Bipolar I in Adults


ICD-10 code: F31.9

Bipolar I Disorder (BPI) is part of a cluster of diagnoses called the bipolar and related disorders.  Bipolar and related disorders are a group of psychiatric conditions that include:

  • Bipolar I disorder
  • Bipolar II disorder
  • Cyclothymic disorder

These disorders are characterized by the occurrence of discrete mood episodes, including the presence of mania (in bipolar I disorder), hypomania (in bipolar II disorder), or hypomanic symptoms that do not meet full diagnostic criteria for hypomania or mania (in cyclothymic disorder).

An individual experiencing mania or hypomania may experience a significantly decreased need for sleep (e.g., feeling rested after only a few hours of sleep), inflated self-esteem or grandiosity, an increase in goal-directed activity (e.g., starting new projects at work or home), pressured speech, and other symptoms.  Most individuals with bipolar and related disorders also experience discrete periods of depression, which are generally characterized by sadness or loss of interest, fatigue, difficulty concentrating, and/or sleep or appetite disturbance.  To be diagnosed with a bipolar-related disorder, these mood symptoms must represent a clear change from normal (baseline) functioning.

The bipolar and related disorders differ from each other in the duration, severity, and types of symptoms that the individual experiences.  Individuals with bipolar I disorder experience discrete manic episodes, in which manic symptoms last a week or longer, require hospitalization, or are accompanied by psychotic symptoms. 

A history of a major depressive episode is not required for a bipolar I diagnosis, but such an episode will occur in the majority of individuals with bipolar I disorder. Individuals with bipolar II disorder experience hypomanic episodes, in which manic symptoms last at least four days, are not severe enough to cause marked impairment or necessitate hospitalization, and are not accompanied by psychotic features.  A bipolar II diagnosis requires a history of at least one major depressive episode.  Finally, individuals with cyclothymic disorder experience numerous periods of hypomanic symptoms and depressive symptoms that do not meet criteria for hypomanic and depressive episodes, respectively. 

 

What is bipolar I disorder?

BPI is a psychiatric disorder that affects approximately 1% of adults.  BPI is characterized primarily by the presence of manic episodes.  Manic episodes are a distinct period of at least one week in which mood is abnormally and persistently elevated or irritable and there is an abnormal and persistent increase in goal-directed activity or energy.  

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Understanding Bipolar I Disorder

BPI severity can range from mild to debilitating.  In severe cases, BPI can lead to inability to work, attend school, or make independent financial or medical decisions.  Oversight by a conservator may be needed in some cases.  BPI can also cause serious problems in interpersonal relationships.  Many people with BPI also have other psychiatric conditions, most commonly anxiety disorders.  Substance abuse may also occur, particularly during manic episodes.

 

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How is bipolar I disorder treated?

BPI is generally thought to be a chronic disorder, but it can be managed effectively.  Published treatment guidelines for BPI include those from the American Psychiatric Association, the Society of Clinical Psychology, and the National Institute for Clinical Excellence. BPI generally should not be managed in primary care; if primary care management is to occur, it should be only in consultation with a specialist.  In all cases, consider hospitalization in the case of moderate to severe manic episodes.

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