Bipolar Disorder

Aka: Bipolar Disorder, Bipolar Depression, Bipolar I Disorder, Bipolar II Disorder, Bipolar 1 Disorder, Bipolar 2 Disorder, Mania, Manic Depression, Manic Disorder, Hypomania, Cyclothymia, Cyclothymic Disorder

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II. Epidemiology

  1. Bipolar Incidence: 1% of adults (United States)
  2. Gender predisposition: Men and women equally affected
  3. Age of onset: Early adulthood to mid-40s
  4. Affective disorder Family History confers risk
    1. One parent with affective disorder: 27%
    2. Two parents with affective disorder: 50-75%
  5. Mean age onset
    1. Bipolar I: Age 18 years
    2. Bipolar II: Age 22 years
  6. Llifetime Incidence
    1. Bipolar I: 0.6%
    2. Bipolar I: 0.4%

III. Risk Factors

  1. Family History of affective disorder or Bipolar Disorder (see epidemiology as above)
  2. Stressful life events
    1. Acute stress often triggers initial episode
    2. Childhood Trauma and adverse events
  3. Family member Suicide
  4. Disrupted sleep cycle

IV. Pathophysiology

  1. Related to noradrenergic system (Norepinephrine)

V. Types

  1. Bipolar I Disorder
    1. Mania Diagnosis criteria met
    2. Psychosis may be present
    3. Major Depression may be present
  2. Bipolar II Disorder
    1. Recurrent Major Depression
    2. Hypomanic episodes that do not meet criteria for Mania Diagnosis
  3. Cyclothymic Disorder (Cyclothymia)
    1. Depressive symptoms that do not meet criteria for Major Depression
    2. Hypomanic episodes that do not meet criteria for Mania Diagnosis
    3. Bipolar II Diagnosis not met
    4. Occurs for over 2 years, and with only two months or less symptom free
  4. Bipolar Disorder with Mixed Features
    1. Concurrent features of Hypomania/mania and depression
  5. Substance-Induced Mania
    1. See Substance-Induced Psychotic Disorder
    2. Examples: Methamphetamine, Cocaine, Alcohol, Corticosteroids
  6. Miscellaneous
    1. Bipolar Disorder not otherwise specified (does not meet criteria for other Bipolar Disorders)
    2. Bipolar Disorder unspecified (unconfirmed diagnosis for acute presentation)

VI. History

  1. Recurrent Major Depression
    1. Typically onset by age 13 years
    2. May present as Seasonal Affective Disorder (seasonal variability to depression episodes)
    3. Failed response to at least three Antidepressants
    4. Atypical Depression
    5. Hypersomnia
    6. Pathologic guilt
    7. Labile Mood or significant irritability
  2. Attempted Suicide
  3. Manic symptoms
    1. Mania or Hypomania episodes
    2. Periods of intense goal oriented activity
    3. Decreased need for sleep
    4. Racing thoughts interfere with sleep
    5. Psychosis
    6. Agitation or mania caused by Antidepressant, Corticosteroid or other medication
    7. Episodic hypersexuality
    8. Impulsive or irrational behavior
  4. Comorbid mental health disorders (up to 75% have 3 concurrent mental health disorders)
    1. See associated conditions as below
    2. Substance Use Disorder (Drug Abuse or Alcohol Abuse)
    3. Anxiety Disorder
    4. Attention Deficit Disorder
  5. Family History
    1. Bipolar Disorder Family History
    2. Multiple relatives with Major Depression, Anxiety Disorder, Panic Disorder or Attention Deficit Disorder
    3. Multiple relatives with Suicidality, incarceration, Drug Abuse or Alcohol Abuse
  6. Impaired social functioning
    1. Multiple divorces
    2. Legal or financial problems
    3. Recurrent job loss
  7. Triggers
    1. Emotional Stressors
    2. Serious life events
    3. Hormonal fluctuations in women (pregnancy, Menopause, Menses)
    4. Sleep disruptions (see symptoms below)
    5. Seasonal pattern (25% of cases)

VII. Symptoms: Adults

  1. Maintains several days with reduced sleep and without feeling tired
  2. Frequent mood swings (or mood lability) or periods of intense goal orientation
  3. Racing thoughts interfere with sleep onset
  4. Sleep disruptions trigger mania or Hypomania
    1. Seasonal changes in spring and fall
    2. Jet Lag on time zone changes
    3. Shift work or child care
  5. Associated symptoms
    1. Irritability
    2. Impulsivity
    3. Irrationality

VIII. Symptoms: Children

  1. Present with irritability, sadness and Insomnia (euphoria is typically absent)

IX. Symptoms: Miscellaneous Features Present in Some Bipolar Patients

  1. Anxious Distress
    1. Feeling restless, Excessive Worry, loss of control
    2. Associated with increased Suicidality risk
  2. Atypical features
    1. Depression related sleeping more and eating more
  3. Catatonic State
  4. Melancholia
  5. Psychotic features
  6. Rapid Cycling (Bipolar 1 Disorder)

X. Exam

  1. Background
    1. Thorough evaluation provides baseline before medications and evaluates for secondary causes and complications
  2. Obtain full Vital Signs
    1. Body Mass Index (BMI)
    2. Blood Pressure
    3. Waist Circumference
  3. Full physical exam
  4. See Mental Status Exam
  5. See Psychosis Exam
  6. Neurologic Exam including gait

XI. Differential Diagnosis

  1. See Mania Secondary Causes
  2. Personality Disorder
  3. Recurrent Major Depression
  4. Schizophrenia
  5. Obsessive-Compulsive Disorder

XII. Associated Conditions

  1. Anxiety Disorder
  2. Impulse Control
  3. Attention Deficit Disorder
  4. Substance Use Disorder
  5. Cardiovascular Disease
    1. Bipolar disease patients have twice the risk of cardiovascular disease than general population
    2. Screen for Cardiovascular Risk Factors

XIII. Diagnosis

  1. Specific Bipolar Disorder diagnosis (see Types above) rely on diagnostic criteria for Major Depression and mania/Hypomania
  2. See Major Depression Diagnosis
  3. See Mania Diagnosis
  4. See Hypomania Diagnosis

XIV. Grading: Severity

  1. Mild
    1. Diagnosis criteria met
    2. Mild functional Impairment
  2. Moderate
  3. Severe
    1. Severe distress and functional Impairment

XV. Labs: Consider for evaluation of secondary causes

  1. Highest yield tests
    1. Thyroid Function Tests (Thyroid Stimulating Hormone)
    2. Urine Drug Screen
    3. Urinalysis
      1. Older patients to evaluate for Urinary Tract Infection
  2. Sexually Transmitted Diseases
    1. Syphilis Serology (e.g. RPR)
    2. HIV Test
    3. Hepatitis C
  3. Uncommon to rare causes
    1. Heavy Metal levels
    2. Serum Ammonia level

XVI. Labs: Consider for baseline labs prior to starting medications

  1. Complete Blood Count
  2. Chemistry panel with Renal Function tests
    1. Serum Sodium
    2. Serum Creatinine
    3. Serum Glucose
  3. Liver Function Tests
  4. Serum Prolactin
    1. Antipsychotics may increase Prolactin levels
    2. Consider in patients with Amenorrhea, Galactorrhea, Gynecomastia
  5. Urine Pregnancy Test
  6. Electrocardiogram (for baseline QT Interval)
    1. Many neuropsychiatric medications risk QT Prolongation
    2. Also provides baseline EKG due to Bipolar Disorder associated cardiovascular disease risk
  7. Cardiovascular Disease Risk Screening
    1. Fasting Glucose
    2. Lipid Profile

XVII. Diagnostics: Consider if suggested by history or examination

  1. Head MRI
  2. Electroencephalogram (EEG)

XVIII. Management: General

  1. Continue mood stabilizers indefinately due to high relapse rate
  2. Consult psychiatry for comanagement
  3. Discuss Teratogenicity of medications with women of child bearing age
    1. Reliable Contraception is critical
  4. Do not use Antidepressants as monotherapy for mania, mixed disorder or Bipolar Disorder
    1. High risk of triggering manic episode
  5. Avoid medications that are more likely to trigger or exacerbate mania
    1. Avoid Trazodone
    2. Avoid Tricyclic Antidepressants
    3. Avoid SNRIs (e.g. Venlafaxine or Duloxetine)
  6. Patient should keep their own of medications, adverse effects and effectiveness
  7. Employ behavioral management as a first line therapy to reduce psychosocial stress
    1. Cognitive Behavioral Therapy
    2. Caregiver Support
    3. Regular Exercise
    4. Coping Strategy education
    5. Well Balanced Nutrition
    6. Intensive psychotherapy for exacerbations
  8. Manage comorbidity
    1. Alcohol Abuse
    2. Tobacco Abuse
    3. Drug Abuse
  9. Patients and their family should be aware of early warning signs of relapse and emergency features
    1. Sleep disturbance
    2. Agitation
    3. Increased goal oriented activity
    4. Disrupted routine
    5. Suicidality
    6. Homicidality
  10. Clinicians should be alert for Extrapyramidal Side Effects (and modify therapy to reduce adverse effects)
    1. Perform Abnormal Involuntary Movement Scale (AIMS) at least every 6 months while on Antipsychotic Medications
      1. https://dmh.mo.gov/media/21821/download
    2. Akathisia
      1. Motor restlessness (differentiate from worsening mania, anxiety)
      2. May increase Suicidality
    3. Parkinsonism
    4. Dystonia
    5. Dyskinesia
    6. Tardive Dyskinesia
      1. Particular caution in elderly, cardiovascular disease risk, HIV Infection, neurologic disorders
  11. Consider medication dose reduction at every visit
    1. Adverse effects (esp. Extrapyramidal Side Effects) should prompt dose reduction (or medication change)
    2. Especially consider lower dose in children, older adults, underweight and with chronic disease
    3. Dose increases are needed with exacerbations

XIX. Management: Acute

  1. Acute Mania
    1. Hospitalize due to high risk of self harm or Suicidality
    2. Therapy goals
      1. Adequate sleep
      2. Reduce psychotic symptoms
    3. Medication protocol
      1. Start mood stabilizer (see below)
        1. Lithium (preferred) or
        2. Valproate
      2. Start adjunctive therapy (see below)
        1. Indicated while mood stabilizer (esp. Lithium) reaches steady state over days
        2. Atypical Antipsychotic (e.g. Olanzapine, Quetiaprine) or Haloperidol
        3. Benzodiazepines (e.g. Lorazepam)
  2. Acute Hypomania
    1. Medication management is similar to acute mania
    2. Observe for major depressive episode immediately following acute Hypomania episode
    3. Assess for functional capacity
      1. Decision making
      2. Compliance with treatment
  3. Acute Major Depression
    1. Hospitalize for Suicidality or Homicidal Thoughts
    2. Psychotherapy
    3. First-line therapies (combination of mood stabilizer with Atypical Antipsychotic)
      1. Primary mood stabilizers are both effective for Major Depression
        1. Lithium (preferred)
        2. Valproate
      2. Atypical Antipsychotics effective for Major Depression
        1. Quetiapine or Seroquel (preferred)
          1. Risk of weight gain, Glucose Intolerance, and Extrapyramidal Side Effects
        2. Olanzapine (Zyprexa)
        3. Cariprazine (Vraylar)
        4. Lurasidone (Latuda)
    4. Second-line therapies
      1. Add only to first line agents if effect is incomplete
        1. Do not use standard Antidepressants without mood stabilizers
        2. These agents do not increase efficacy over mood stabilizers alone
        3. Avoid Tricyclic Antidepressants, Trazodone, or Venlafaxine which can trigger manic episodes
      2. Selective Serotonin Reuptake Inhibitors
      3. Bupropion (Wellbutrin)
      4. Anticonvulsants effective for Major Depression
        1. Lamotrigine or Lamictal (preferred)
          1. Requires 6 weeks to titrate to level (due to Steven's Johnson Syndrome risk)
        2. Carbamazepine or Tegretol
        3. Topiramate
  4. Acute Mixed Features (combined features of Major Depression and mania/Hypomania)
    1. Avoid Lithium in mixed features or rapid cycling presentation (ineffective)
    2. Avoid monotherapy with Antidepressant for mixed features presentation
    3. Atypical Antidepressants are preferred in acute mixed feature presentations
      1. Aripiprazole (Abilify)
      2. Olanzapine (Zyprexa)
      3. Quetiapine (Seroquel)
      4. Risperidone (Risperdal)
      5. Ziprasidone (Geodon)
      6. Asenapine (Saphris)
      7. Cariprazine (Vraylar)
  5. Refractory Cases
    1. Consider switching mood stabilizer
    2. Consider combining 2-3 mood stabilizers
    3. Consider Electroconvulsive Therapy
      1. Older patients
      2. Refractory to medications
      3. Catatonia
      4. Acute Psychosis with Suicidality

XX. Management: Mood Stabilizer Selection

  1. Mood stabilizer options
    1. First-line agents
      1. Lithium (preferred)
        1. Suicide is 3 fold less likely with Lithium than Valproate
        2. Starting dose may be up to 300 mg twice daily
        3. Titrate dose every 2-3 days as tolerated to effect and serum Lithium level of 0.6 to 1.5 mEq/L
        4. Target dose: 900 to 1800 mg orally daily
      2. Valproate
        1. Loading dose in acute mania: 15-20 mg/kg
        2. Starting dose without load: 500 to 750 mg/day in divided dosing
        3. Titrate every 2-3 days as tolerated to serum Valproic Acid level of 50 to 125 mcg/ml
        4. Target dose: 200 to 1600 mg daily
    2. Alternative mood stabilizers (consider for specific indications)
      1. Carbamazepine (Tegretol)
        1. Starting dose 200 mg twice daily
        2. Therapeutic range for biopolar: 4-12 mcg/ml
        3. Available as long acting agent (Equetro)
      2. Oxcarbazepine
        1. Consider instead of Carbamazepine
        2. Similar efficacy with fewer adverse effects
      3. Lamotrigine (Lamictal)
        1. Starting dose 25 mg daily
        2. Effective as mood stabilizer and Antidepressant
        3. No blood monitoring needed
        4. Rash develops in 10% of patients (Risk of Steven's Johnson)
          1. Requires slow titration over at least 6 weeks to effective dose
          2. Titrate Lamotrigine slowly (2 week increments)
          3. Do not exceed 100 mg when combined with Valproate
        5. Compared with Lithium
          1. Similar efficacy in treating depressive symptoms and reducing the need for additional psychotropics
          2. Less effective than Litium in recurrent mania prevention (but more effective than Placebo)
          3. Fewer adverse effects than Lithium
          4. Hashimoto (2021) Cochrane Database Syst Rev (9):CD013575 +PMID: 34523118 [PubMed]
  2. Specific agent indications
    1. Classic mania or Hypomania (Euphoric mood)
      1. Lithium (preferred) or
      2. Valproate
    2. Mixed episode or rapid cycling
      1. Valproate (preferred) or
      2. Carbamazepine
  3. Combinations in refractory cases
    1. Lithium with Lamotrigine OR Valproate
    2. Valproate with Lithium OR Lamotrigine

XXI. Management: Adjunctive Medications

  1. Adjunctive medications: Benzodiazepine
    1. Examples: Lorazepam, Clonazepam
    2. Indications for Benzodiazepine
      1. Mania or Hypomania with Insomnia or Agitation
      2. Psychosis refractory to Antipsychotic
    3. Alternatives
      1. Consider Gabapentin for anxiety
  2. Adjunctive medications: Antipsychotics
    1. Precautions
      1. Monitor for Extrapyramidal Side Effects (e.g. Tardive Dyskinesia)
      2. Atypical Antipsychotic agents have specific lab monitoring guidelines
    2. Antipsychotic indications
      1. Psychosis
        1. Consider Electroconvulsive Therapy
      2. Mania with Insomnia or Agitation
        1. Despite Benzodiazepine
      3. Acute mania episode
        1. Antipsychotic use may increase Lithium or Valproate efficacy
    3. Agents (low doses are often effective in mania)
      1. Risperidone (Risperdal) 2-4 mg per day
      2. Olanzapine (Zyprexa) 10-15 mg per day
      3. Lurasidone (Latuda) 20 mg orally daily (may advance gradually to 60 mg daily)
      4. Quetiapine 400-800 mg per day
        1. Mood stabilizers have improved efficacy when used with Quetiapine
        2. Quetiapine may be used as an alternative to Lithium for monotherapy
          1. Effective in mania, depression and mixed disorder and prevents future episodes
        3. Yatham (2009) Bipolar Disord 11(3):225-55 [PubMed]
        4. (2024) Am Fam Physician 109(6): 585-7
      5. Avoid Antipsychotics with lower efficacy in Bipolar Disorder
        1. Avoid Aripiprazole (Abilify)
        2. Avoid Ziprasidone (Geodon)
  3. Adjunctive medications: Antidepressants
    1. See Acute Depression Management above
    2. First-line agents
      1. Mood Stabilizers (Lithium, Valproate)
    3. Second-line agents (used only in combination with mood stabilizers)
      1. Selective Seotonin Reuptake Inhibitors (SSRIs) or Bupropion
        1. Risk of precipitating mania (do not use as montherapy)
        2. Avoid Tricyclic Antidepressants, Trazodone, or Venlafaxine which can trigger manic episodes
        3. Avoid Paroxetine (Paxil) as it is less effective in Bipolar Disorder
        4. May taper off 6-8 weeks after full bipolar remission (restart as needed)
  4. Other adjunctive measures (insufficient evidence)
    1. Omega-3 Fatty Acid Supplements
    2. Light Therapy

XXII. Prognosis

  1. Relapse Rate
    1. One year: 25% with treatment (40% without treatment)
    2. Five years: 70% (regardless of treatment)
  2. Suicide Attempt: 33% lifetime risk (half of those within the last year)
    1. Higher risk with anxious stress
    2. Completed Suicide in 6-7%
    3. Within 6 weeks of hospital discharge in 26%
    4. Schaffer (2015) Aust N Z J Psychiatry 49(11): 1006-20 [PubMed]

XXIII. References

  1. (2015) Presc Lett 22(1): 4
  2. (1997) Am Fam Physician 55(4):1447-9 [PubMed]
  3. Docherty (1996) J Clin Psychiat 57(suppl 12A):1-89 [PubMed]
  4. Marzani (2021) Am Fam Physician 103(4): 227-39 [PubMed]
  5. Manning (2010) J Clin Psychiatry 12(suppl 1): 17-22 [PubMed]
  6. McIntyre (2004) Can Fam Physician 50:388-94 [PubMed]
  7. Price (2012) Am Fam Physician 85(5): 483-93 [PubMed]
  8. Werder (1995) Am Fam Physician 51(5):1126-36 [PubMed]

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Related Studies

Ontology: Depression, Bipolar (C0005587)

Definition (NCI) The depressive stage of bipolar disorder.
Definition (CSP) severe disorder characterized by one or more manic episodes; although diagnosis does not require a major depressive episode, virtually all cases eventually develop one.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001714
SnomedCT 191627008
English Bipolar affective disorder, depressed, Bipolar affective - now depres, Manic-depress.-now depressed, MANIC DEPRESSIVE DISEASE DEPRESSED PHASE, Bipolar depression, bipolar depression disorder, bipolar disorder depressed, depression bipolar disorder, bipolar depression, depression bipolar, bipolar disorder depression, bipolar affective disorder, current episode depressed (diagnosis), bipolar affective disorder, current episode depressed, bipolar disorder affective, current episode depressed, Bipolar affective disorder, current episode depression, Manic-depressive - now depressed, Bipolar affective disorder, current episode depression (disorder), Bipolar Depression, Depression, Bipolar
Dutch bipolaire depressie, depressieve bipolaire affectieve stoornis, Depressie, bipolaire
French Trouble affectif bipolaire, épisode dépressif, Dépression bipolaire
German bipolare affektive Stoerung, depressiv, bipolare Depression, Depression, bipolare
Italian Sindrome affettiva bipolare, episodio depressivo, Depressione bipolare
Portuguese Perturbação afectiva bipolar, deprimida, Depressão bipolar, Depressão Bipolar
Spanish Trastorno afectivo bipolar en fase depresiva, Depresión bipolar, Depresión Bipolar, maníaco depresivo - actualmente deprimido, trastorno afectivo bipolar, actualmente episodio depresivo (trastorno), trastorno afectivo bipolar, actualmente episodio depresivo, trastorno bipolar afectivo, actualmente episodio depresivo (trastorno), trastorno bipolar afectivo, actualmente episodio depresivo
Japanese 双極性感情障害、うつ病型, 双極性うつ病, ｿｳｷｮｸｾｲｶﾝｼﾞｮｳｼｮｳｶﾞｲｳﾂﾋﾞｮｳｶﾞﾀ, ｿｳｷｮｸｾｲｳﾂﾋﾞｮｳ
Czech deprese bipolární, Bipolární afektivní porucha, depresivní epizoda, Bipolární deprese
Hungarian Bipolaris affectiv zavar, depressziós, Bipolaris depresszió
Norwegian Depresjon, bipolar, Bipolar depresjon
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Cyclothymic Disorder (C0010598)

Definition (MSH) An affective disorder characterized by periods of depression and hypomania. These may be separated by periods of normal mood.
Definition (PSY) Affective disorder characterized by alternating and recurring periods of depression and elation, similar to manic depressive disorder but of a less severe nature.
Definition (CSP) chronic mood disturbance of at least 2 years' duration involving numerous hypomanic episodes separated by periods of depression or loss of pleasure or interest.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D003527
ICD9 301.13, 301.10, 301.1
ICD10 F34.0
SnomedCT 14697007, 191754000, 191755004, 191752001, 192383002, 286737005, 191751008, 268756002, 76105009, 386798001
DSM4 301.13
English Cyclothymic Disorder, Cyclothymic Disorders, Cyclothymic Personalities, Cyclothymic Personality, Disorder, Cyclothymic, Disorders, Cyclothymic, Personalities, Cyclothymic, Personality, Cyclothymic, Affective personality dis. NOS, Affective personality dis.unsp, Affective personality disorder NOS, Affective personality disorder, unspecified, Unspecified affective personality disorder, CYCLOTHYMIC DIS, Cyclothymic personality trait, cyclothymic disorder (diagnosis), affective personality disorder (diagnosis), affective personality disorder, cyclothymic disorder, cyclothymia, Disorder cyclothymic, Cyclothymic personality disorder, Affectiv personality NOS, Cyclothymic Disorder [Disease/Finding], affective personality, cyclothymia disorder, cyclothymic disorders, Tends to be unstable in affect (finding), Unspecified affective personality disorder (disorder), Affective personality disorder NOS (disorder), Cyclothymia, Affective personality disorder, Affective personality trait, Cyclothymic disorder, Cyclothymic personality, Unstable personality trait, Cycloid personality, Tends to be unstable in affect, Cyclothymia (disorder), Affective personality trait (finding), cycloid personality, cyclothymic personality, cyclothymic; disorder, cyclothymic; personality disorder, disorder; cyclothymic, affective; personality disorder, personality disorder; affective, personality disorder; cyclothymic, Cyclothymia [Ambiguous]
Dutch affectieve persoonlijkheidsstoornis, cyclothymie, stoornis cyclothymisch, niet-gespecificeerde affectieve persoonlijkheidsstoornis, cycloïde persoonlijkheid, cyclothyme persoonlijkheidsstoornis, affectief; persoonlijkheidsstoornis, cyclothym; persoonlijkheidsstoornis, cyclothym; stoornis, persoonlijkheidsstoornis; affectief, persoonlijkheidsstoornis; cyclothym, stoornis; cyclothym, Cyclothymie, cyclothyme stoornis, Cyclothyme persoonlijkheid, Cyclothyme stoornis
French Trouble de personnalité affective, non précisé, Personnalité cycloïde, Troubles affectifs de la personnalité, Cyclothymie, Trouble cyclothymique, Personnalité cyclothymique
German affektive Persoenlichkeitsstoerung, zykloide Persoenlichkeit, zyklothyme Persoenlichkeitsstoerung, affektive Persoenlichkeitsstoerung, unspezifisch, Stoerung, zyklothym, Zyklothymia, zyklothyme Stoerung, Zyklothymie, Zyklothyme Persönlichkeit, Zyklothyme Störung
Italian Disturbo di personalità affettivo, Disturbo di personalità affettivo, non specificato, Personalità cicloide, Ciclotimia, Disturbo ciclotimico della personalità, Personalità ciclotimica, Disturbo ciclotimico
Portuguese Perturbação afectiva da personalidade, Personalidade ciclóide, Perturbação de personalidade ciclotímica, Ciclotimia, Perturbação afectiva da personalidade NE, Perturbação ciclotímica, Personalidade Ciclotímica, Transtorno Ciclotímico
Spanish Ciclotimia, Trastorno ciclotímico de la personalidad, Trastorno afectivo de la personalidad, Personalidad ciclotímica, Trastorno afectivo de la personalidad, no especificado, rasgo de personalidad afectiva, trastorno ciclotímico, trastorno cilotímico, rasgo de personalidad ciclotímica, trastorno afectivo de la personalidad no especificado, trastorno afectivo de la personalidad no especificado (trastorno), característica de personalidad afectiva, característica de personalidad inestable, trastorno afectivo de la personalidad, SAI (trastorno), trastorno afectivo de la personalidad, SAI, rasgo de personalidad ciclotímica (hallazgo), ciclotimia (trastorno), ciclotimia, rasgo afectivo de personalidad (hallazgo), rasgo afectivo de personalidad, rasgo de personalidad afectiva (hallazgo), Trastorno ciclotímico, Personalidad Ciclotímica, Trastorno Ciclotímico
Japanese 情動性人格異常, 気分循環性障害, 循環性人格, ｼﾞｭﾝｶﾝｾｲｼﾞﾝｶｸ, ｷﾌﾞﾝｼﾞｭﾝｶﾝｾｲｼｮｳｶﾞｲ, ｼﾞｭﾝｶﾝｷｼﾂ, ｼﾞｮｳﾄﾞｳｾｲｼﾞﾝｶｸｲｼﾞｮｳ, 気分循環症, 循環気質障害, 循環性パーソナリティ障害, 情動性パーソナリティ障害、詳細不明, ｼﾞｮｳﾄﾞｳｾｲﾊﾟｰｿﾅﾘﾃｨｼｮｳｶﾞｲｼｮｳｻｲﾌﾒｲ, ｼﾞｭﾝｶﾝｾｲﾊﾟｰｿﾅﾘﾃｨｼｮｳｶﾞｲ, 循環性格, 循環気質, 循環病
Swedish Stämningsstörningar
Czech cyklotymní poruchy, Cyklotymie, Afektivní porucha osobnosti, blíže neurčená, Cyklotymní porucha osobnosti, Porucha cyklotymní, Afektivní porucha osobnosti, Cykloidní osobnost, Cyklotymní porucha
Finnish Mielialan aaltoiluhäiriö
Russian TSIKLOTIMICHESKAIA LICHNOST', TSIKLOTIMIIA, ЦИКЛОТИМИЧЕСКАЯ ЛИЧНОСТЬ, ЦИКЛОТИМИЯ
Korean 순환성 기분장애
Polish Zaburzenia cyklotymiczne, Osobowość cyklotymiczna
Hungarian Érzelmi élet eltérése, Cyclothymiás zavar, Cyclothymiás személyiség, Cyclothymiás személyiségzavar, Érzelmi élet eltérése, nem meghatározott, Cyclothymia, Cyclothym zavar
Norwegian Cyklotym forstyrrelse, Cyklotymi, Cykloid personlighet, Cyklotym personlighet
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Manic Disorder (C0024713)

Definition (CSP) manic episode of the major affective disorder bipolar depression; tendency to remission and recurrence and to swing to the major depressive episode.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001714
ICD9 296.40
SnomedCT 68569003
DSM4 296.40
English Manic Disorders, Bipolar affective disorder, manic, bipolar depression manic phase, Bipolar I Disorder, Most Recent Episode Manic, Unspecified, Disorder, Manic, Bipolar affective disorder, manic, unspecified degree, MANIC DEPRESSIVE DISEASE MANIC PHASE, MANIC DIS, bipolar disorder manic phase, Manic bipolar disorder, NOS, monopolar mania, bipolar I disorder, most recent episode, manic, bipolar I disorder, most recent episode, manic (diagnosis), Bipol I currnt manic NOS, bipolar disorder manic, manic disorder, manic disorders, Bipolar I disorder, most recent episode (or current) manic, unspecified, Bipolar I disorder, most recent episode manic, Manic bipolar I disorder (disorder), Manic bipolar I disorder, disorder; bipolar, I, most recent episode, manic, disorder; manic, manic; disorder, Manic bipolar I disorder, NOS, Manic Bipolar Affective Disorder, Manic Disorder
Dutch manische bipolaire affectieve stoornis, manische bipolaire affectieve stoornis, ernst niet-gespecificeerd, manisch; stoornis, stoornis; bipolair, I, meest recente episode, manisch, stoornis; manisch, Manische stoornis
French Trouble affectif bipolaire, épisode maniaque, degré non précisé, Trouble affectif bipolaire, épisode maniaque, Trouble maniaque
German bipolare affektive Stoerung, manisch, unspezifische Form, bipolare affektive Stoerung, manisch, Manische Störung
Italian Sindrome affettiva bipolare, episodio maniacale, Sindrome affettiva bipolare, episodio maniacale, grado non specificato, Disturbo maniacale
Portuguese Perturbação afectiva bipolar, maníaca, NE, Perturbação afectiva bipolar, maníaca, Transtorno Maníaco
Spanish Trastorno afectivo bipolar maniaco, Trastorno afectivo bipolar maniaco, grado no especificado, Trastorno Maníaco, trastorno bipolar I maníaco (trastorno), trastorno bipolar I maníaco, trastorno bipolar I, episodio más reciente maníaco
Japanese 双極性感情障害、躁病型, ｿｳｷｮｸｾｲｶﾝｼﾞｮｳｼｮｳｶﾞｲｿｳﾋﾞｮｳｶﾞﾀ
Czech manická porucha, Bipolární afektivní porucha, manická epizoda, Bipolární afektivní porucha, manická epizoda, blíže neurčená závažnost
Hungarian Bipolaris affectiv zavar, mániás, nem meghatározott súlyosságú, Bipolaris affectiv zavar, mániás
Norwegian Manisk forstyrrelse
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bipolar II disorder (C0236788)

Concepts Mental or Behavioral Dysfunction (T048)
ICD10 F31.81
SnomedCT 83225003, 231497008
DSM4 296.89
English Bipolar II Disorder, bipolar II disorder, bipolar II disorder (diagnosis), bipolar disorder ii, bipolar ii disorder, Bipolar 2 disorder, Bipolar II disorder, Bipolar II disorder (disorder), bipolar; disorder, II, disorder; bipolar, II, Bipolar II disorder, NOS
Italian Disturbo bipolare II
Japanese 双極２型障害, ｿｳｷｮｸ2ｶﾞﾀｼｮｳｶﾞｲ
Czech Bipolární porucha II
Hungarian Bipolaris II zavar
Spanish trastorno bipolar 2, trastorno bipolar II (trastorno), trastorno bipolar II, Trastorno bipolar II
Dutch bipolair; stoornis, II, stoornis; bipolair, II, bipolaire II stoornis
Portuguese Perturbação bipolar II
French Trouble bipolaire II
German Bipolar-II-Stoerung
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Hypomania (C0241934)

Definition (NCI) A less severe form of mania characterized by elevated mood, hyperactivity, and grandiosity. In contrast to mania, these symptoms do not cause significant impairment of the individual's productivity at work, or social and family relationships.
Definition (PSY) Mild form of mania.
Concepts Mental or Behavioral Dysfunction (T048)
ICD10 F30.0 , F30.8
SnomedCT 192350009, 154872008, 268750008, 231496004
English HYPOMANIA, hypomania, Hypomania (diagnosis), manic episode hypomania, Hypomania, Hypomania (disorder)
Italian Ipomania
Japanese 軽躁, ｹｲｿｳ
Czech Hypománie
Korean 경조병
Hungarian Hypomania
Dutch Hypomanie, hypomanie
Spanish hipomanía (trastorno), hipomanía, Hipomanía
Portuguese Hipomania
French Hypomanie
German Hypomanie
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Manic (C0338831)

Definition (NCI) Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganisation of behaviour and elevation of mood.(On-line Medical Dictionary)
Definition (NCI_CTCAE) A disorder characterized by excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behavior and elevation of mood.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001714
ICD10 F30.9
SnomedCT 154872008, 268750008, 231494001
English Manias, Manic State, Manic States, State, Manic, States, Manic, MANIA, Manic, Manic state, Mania NOS, manic state, manic, Mania (disorder), mania, Mania
French MANIE, Etat maniaque, Manie, État maniaque
Portuguese MANIA, Estado maníaco, Mania
Spanish MANIA, Estado maníaco, manía (trastorno), maníaco, manía, Manía
Dutch manische toestand, manie
German manischer Zustand, MANIE, Manie
Japanese ｿｳﾋﾞｮｳ, ｿｳｼﾞｮｳﾀｲ, 躁障害, 躁状態, 躁病, そう病, 躁狂, そう状態, 定型的躁状態, メーニア
Czech mánie, Manický stav, Mánie
Italian Mania, Stato maniacale
Hungarian Mania, Maniás állapot
Norwegian Mani
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Bipolar I disorder (C0853193)

Concepts Mental or Behavioral Dysfunction (T048)
SnomedCT 371596008
Italian Disturbo bipolare I
Japanese 双極１型障害, ｿｳｷｮｸ1ｶﾞﾀｼｮｳｶﾞｲ
Czech Bipolární porucha I
English bipolar i disorder, Bipolar 1 disorder, Bipolar I disorder (diagnosis), Bipolar I disorder, Bipolar I disorder (disorder), bipolar; disorder, I, disorder; bipolar, I
Hungarian Bipolaris I zavar
Dutch bipolair; stoornis, I, stoornis; bipolair, I, bipolaire I stoornis
Spanish trastorno bipolar I (trastorno), trastorno bipolar I, Trastorno bipolar I
Portuguese Perturbação bipolar I
French Trouble bipolaire I
German Bipolar-I-Stoerung
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Other and unspecified bipolar disorders (C1456309)

Concepts Mental or Behavioral Dysfunction (T048)
ICD9 296.8
English Other and unspecified bipolar disorders
Derived from the NIH UMLS (Unified Medical Language System)

Related Topics in Bipolar Disorder

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