Bipolar disorder

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  • mental disorder characterized by periods of elevated moods and periods of depression
  • spectrum of disorders including Bipolar Type I, Bipolar Type II, and Bipolar NOS

Clinical Features

Manic Episode

  • abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week
  • at least 3 of the following symptoms (4 if only irritable)
    • inflated self esteem or grandiosity
    • decreased need for sleep
    • more talkative/pressured speech
    • flight of ideas/racing thoughts
    • easily distractible
    • increase in goal-directed activity or psychomotor agitation
    • involvement in high pleasure, high risk activities
      • gambling, shopping sprees, sexual indiscretions
  • sufficient to cause impairment in functioning, relationships, or hospitalization
  • not as a result of substance abuse or medical condition (e.g. hyperthyroid)

Hypomanic Episode

  • Same features as manic episode however less intense
  • Symptoms only need to persist for 4 days

Major Depressive Episode

  • Sleep - increased or decreased
  • Interest - losing interest or pleasure in activities
  • Guilt - excessive guilt
  • Energy - feels of fatigue, low energy
  • Concentration - cognitive decine, indecisiveness
  • Appetite - weight loss/gain
  • Psychomotor agitation or depression
  • Suicidal ideation

Must have 5 symptoms in a 2 week period including depressed mood and loss of interest

Mixed Episode

  • fulfill features of both manic and major depressive episode
  • must last at least 1 week

Differential Diagnosis

General Psychiatric


  • usually will not be diagnosed in the emergency department
  • needs evaluation by a psychiatrist

Bipolar I

  • meets criteria for one manic or mixed episode
  • symptoms cause social/occupational distress or impairment

Bipolar II

  • meets criteria for at least one major depressive episode
  • meets criteria for at least one hypomanic episode
  • does not meet criteria for manic or mixed episode
  • symptoms cause social/occupational distress or imairment

Bipolar NOS

  • disorder with bipolar features that don't meet criteria for specific bipolar disorder


  • medically clear
  • determine whether patient meets 5150 criteria
  • arrange psychiatry evaluation (psych ED, PET team, outpatient depending on clinical severity)


See Also

External Links


  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Arlington, VA: American Psychiatric Publishing.