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. The Journal of clinical psychiatry. Jan 2012;73(1):81-86.