Bipolar disorder

Manic depression redirects here. For other uses, see

Manic depression (disambiguation).
Bipolar disorders redirects here. For the medical
journal, see Bipolar Disorders (journal).

it is recommended that this be done slowly. Many people have social, nancial, or work-related problems due to
the disorder. These diculties occur a quarter to a third
of the time on average. The risk of death from natural
causes such as heart disease is twice that of the general
lifestyle choices and the
Bipolar disorder, also known as bipolar aective dis- population. This is due to poor
side eects from medications.[1]
order and manic-depressive illness, is a mental disorder
characterized by periods of elevated mood and periods of About 3% of people in the United States have bipolar disdepression.[1][2] The elevated mood is signicant and is order at some point in their life.[4] Lower rates of around
known as mania or hypomania depending on the severity 1% are found in other countries. The most common age
or whether there is psychosis. During mania an individual at which symptoms begin is 25.[1] Rates appear to be simfeels or acts abnormally happy, energetic, or irritable.[1] ilar in males as females.[5] The economic costs of the disThey often make poorly thought out decisions with little order has been estimated at $45 billion for the United
regard to the consequences. The need for sleep is usually States in 1991.[6] A large proportion of this was related to
reduced.[2] During periods of depression there may be a higher number of missed work days, estimated at 50 per
crying, poor eye contact with others, and a negative out- year.[6] People with bipolar disorder often face problems
look on life.[1] The risk of suicide among those with the with social stigma.[1]
disorder is high at greater than 6% over 20 years, while
self harm occurs in 3040%.[1] Other mental health issues such as anxiety disorder and substance use disorder
1 Signs and symptoms
are commonly associated.[1]
The cause is not clearly understood, but both genetic and
environmental factors play a role.[1] Many genes of small
eect contribute to risk.[1][3] Environmental factors include long term stress and a history of childhood abuse.[1]
It is divided into bipolar I disorder if there is at least
one manic episode and bipolar II disorder if there are
at least one hypomanic episode and one major depressive episode. In those with less severe symptoms of a
prolonged duration the condition cyclothymic disorder
may be present. If due to drugs or medical problems
it is classied separately.[2] Other conditions that may
present in a similar manner include substance use disorder, personality disorders, attention decit hyperactivity
disorder, and schizophrenia as well as a number of medical conditions.[1]

Mania is the dening feature of bipolar disorder,[7] and

can occur with dierent levels of severity. With milder
levels of mania, known as hypomania, individuals appear
energetic, excitable, and may be highly productive.[8] As
mania worsens, individuals begin to exhibit erratic and
impulsive behavior, often making poor decisions due to
unrealistic ideas about the future, and sleep very little.[8]
At the most severe level, manic individuals can experience very distorted beliefs about the world known as
psychosis.[8] A depressive episode commonly follows an
episode of mania.[8] The biological mechanisms responsible for switching from a manic or hypomanic episode
to a depressive episode or vice versa remain poorly
understood.[9]

Treatment commonly includes psychotherapy and medications such as mood stabilizers or antipsychotics. Examples of mood stabilizers that are commonly used include lithium and anticonvulsants. Treatment in hospital against a persons wishes may be required at times as
people may be a risk to themselves or others yet refuse
treatment. Severe behavioural problems may be managed
with short term benzodiazepines or antipsychotics. In periods of mania it is recommended that antidepressants
be stopped. If antidepressants are used for periods of
depression they should be used with a mood stabilizer.
Electroconvulsive therapy may be helpful in those who do
not respond to other treatments. If treatments are stopped

1.1 Manic episodes

Mania is a distinct period of at least one week of elevated
or irritable mood, which can take the form of euphoria, and exhibit three or more of the following behaviors
(four if irritable): speak in a rapid, uninterruptible manner, are easily distracted, have racing thoughts, display
an increase in goal-oriented activities or feel agitated, or
exhibit behaviors characterized as impulsive or high-risk
such as hypersexuality or excessive money spending.[7]
To meet the denition for a manic episode, these behaviors must impair the individuals ability to socialize
1

SIGNS AND SYMPTOMS

or work.[7][8] If untreated, a manic episode usually lasts trating; loneliness, self-loathing, apathy or indierence;
three to six months.[10]
depersonalization; loss of interest in sexual activity; shyPeople with mania may also experience a decreased ness or social anxiety; irritability, chronic pain (with or
lack of motivation; and morneed for sleep, speak excessively in addition to speaking without a known cause);
[21]
bid
suicidal
thoughts.
In
severe cases, the individual
[8][11]
rapidly, and may have impaired judgment.
Manic
may
become
psychotic,
a
condition
also known as severe
individuals often have issues with substance abuse due
bipolar
depression
with
psychotic
features.
These symp[12]
to a combination of thrill-seeking and poor judgment.
delusions
or,
less
commonly,
hallucinations,
toms
include
At more extreme levels, a person in a manic state can
which are usually frightening and/or intimidating. A maexperience psychosis, or a break with reality, a state in
and
[8]
which thinking is aected along with mood. They may jor depressive episode persists for at least two weeks,
may continue for over six months if left untreated.[22]
feel out of control or unstoppable, or as if they have
been chosen and are on a special mission, or have other The earlier the age of onset, the more likely the rst few
grandiose or delusional ideas.[13] Approximately 50% episodes are to be depressive.[23] Because a bipolar diagof those with bipolar disorder experience delusions or nosis requires a manic or hypomanic episode, many pahallucinations.[14] This may lead to violent behaviors and tients are initially diagnosed and treated as having major
hospitalization in an inpatient psychiatric hospital.[8][11] depression.[24]
The severity of manic symptoms can be measured by rating scales such as the Young Mania Rating Scale.[11][15]
The onset of a manic (or depressive) episode is often 1.4 Mixed aective episodes
foreshadowed by sleep disturbances.[16] Mood changes,
psychomotor and appetite changes, and an increase in
In the context of bipolar disorder, a mixed state is a conanxiety can also occur up to three weeks before a manic
dition during which symptoms of both mania and depres[17]
episode develops.
sion occur at the same time.[25] Individuals experiencing a
mixed state may have manic symptoms such as grandiose
thoughts while at the same time experiencing depressive
1.2 Hypomanic episodes
symptoms such as excessive guilt or feeling suicidal.[25]
Mixed states are considered to be high-risk for suicidal
Hypomania is a milder form of mania dened as at behavior since depressive emotions such as hopelessness
least four days of the same criteria as mania,[8] but are often paired with mood swings or diculties with
does not cause a signicant decrease in the individ- impulse control.[25] Anxiety disorder occurs more freuals ability to socialize or work, lacks psychotic fea- quently as a comorbidity in mixed bipolar episodes than
tures (i.e., delusions or hallucinations), and does not in non mixed bipolar depression or mania.[25] Substance
require psychiatric hospitalization.[7] Overall function- abuse (including alcohol) also follows this trend.[25]
ing may actually increase during episodes of hypomania
and is thought to serve as a defense mechanism against
depression.[18] Hypomanic episodes rarely progress to
true manic episodes.[18] Some hypomanic people show 1.5 Associated features
increased creativity[8] while others are irritable or demonstrate poor judgment. Hypomanic people generally have Main article: Associated features of bipolar disorder
increased energy and increased activity levels.
Hypomania may feel good to the person who experiences
it.[8] Thus, even when family and friends recognize mood
swings, the individual will often deny that anything is
wrong.[19] What might be called a hypomanic event,
if not accompanied by depressive episodes, is often not
deemed as problematic, unless the mood changes are uncontrollable, volatile or mercurial.[18] Most commonly,
symptoms continue for a few weeks to a few months.[20]

1.3

Depressive episodes

Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness, anxiety, guilt, anger, isolation, or hopelessness;[21] disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concen-

Associated features are clinical phenomena that often accompany the disorder but are not part of the diagnostic
criteria. In adults with the condition, bipolar disorder is
often accompanied by changes in cognitive processes and
abilities. These include reduced attentional and executive
capabilities and impaired memory. How the individual processes the world also depends on the phase of
the disorder, with dierential characteristics between the
manic, hypomanic and depressive states.[17] Some studies
have found a signicant association between bipolar disorder and creativity.[26] Those with bipolar disorder may
have diculty in maintaining relationships.[27] There are
several common childhood precursors seen in children
who later receive a diagnosis of bipolar disorder; these
disorders include mood abnormalities, full major depressive episodes, and attention decit hyperactivity disorder
(ADHD).[28]

2.2

1.6

Physiological

Comorbid conditions

3
Findings point strongly to heterogeneity, with dierent genes being implicated in dierent families.[37] Robust and replicable genome-wide signicant associations showed several common single nucleotide polymorphisms, including variants within the genes CACNA1C,
ODZ4, and NCAN.[14][36]

The diagnosis of bipolar disorder can be complicated

by coexisting (comorbid) psychiatric conditions including
the following: obsessive-compulsive disorder, substance
abuse, eating disorders, attention decit hyperactivity
disorder, social phobia, premenstrual syndrome (includAdvanced paternal age has been linked to a somewhat ining premenstrual dysphoric disorder), or panic disorcreased chance of bipolar disorder in ospring, consistent
der.[12][14][21][29] A careful longitudinal analysis of sympwith a hypothesis of increased new genetic mutations.[38]
toms and episodes, enriched if possible by discussions
with friends and family members, is crucial to establishing a treatment plan where these comorbidities exist.[30]

2.2 Physiological

Causes

The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder
remains unclear.[31] Genetic inuences are believed to account for 6080% of the risk of developing the disorder
indicating a strong hereditary component.[14] The overall
heritability of the bipolar spectrum has been estimated
at 0.71.[32] Twin studies have been limited by relatively
small sample sizes but have indicated a substantial genetic
contribution, as well as environmental inuence. For
bipolar disorder type I, the (probandwise) concordance
rates in modern studies have been consistently estimated
at around 40% in identical twins (same genes), compared
to about 5% in fraternal twins.[7][33] A combination of
bipolar I, II and cyclothymia produced concordance rates
of 42% vs. 11%, with a relatively lower ratio for bipolar
II that likely reects heterogeneity. There is overlap with
unipolar depression and if this is also counted in the cotwin the concordance with bipolar disorder rises to 67%
in monozygotic twins and 19% in dizygotic.[34] The relatively low concordance between dizygotic twins brought
up together suggests that shared family environmental effects are limited, although the ability to detect them has
been limited by small sample sizes.[32]

2.1

Genetic

Genetic studies have suggested that many chromosomal

regions and candidate genes are related to bipolar disorder susceptibility with each gene exerting a mild to moderate eect.[14] The risk of bipolar disorder is nearly tenfold higher in rst degree-relatives of those aected with
bipolar disorder when compared to the general population; similarly, the risk of major depressive disorder is
three times higher in relatives of those with bipolar disorder when compared to the general population.[7]

Brain imaging studies have revealed dierences in the volume of

various brain regions between BD patients and healthy control
subjects

Abnormalities in the structure and/or function of certain brain circuits could underlie bipolar. Meta-analyses
of structural MRI studies in bipolar disorder report
an increase in the volume of the lateral ventricles,
globus pallidus and increase in the rates of deep white
matter hyperintensities.[39][40][41] Functional MRI ndings suggest that abnormal modulation between ventral
prefrontal and limbic regions, especially the amygdala,
are likely contribute to poor emotional regulation and
mood symptoms.[42]

According to the kindling hypothesis, when people who

are genetically predisposed toward bipolar disorder experience stressful events, the stress threshold at which
mood changes occur becomes progressively lower, until
the episodes eventually start (and recur) spontaneously.
There is evidence supporting an association between
early-life stress and dysfunction of the hypothalamicpituitary-adrenal axis (HPA axis) leading to its over actimay play a role in the pathogenesis of bipoAlthough the rst genetic linkage nding for mania was vation, which[43][44]
[35]
[7] lar disorder.
in 1969, the linkage studies have been inconsistent.
The largest and most recent genome-wide association Other brain components which have been proposed to
study failed to nd any particular locus that exerts a large play a role are the mitochondria[31] and a sodium ATPase
eect reinforcing the idea that no single gene is responsi- pump.[45] Circadian rhythms and melatonin activity also
seem to be altered.[46]
ble for bipolar disorder in most cases.[36]

2.3

PREVENTION

Environmental

evolutionary theory would suggest that the genes responsible would have been naturally selected against, eectively
Evidence suggests that environmental factors play a sig- culling the disorder. Yet there continue to be high rates
nicant role in the development and course of bipolar of bipolar disorder in many populations, suggesting the
disorder, and that individual psychosocial variables may genes responsible may have an evolutionary benet.
interact with genetic dispositions.[47] There is fairly con- Proponents of evolutionary medicine hypothesize that the
sistent evidence from prospective studies that recent life genes that cause severe bipolar disorder when inherited in
events and interpersonal relationships contribute to the large doses may increase tness when inherited in small
likelihood of onsets and recurrences of bipolar mood doses.[56] High rates of bipolar disorder throughout hisepisodes, as they do for onsets and recurrences of unipo- tory suggest that the ability to switch between depressive
lar depression.[48] There have been repeated ndings that and manic moods conveyed some evolutionary advantage
3050% of adults diagnosed with bipolar disorder report on ancestral humans. Theories put forward to explain
traumatic/abusive experiences in childhood, which is as- the evolutionary advantages of major depressive disorsociated on average with earlier onset, a higher rate of der may also explain the adaptiveness of the depressive
suicide attempts, and more co-occurring disorders such as episodes of bipolar disorder. For example, in individPTSD.[49] The total number of reported stressful events uals under increased stress, depressive mood may serve
in childhood is higher in those with an adult diagnosis as a defensive strategy that causes the individual to reof bipolar spectrum disorder compared to those without, treat from the external stressor, increase sleep, and preparticularly events stemming from a harsh environment serve resources and energy for better times.[57] Additionrather than from the childs own behavior.[50]
ally, manic moods may convey advantage in some situ-

2.4

Neurological

Less commonly bipolar disorder or a bipolar-like disorder may occur as a result of or in association with a neurological condition or injury. Such conditions and injuries
include (but are not limited to) stroke, traumatic brain
injury, HIV infection, multiple sclerosis, porphyria, and
rarely temporal lobe epilepsy.[51]

2.5

Neuroendocrinological

Dopamine, a known neurotransmitter responsible for

mood cycling, has been shown to have increased transmission during the manic phase.[9][52] The dopamine hypothesis states that the increase in dopamine results in
secondary homeostatic down regulation of key systems
and receptors such as an increase in dopamine mediated
G protein-coupled receptors. This results in decreased
dopamine transmission characteristic of the depressive
phase.[9] The depressive phase ends with homeostatic up
regulation potentially restarting the cycle over again.[53]
Glutamate is signicantly increased within the left dorsolateral prefrontal cortex during the manic phase of bipolar disorder, and returns to normal levels once the phase
is over.[54] The increase in GABA is possibly caused by
a disturbance in early development causing a disturbance
of cell migration and the formation of normal lamination,
the layering of brain structures commonly associated with
the cerebral cortex.[55]

2.6

Evolutionary

ations. Creativity, condence, and high energy have all

been linked to mania and hypomania.[58][59] The ability
to utilize mild manic symptoms to be more productive
and think more creatively during stress-free times may
have increased the tness of ancestral humans. Being able
to employ both hypomania and mild depression convey
advantages that benet individuals in a variable environment. However, if the genes enabling the manipulation of
both of these moods are over activated, the manic and/or
severe depressive moods of full bipolar disorder may be
triggered instead.
Evolutionary biologists have hypothesized that bipolar
disorder could have come from an adaptation to extreme climates in the northern temperate zone during the
Pleistocene. The Evolutionary Origin of Bipolar Disorder (EOBD) hypothesis states that during the short summers of extreme climates, hypomania would be adaptive,
allowing the completion of many tasks necessary for survival within a short period of time. During long winters the lethargy, hypersomnia, lack of interest in social
activities, and overeating of depression would be adaptive to group cohesion and survival.[60] Evidence for the
EOBD hypothesis include an association between bipolar disorder and a cold-adapted build, correlation between seasonality and mood changes in those with bipolar disorder, and low rates of bipolar disorder in African
Americans.[61] The EOBD hypothesis suggests that in the
absence of the extreme climatic conditions that fostered
the success of bipolar disorder genes, many bipolar disorder behaviors are maladaptive and can often severely
impair normal functioning.

3 Prevention

Because bipolar disorder aects an individuals ability Prevention of bipolar has focused on stress (such as
to function in society and has a high morbidity rate, childhood adversity or highly conictual families) which,

4.1

Bipolar spectrum

although not a diagnostically specic causal agent for

bipolar, does place genetically and biologically vulnerable individuals at risk for a more pernicious course of
illness.[62] There has been debate regarding the causal
relationship between usage of cannabis and bipolar
disorder.[63]

Diagnosis

Bipolar disorder often goes unrecognized and is

commonly diagnosed during adolescence or early
adulthood.[64] The disorder can be dicult to distinguish
from unipolar depression and the mean delay in diagnosis
is 510 years after symptoms begin.[65] Diagnosis of
bipolar disorder takes several factors into account and
considers the self-reported experiences of the symptomatic individual, behavior abnormalities reported by
family members, friends or co-workers, and observable
signs of illness as assessed by a psychiatrist, nurse, social
worker, clinical psychologist or other health professional.
Assessment is usually done on an outpatient basis;
admission to an inpatient facility is considered if there is
a risk to oneself or others. The most widely used criteria
for diagnosing bipolar disorder are from the American
Psychiatric Associations Diagnostic and Statistical
Manual of Mental Disorders, the current version being
DSM-IV-TR, and the World Health Organization's
International Statistical Classication of Diseases and
Related Health Problems, currently the ICD-10. The
latter criteria are typically used in Europe and other
regions while the DSM criteria are used in the USA and
other regions, as well as prevailing in research studies.
The DSM-V, published in 2013, included further and
more accurate sub-typing.[66]
An initial assessment may include a physical exam by a
physician. Although there are no biological tests that are
diagnostic of bipolar disorder,[36] tests may be carried out
to exclude medical illnesses with clinical presentations
similar to that of bipolar disorder such as hypothyroidism
or hyperthyroidism, metabolic disturbance, a chronic disease, or an infection such as HIV or syphilis.[64] An
EEG may be used to exclude a seizure disorder such as
epilepsy, and a CT scan of the head may be used to exclude brain lesions.[64] Investigations are not generally repeated for a relapse unless there is a specic medical indication.

4.1 Bipolar spectrum

Bipolar spectrum disorders (BSD) include the following
four disorders: bipolar I disorder, bipolar II disorder,
cyclothymic disorder, and bipolar disorder not otherwise
specied.[64] These disorders typically involve depressive
symptoms or episodes that alternate with elevated mood
states or with mixed episodes that feature symptoms of
both depressive and elevated mood states.[68] The concept
of the bipolar spectrum is similar to that of Emil Kraepelin's original concept of manic depressive illness.[69]
Unipolar hypomania without accompanying depression
has been noted in the medical literature.[70] There is
speculation as to whether this condition may occur
with greater frequency in the general, untreated population; successful social function of these potentially highachieving individuals may lead to being labeled as normal, rather than as individuals with substantial dysregulation.

4.2 Criteria and subtypes

There is no clear consensus as to how many types of bipolar disorder exist.[71] In DSM-IV-TR and ICD-10, bipolar disorder is conceptualized as a spectrum of disorders
occurring on a continuum. The DSM-IV-TR lists three
specic subtypes and one for non-specied:[72][73]
Bipolar I disorder: At least one manic episode
is necessary to make the diagnosis;[74] depressive
episodes are common in bipolar disorder I, but are
unnecessary for the diagnosis.[7]
Bipolar II disorder: No manic episodes, but one or
more hypomanic episodes and one or more major
depressive episode.[74] Hypomanic episodes do not
go to the full extremes of mania (i.e., do not usually
cause severe social or occupational impairment, and
are without psychosis), and this can make bipolar
II more dicult to diagnose, since the hypomanic
episodes may simply appear as a period of successful
high productivity and is reported less frequently than
a distressing, crippling depression.
Cyclothymia: A history of hypomanic episodes with
periods of depression that do not meet criteria for
major depressive episodes.[75] There is a low-grade
cycling of mood which appears to the observer as a
personality trait and interferes with functioning.
Bipolar disorder NOS (not otherwise specied):
This is a catchall category, diagnosed when the
disorder does not fall within a specic subtype.[76]
Bipolar NOS can still signicantly impair and adversely aect the quality of life of the patient.

Several rating scales for the screening and evaluation of

bipolar disorder exist, such as the Bipolar spectrum diagnostic scale.[67] The use of evaluation scales can not
substitute a full clinical interview but they serve to systematize the recollection of symptoms.[67] On the other
hand, instruments for the screening of bipolar disorder The bipolar I and II categories have speciers that indicate the presentation and course of the disorder. For
have low sensitivity and limited diagnostic validity.[67]

MANAGEMENT

example, the with full interepisode recovery specier disorder. Individuals may use self-help and pursue
applies if there was full remission between the two most recovery.
recent episodes.[77]
Hospitalization may be required especially with the manic
episodes present in bipolar I. This can be voluntary or
(if mental health legislation allows and varying state-to4.2.1 Rapid cycling
state regulations in the USA) involuntary (called civil or
Most people who meet criteria for bipolar disorder expe- involuntary commitment). Long-term inpatient stays are
rience a number of episodes, on average 0.4 to 0.7 per now less common due to deinstitutionalization, although
[86]
year, lasting three to six months.[78] Rapid cycling, how- these can still occur. Following (or in lieu of) a hospital
ever, is a course specier that may be applied to any of admission, support services available can include dropthe above subtypes. It is dened as having four or more in centers, visits from members of a community mental
mood disturbance episodes within a one-year span and health team or an Assertive Community Treatment team,
is found in a signicant proportion of individuals with supported employment and patient-led support groups,
bipolar disorder.[21] These episodes are separated from intensive outpatient programs. These are sometimes re[87]
each other by a remission (partial or full) for at least ferred to as partial-inpatient programs.
two months or a switch in mood polarity (i.e., from a
depressive episode to a manic episode or vice versa).[7]
The denition of rapid cycling most frequently cited in 5.1 Psychosocial
the literature (including the DSM) is that of Dunner and
Fieve: at least four major depressive, manic, hypomanic Psychotherapy is aimed at alleviating core symptoms,
or mixed episodes are required to have occurred during recognizing episode triggers, reducing negative expressed
a 12-month period.[79] Ultra-rapid (days) and ultra-ultra emotion in relationships, recognizing prodromal sympthe
rapid or ultradian (within a day) cycling have also been toms before full-blown recurrence, and, practicing
[88][89][90]
factors
that
lead
to
maintenance
of
remission.
[80]
described. The literature examining the pharmacological treatment of rapid cycling is sparse and there is no Cognitive behavioral therapy, family-focused therapy,
clear consensus with respect to its optimal pharmacolog- and psychoeducation have the most evidence for ecacy
in regard to relapse prevention, while interpersonal and
ical management.[81]
social rhythm therapy and cognitive-behavioral therapy
appear the most eective in regard to residual depressive
symptoms. Most studies have been based only on bipo4.3 Dierential diagnosis
lar I, however, and treatment during the acute phase can
There are several other mental disorders with symptoms be a particular challenge.[91] Some clinicians emphasize
similar to those seen in bipolar disorder. These disor- the need to talk with individuals experiencing mania, to
ders include schizophrenia, major depressive disorder,[82] develop a therapeutic alliance in support of recovery.[92]
attention decit hyperactivity disorder (ADHD), and certain personality disorders, such as borderline personality
5.2 Medication
disorder.[83][84][85]
It has been noted that the bipolar disorder diagnosis is ofcially characterized in historical terms such that, technically, anyone with a history of (hypo)mania and depression has bipolar disorder whatever their current or
future functioning and vulnerability. This has been described as an ethical and methodological issue, as it
means no one can be considered as being recovered (only
in remission") from bipolar disorder according to the
ocial criteria. This is considered especially problematic given that brief hypomanic episodes are widespread
among people generally and not necessarily associated
with dysfunction.[17]

Management

Main article: Treatment of bipolar disorder

Lithium carbonate is one of many treatments for bipolar disorder.

There are a number of pharmacological and A number of medications are used to treat bipolar
psychotherapeutic techniques used to treat bipolar disorder.[48] The medication with the best evidence

6.1

Functioning

is lithium, which is eective in treating acute manic

episodes and preventing relapses; lithium is also an eective treatment for bipolar depression.[93] Lithium reduces
the risk of suicide, self-harm, and death in people with
bipolar disorder.[94]

Bipolar disorder can be a severely disabling medical condition. However, many individuals with bipolar disorder
can live full and satisfying lives. Quite often, medication
is needed to enable this. Persons with bipolar disorder
may have periods of normal or near normal functioning
[106]
Four anticonvulsants are used in the treatment of bipo- between episodes.
lar disorder. Carbamazepine eectively treats manic
episodes, with some evidence it has greater benet in
rapid-cycling bipolar disorder, or those with more psy- 6.1 Functioning
chotic symptoms or a more schizoaective clinical picture. It is less eective in preventing relapse than lithium Functioning in bipolar I and II varies over time along
or valproate.[95][96] Carbamazepine became a popular a spectrum from good to fair to poor. During periods
treatment option for bipolar in the late 1980s and early of major depression or mania (in BPI), functioning was
1990s, but was displaced by sodium valproate in the on average poor, with depression being more persistently
1990s. Since then, valproate has become a commonly associated with disability than mania. Functioning beprescribed treatment, and is eective in treating manic tween episodes was on average good more or less norepisodes.[97] Lamotrigine has some ecacy in treating mal. Subthreshold symptoms were generally still substanbipolar depression, and this benet is greatest in more tially impairing, however, except for hypomania (below
severe depression.[98] It has also been shown to have or above threshold) which was associated with improved
some benet in preventing further episodes, though there functioning.[107]
are concerns about the studies done, and is of no benet in rapid cycling disorder.[99] The eectiveness of
topiramate is unknown.[100] Depending on the severity
of the case, anticonvulsants may be used in combination 6.2 Recovery and recurrence
with lithium or on their own.[101]
Antipsychotic medications are eective for short-term A naturalistic study from rst admission for mania or
treatment of bipolar manic episodes and appear to be su- mixed episode (representing the hospitalized and thereperior to lithium and anticonvulsants for this purpose.[48] fore most severe cases) found that 50% achieved synHowever, other medications such as lithium are preferred dromal recovery (no longer meeting criteria for the difor long-term use.[48] Olanzapine is eective in prevent- agnosis) within six weeks and 98% within two years.
ing relapses, although the evidence is not as solid as for Within two years, 72% achieved symptomatic recovery
lithium.[102] Antidepressants have not been found to be of (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential staany benet over that found with mood stabilizers.[103]
tus). However, 40% went on to experience a new episode
Short courses of benzodiazepines may be used in addi- of mania or depression within 2 years of syndromal retion to other medications until mood stabilizing become covery, and 19% switched phases without recovery.[108]
eective.[104]
Symptoms preceding a relapse (prodromal), specially
those related to mania, can be reliably identied by people with bipolar disorder.[109] There have been intents to
5.3 Alternative medicine
teach patients coping strategies when noticing such symptoms with encouraging results.[110]
There is some evidence that the addition of omega 3 fatty
acids may have benecial eects on depressive symptoms, although studies have been scarce and of variable
6.3 Suicide
quality.[105]

Prognosis

For many individuals with bipolar disorder a good

prognosis results from good treatment, which, in turn, results from an accurate diagnosis. Of the various forms of
bipolar disorder, rapid cycling bipolar disorder is associated with the worst prognosis.[21] Because bipolar disorder can have a high rate of both under-diagnosis and
misdiagnosis,[23] it is often dicult for individuals with
the condition to receive timely and competent treatment.

Bipolar disorder can cause suicidal ideation that leads

to suicidal attempts. Individuals whose bipolar disorder begins with a depressive or mixed aective episode
seem to have a poorer prognosis and an increased risk
of suicide.[82] One out of two people with bipolar disorder attempt suicide at least once during their lifetime and
many attempts are successfully completed.[14] The annual
average suicide rate is 0.4%, which is 1020 times that
of the general population.[111] The standardized mortality
ratio from suicide in bipolar disorder is between 18 and
25.[112] The lifetime risk of suicide has been estimated to
be as high as 20% in those with bipolar disorder.[7]

8 HISTORY

Epidemiology

for the onset of bipolar disorder.[120][121] One study also

found that in 10% of bipolar cases, the onset of mania
had happened after the patient had turned 50.[122]

8 History
Main article: History of bipolar disorder
Variations in moods and energy levels have been ob-

Burden of bipolar disorder around the world: disability-adjusted

life years per 100,000 inhabitants in 2004.

Bipolar disorder is the sixth leading cause of disability

worldwide and has a lifetime prevalence of about 3% in
the general population.[4][113] However, a reanalysis of
data from the National Epidemiological Catchment Area
survey in the United States suggested that 0.8% of the
population experience a manic episode at least once (the
diagnostic threshold for bipolar I) and a further 0.5% have
a hypomanic episode (the diagnostic threshold for bipolar II or cyclothymia). Including sub-threshold diagnostic
criteria, such as one or two symptoms over a short timeperiod, an additional 5.1% of the population, adding up to
a total of 6.4%, were classied as having a bipolar spectrum disorder.[114] A more recent analysis of data from a
second US National Comorbidity Survey found that 1%
met lifetime prevalence criteria for bipolar I, 1.1% for
bipolar II, and 2.4% for subthreshold symptoms.[115]
There are conceptual and methodological limitations and
variations in the ndings. Prevalence studies of bipolar
disorder are typically carried out by lay interviewers who
follow fully structured/xed interview schemes; responses
to single items from such interviews may suer limited
validity. In addition, diagnoses (and therefore estimates
of prevalence) vary depending on whether a categorical German psychiatrist Emil Kraepelin rst distinguished between
or spectrum approach is used. This consideration has led manicdepressive illness and dementia praecox (now known as
to concerns about the potential for both underdiagnosis schizophrenia) in the late 19th century
and overdiagnosis.[116]
served as part of the human experience since throughThe incidence of bipolar disorder is similar in men and out history. The words "melancholia" (an old word for
women[117] as well as across dierent cultures and eth- depression) and mania originated in Ancient Greek.
nic groups. A 2000 study by the World Health Organiza- The word melancholia is derived from melas/,
tion found that prevalence and incidence of bipolar disor- meaning black, and chole/, meaning bile or
der are very similar across the world. Age-standardized gall,[123] indicative of the terms origins in preprevalence per 100,000 ranged from 421.0 in South Asia Hippocratic humoral theories. Within the humoral theto 481.7 in Africa and Europe for men and from 450.3 ories, mania was viewed as arising from an excess of
in Africa and Europe to 491.6 in Oceania for women. yellow bile, or a mixture of black and yellow bile. The
However, severity may dier widely across the globe. linguistic origins of mania, however, are not so clear-cut.
Disability-adjusted life year rates, for example, appear Several etymologies are proposed by the Roman physito be higher in developing countries, where medical cov- cian Caelius Aurelianus, including the Greek word ania,
erage may be poorer and medication less available.[118] meaning to produce great mental anguish, and manos,
Within the United States, Asian Americans have signi- meaning relaxed or loose, which would contextucantly lower rates than their African and European Amer- ally approximate to an excessive relaxing of the mind
ican counterparts.[119]
or soul.[124] There are at least ve other candidates, and
Late adolescence and early adulthood are peak years part of the confusion surrounding the exact etymology of

9
the word mania is its varied usage in the pre-Hippocratic
poetry and mythologies.[124]
In the early 1800s, French psychiatrist Jean-tienne
Dominique Esquirol's lypemania, one of his aective
monomanias, was the rst elaboration on what was to
become modern depression.[125] The basis of the current conceptualisation of manicdepressive illness can be
traced back to the 1850s; on January 31, 1854, Jules
Baillarger described to the French Imperial Academy
of Medicine a biphasic mental illness causing recurrent
oscillations between mania and depression, which he
termed folie double forme (dual-form insanity).[126]
Two weeks later, on February 14, 1854, Jean-Pierre Falret presented a description to the Academy on what was
essentially the same disorder, and designated folie circulaire (circular insanity") by him.[127]
These concepts were developed by the German
psychiatrist Emil Kraepelin (18561926), who, using
Kahlbaum's concept of cyclothymia,[128] categorized
and studied the natural course of untreated bipolar
patients. He coined the term manic depressive psychosis,
after noting that periods of acute illness, manic or
depressive, were generally punctuated by relatively
symptom-free intervals where the patient was able to
Singer Rosemary Clooney's public revelation of bipolar disorder
function normally.[129]
The term manicdepressive reaction" appeared in the
rst American Psychiatric Association Diagnostic Manual in 1952, inuenced by the legacy of Adolf Meyer.[130]
Subclassifying this into 'unipolar' and 'bipolar' disorder
was rst proposed by German psychiatrists Karl Kleist
and Karl Leonhard in the 1950s and, since the DSM-III,
Major Depressive Disorder has been regarded as a separate condition to Bipolar Disorder. Subtypes of 'Bipolar
II' and 'rapid cycling' have been included since the DSMIV, based on work from the 1970s by David L. Dunner, Elliot S. Gershon, Frederick K. Goodwin, Ronald
R. Fieve and Joseph L. Fleiss.[131][132][133]

in 1977 made her an early celebrity spokeswoman for mental

illness

lar illness.[136]

Several dramatic works have portrayed characters with

traits suggestive of the diagnosis that has been the subject
of discussion by psychiatrists and lm experts alike. A
notable example is Mr. Jones (1993), in which Mr. Jones
(Richard Gere) swings from a manic episode into a depressive phase and back again, spending time in a psychiatric hospital and displaying many of the features of the
syndrome.[137] In The Mosquito Coast (1986), Allie Fox
(Harrison Ford) displays some features including recklessness, grandiosity, increased goal-directed activity and
mood lability, as well as some paranoia.[138] Psychiatrists
9 Society and culture
have suggested that Willy Loman, the main character in
Arthur Miller's classic play Death of a Salesman, suers
See also: List of people with bipolar disorder, Category:
[139]
though that specic term for
Books about bipolar disorder and Category:Films about from bipolar disorder,
the
condition
did
not
exist
when
the play was written.
bipolar disorder
There are widespread problems with social stigma, TV specials, for example the BBC's Stephen Fry: The Sestereotypes, and prejudice against individuals with a di- cret Life of the Manic Depressive,[140] MTV's True Life:
agnosis of bipolar disorder.[134]
I'm Bipolar, talk shows, and public radio shows, and the
Kay Redeld Jamison, a clinical psychologist and Pro- greater willingness of public gures to discuss their own
fessor of Psychiatry at the Johns Hopkins University bipolar disorder, have focused on psychiatric conditions,
School of Medicine, proled her own bipolar disorder thereby, raising public awareness.
in her memoir An Unquiet Mind (1995).[135] In his autobiography Manicdotes: Theres Madness in His Method
(2008) Chris Joseph describes his struggle between the
creative dynamism which allowed the creation of his
multi-million pound advertising agency Hook Advertising, and the money-squandering dark despair of his bipo-

On April 7, 2009, the nighttime drama 90210 on the

CW network, aired a special episode where the character Silver was diagnosed with bipolar disorder.[141] Stacey
Slater, a character from the BBC soap EastEnders, has
been diagnosed with the disorder. The storyline was developed as part of the BBCs Headroom campaign.[142]

10

10 SPECIFIC POPULATIONS

The Channel 4 soap Brookside had earlier featured a

story about bipolar disorder when the character Jimmy
Corkhill was diagnosed with the condition.[143] In April
2014, ABC premiered a medical drama, Black Box, in
which the main character, a world-renowned neuroscientist, is bipolar.[144]

10
10.1

Specic populations
Children

following the DSM criteria.[147] Others believe that

these criteria do not correctly separate children with
bipolar disorder from other problems such as ADHD,
and emphasize fast mood cycles.[147] Still others argue
that what accurately dierentiates children with bipolar
disorder is irritability.[147] The practice parameters of the
AACAP encourage the rst strategy.[145][147] American
children and adolescents diagnosed with bipolar disorder
in community hospitals increased 4-fold reaching rates
of up to 40% in 10 years around the beginning of the 21st
century, while in outpatient clinics it doubled reaching
6%.[147] Studies using DSM criteria show that up to 1%
of youth may have bipolar disorder.[145]

Main article: Bipolar disorder in children

[147]
In the 1920s, Emil Kraepelin noted that manic episodes Treatment involves medication and psychotherapy.
Drug prescription usually consists in mood stabilizers and atypical antipsychotics.[147] Among the former, lithium is the only compound approved by the
FDA for children.[145] Psychological treatment combines
normally education on the disease, group therapy and
cognitive behavioral therapy.[147] Chronic medication is
often needed.[147]
Current research directions for bipolar disorder in children include optimizing treatments, increasing the knowledge of the genetic and neurobiological basis of the pediatric disorder and improving diagnostic criteria.[147] The
DSM-V has proposed a new diagnosis which is considered to cover some presentations currently thought of as
childhood-onset bipolar.[149]
Lithium is the only medication approved by the FDA for treating
mania in children.

are rare before puberty.[145] In general, bipolar disorder in

children was not recognized in the rst half of the twen- 10.2 Elderly
tieth century. This issue diminished with an increased
following of the DSM criteria in the last part of the twenThere is a relative lack of knowledge about bipolar distieth century.[145][146]
order in late life. There is evidence that it becomes less
While in adults the course of bipolar disorder is char- prevalent with age but nevertheless accounts for a similar
acterized by discrete episodes of depression and mania percentage of psychiatric admissions; that older bipolar
with no clear symptomatology between them, in children patients had rst experienced symptoms at a later age;
and adolescents very fast mood changes or even chronic that later onset of mania is associated with more neusymptoms are the norm.[147] Pediatric bipolar disorder is rologic impairment; that substance abuse is considerably
commonly characterized by outbursts of anger, irritabil- less common in older groups; and that there is probably a
ity and psychosis, rather than euphoric mania, which is greater degree of variation in presentation and course, for
more likely to be seen in adults.[145][147] Early onset bipo- instance individuals may develop new-onset mania assolar disorder is more likely to manifest as depression rather ciated with vascular changes, or become manic only afthan mania or hypomania.[148]
ter recurrent depressive episodes, or may have been diThe diagnosis of childhood bipolar disorder is agnosed with bipolar disorder at an early age and still
controversial,[147] although it is not under discus- meet criteria. There is also some weak and not consion that the typical symptoms of bipolar disorder have clusive evidence that mania is less intense and there is
negative consequences for minors suering them.[145] a higher prevalence of mixed episodes, although there
The debate is mainly centered on whether what is called may be a reduced response to treatment. Overall, there
bipolar disorder in children refers to the same disorder are likely more similarities than dierences from younger
as when diagnosing adults,[145] and the related question adults.[150][151] In the elderly, recognition and treatment
of whether the criteria for diagnosis for adults are useful of bipolar disorder may be complicated by the presence
and accurate when applied to children.[147] Regard- of dementia or the side eects of medications being taken
ing diagnosis of children, some experts recommend for other conditions.[152]

11

11

See also

Bipolar disorders research

Bipolar Disorders (journal)

12

Notes

[1] Anderson, IM; Haddad, PM; Scott, J (Dec 27, 2012).

Bipolar disorder.. BMJ (Clinical research ed.) 345:
e8508. doi:10.1136/bmj.e8508. PMID 23271744.
[2] American Psychiatry Association (2013). Diagnostic and
Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 123154.
ISBN 0890425558.
[3] Goodwin, Guy M. Bipolar disorder. Medicine 40 (11):
596598. doi:10.1016/j.mpmed.2012.08.011.
[4] Schmitt A, Malchow B, Hasan A, Falkai P (February 2014). The impact of environmental factors in
severe psychiatric disorders. Front Neurosci 8 (19).
doi:10.3389/fnins.2014.00019. PMC 3920481. PMID
24574956.
[5] Diorio, A; Jones, I (2010). Is sex important? Gender dierences in bipolar disorder.. International review of psychiatry (Abingdon, England) 22 (5): 43752.
doi:10.3109/09540261.2010.514601. PMID 21047158.
[6] Hirschfeld, RM; Vornik, LA (Jun 2005). Bipolar
disordercosts and comorbidity.. The American journal
of managed care 11 (3 Suppl): S8590. PMID 16097719.
[7] Barnett JH, Smoller JW (2009).
The genetics
of bipolar disorder. Neuroscience 164 (1): 331
43. doi:10.1016/j.neuroscience.2009.03.080. PMC
3637882. PMID 19358880.
[8] Beentjes TA, Goossens PJ, Poslawsky IE (October 2012).
Caregiver burden in bipolar hypomania and mania: a
systematic review. Perspect Psychiatr Care 48 (4):
18797. doi:10.1111/j.1744-6163.2012.00328.x. PMID
23005586.
[9] Salvadore G, Quiroz JA, Machado-Vieira R, Henter ID,
Manji HK, Zarate CA (November 2010). The neurobiology of the switch process in bipolar disorder:
a review. J Clin Psychiatry 71 (11): 14881501.
doi:10.4088/JCP.09r05259gre. PMC 3000635. PMID
20492846.
[10] Titmarsh S (MayJune 2013). Characteristics and duration of mania: implications for continuation treatment. Progress in Neurology and Psychiatry 17 (3): 267.
doi:10.1002/pnp.283.
[11] Tarr GP, Glue P, Herbison P (November 2011). Comparative ecacy and acceptability of mood stabilizer and
second generation antipsychotic monotherapy for acute
maniaa systematic review and meta-analysis. J Aect
Disord 134 (13): 149. doi:10.1016/j.jad.2010.11.009.
PMID 21145595.

[12] Post RM, Kalivas P (March 2013). Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and crosssensitisation.
Br J Psychiatry 202 (3): 1726.
doi:10.1192/bjp.bp.112.116855. PMID 23457180.
[13] Knowles R, McCarthy-Jones S, Rowse G (June 2011).
Grandiose delusions: a review and theoretical integration
of cognitive and aective perspectives. Clin Psychol Rev
31 (4): 68496. doi:10.1016/j.cpr.2011.02.009. PMID
21482326.
[14] Kerner B (February 2014).
Genetics of bipolar disorder.
Appl Clin Genet 7:
3342.
doi:10.2147/tacg.s39297.
PMC 3966627.
PMID
24683306.
[15] Furukawa TA (2010). Assessment of mood: Guides for
clinicians. Journal of Psychosomatic Research 68 (6):
581589. doi:10.1016/j.jpsychores.2009.05.003. PMID
20488276.
[16] McKenna BS, Eyler LT (November 2012). Overlapping
prefrontal systems involved in cognitive and emotional
processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies. Clin Psychol Rev 32 (7): 65063.
doi:10.1016/j.cpr.2012.07.003. PMC 3922056. PMID
22926687.
[17] Mansell W, Pedley R (Mar 2008). The ascent into mania:
a review of psychological processes associated with the
development of manic symptoms.. Clinical Psychology
Review 28 (3): 494520. doi:10.1016/j.cpr.2007.07.010.
PMID 17825463.
[18] Bowins B (2007). Cognitive regulatory control therapies. Am J Psychother 67 (3): 21536. PMID 24236353.
[19] Bipolar Disorder: NIH Publication No. 95-3679. U.S.
National Institutes of Health. September 1995. Archived
from the original on 2008-04-29.
[20] Bipolar II Disorder Symptoms and Signs. Web M.D.
Retrieved 2010-12-06.
[21] Muneer A (June 2013). Treatment of the depressive
phase of bipolar aective disorder: a review. J Pak Med
Assoc 63 (6): 7639. PMID 23901682.
[22] APA Practice Guidelines for the Treatment
of
Psychiatric
Disorders:
Comprehensive
Guidelines and Guideline Watches 1.
2006.
doi:10.1176/appi.books.9780890423363.50051. ISBN
978-0-89042-336-3. |chapter= ignored (help)
[23] Bowden CL (January 2001). Strategies to reduce misdiagnosis of bipolar depression. Psychiatr Serv 52 (1):
515. doi:10.1176/appi.ps.52.1.51. PMID 11141528.
[24] Muzina DJ, Kemp DE, McIntyre RS (October
December 2007). Dierentiating bipolar disorders
from major depressive disorders:
treatment implications. Ann Clin Psychiatry 19 (4): 30512.
doi:10.1080/10401230701653591. PMID 18058287.

12

[25] Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk

WM, Scott J, Ha K, Suppes T (January 2013). Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of
illness, and diagnosis. Am J Psychiatry 170 (1): 3142.
doi:10.1176/appi.ajp.2012.12030301. PMID 23223893.
[26] Srivastava S, Ketter TA (December 2010). The link between bipolar disorders and creativity: evidence from personality and temperament studies.. Current psychiatry reports 12 (6): 52230. doi:10.1007/s11920-010-0159-x.
PMID 20936438.
[27] Goodwin & Jamison 2007, p. 338.
[28] Reinhardt MC, Reinhardt CA (MarchApril 2013). Attention decit-hyperactivity disorder, comorbidities, and
risk situations. J Pediatr (Rio J) 89 (2): 12430.
doi:10.1016/j.jped.2013.03.015. PMID 23642421.
[29] Cirillo PC, Passos RB, Bevilaqua MC, Lpez JR, Nardi
AE (December 2012). Bipolar disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder comorbidity: a systematic review. Rev Bras Psiquiatr 34
(4): 46779. doi:10.1016/j.rbp.2012.04.010. PMID
23429819.
[30] Sagman D and Tohen M (2009). Comorbidity in Bipolar
Disorder: The Complexity of Diagnosis and Treatment.
Psychiatric Times.
[31] Nierenberg AA, Kansky C, Brennan BP, Shelton RC,
Perlis R, Iosifescu DV (January 2013). Mitochondrial modulators for bipolar disorder: a pathophysiologically informed paradigm for new drug development.
Aust N Z J Psychiatry 47 (1): 2642.
doi:10.1177/0004867412449303. PMID 22711881.
[32] Edvardsen J, Torgersen S, Rysamb E, Lygren S,
Skre I, Onstad S, Oien PA (2008).
Heritability
of bipolar spectrum disorders. Unity or heterogeneity?". Journal of Aective Disorders 106 (3): 229240.
doi:10.1016/j.jad.2007.07.001. PMID 17692389.
[33] Kiesepp T, Partonen T, Haukka J, Kaprio J, Lnnqvist J (2004). High Concordance of Bipolar I
Disorder in a Nationwide Sample of Twins. American Journal of Psychiatry 161 (10): 18141821.
doi:10.1176/appi.ajp.161.10.1814. PMID 15465978.
[34] McGun P, Rijsdijk F, Andrew M, Sham P, Katz R,
Cardno A (2003). The Heritability of Bipolar Aective
Disorder and the Genetic Relationship to Unipolar Depression. Archives of General Psychiatry 60 (5): 497
502. doi:10.1001/archpsyc.60.5.497. PMID 12742871.
[35] Reich T, Clayton PJ, Winokur G (1969).
Family history studies: V. The genetics of mania. The
American Journal of Psychiatry 125 (10): 13581369.
doi:10.1176/ajp.125.10.1358. PMID 5304735.
[36] Craddock N, Sklar P (May 2013).
Genetics of
bipolar disorder.
Lancet 381 (9878): 165462.
doi:10.1016/S0140-6736(13)60855-7. PMID 23663951.

12 NOTES

[37] Segurado R, Detera-Wadleigh SD, Levinson DF, Lewis

CM, Gill M, Nurnberger JI, Craddock N, DePaulo JR,
Baron M, Gershon ES, Ekholm J, Cichon S, Turecki G,
Claes S, Kelsoe JR, Schoeld PR, Badenhop RF, Morissette J, Coon H, Blackwood D, McInnes LA, Foroud
T, Edenberg HJ, Reich T, Rice JP, Goate A, McInnis
MG, McMahon FJ, Badner JA, Goldin LR, Bennett P,
Willour VL, Zandi PP, Liu J, Gilliam C, Juo SH, Berrettini WH, Yoshikawa T, Peltonen L, Lnnqvist J, Nthen
MM, Schumacher J, Windemuth C, Rietschel M, Propping P, Maier W, Alda M, Grof P, Rouleau GA, DelFavero J, Van Broeckhoven C, Mendlewicz J, Adolfsson R, Spence MA, Luebbert H, Adams LJ, Donald JA,
Mitchell PB, Barden N, Shink E, Byerley W, Muir W,
Visscher PM, Macgregor S, Gurling H, Kalsi G, McQuillin A, Escamilla MA, Reus VI, Leon P, Freimer NB,
Ewald H, Kruse TA, Mors O, Radhakrishna U, Blouin
JL, Antonarakis SE, Akarsu N (2003). Genome Scan
Meta-Analysis of Schizophrenia and Bipolar Disorder,
Part III: Bipolar Disorder. The American Journal of Human Genetics 73 (1): 4962. doi:10.1086/376547. PMC
1180589. PMID 12802785.
[38] Frans EM, Sandin S, Reichenberg A, Lichtenstein P,
Lngstrm N, Hultman CM (2008). Advancing Paternal
Age and Bipolar Disorder. Archives of General Psychiatry 65 (9): 10341040. doi:10.1001/archpsyc.65.9.1034.
PMID 18762589.
[39] Kempton MJ, Geddes JR, Ettinger U, Williams SC,
Grasby PM (2008). Meta-analysis, Database, and Metaregression of 98 Structural Imaging Studies in Bipolar Disorder. Archives of General Psychiatry 65 (9):
10171032. doi:10.1001/archpsyc.65.9.1017. PMID
18762588.
[40] Arnone D, Cavanagh J, Gerber D, Lawrie SM, Ebmeier
KP, McIntosh AM (2009). Magnetic resonance imaging studies in bipolar disorder and schizophrenia: Metaanalysis. The British Journal of Psychiatry 195 (3): 194
201. doi:10.1192/bjp.bp.108.059717. PMID 19721106.
[41] Bipolar MRI Database. Bipolar Disorder Neuroimaging
Database (BiND).
[42] Strakowski SM, Adler CM, Almeida J, Altshuler LL,
Blumberg HP, Chang KD, DelBello MP, Frangou S,
McIntosh A, Phillips ML, Sussman JE, Townsend JD
(2012). The functional neuroanatomy of bipolar disorder: A consensus model. Bipolar Disorders 14 (4): 313
325. doi:10.1111/j.1399-5618.2012.01022.x. PMID
22631617.
[43] Bender RE, Alloy LB (April 2011).
Life stress
and kindling in bipolar disorder: review of the evidence and integration with emerging biopsychosocial theories. Clin Psychol Rev 31 (3): 38398.
doi:10.1016/j.cpr.2011.01.004. PMC 3072804. PMID
21334286.
[44] Lee HJ, Son GH, Geum D (September 2013). Circadian
Rhythm Hypotheses of Mixed Features, Antidepressant
Treatment Resistance, and Manic Switching in Bipolar Disorder. Psychiatry Investig 10 (3): 22532.
doi:10.4306/pi.2013.10.3.225. PMC 3843013. PMID
24302944.

13

[45] Brown & Basso 2004, p. 16.

[46] Dallaspezia S, Benedetti F (December 2009). Melatonin, circadian rhythms, and the clock genes in bipolar disorder. Curr Psychiatry Rep 11 (6): 48893.
doi:10.1007/s11920-009-0074-1. PMID 19909672.
[47] Serretti A, Mandelli L (2008). The genetics of bipolar disorder: Genome 'hot regions,' genes, new potential candidates and future directions. Molecular Psychiatry 13 (8): 742771. doi:10.1038/mp.2008.29. PMID
18332878.
[48] Geddes JR, Miklowitz DJ (May 11, 2013). Treatment
of bipolar disorder. Lancet 381 (9878): 167282.
doi:10.1016/S0140-6736(13)60857-0. PMID 23663953.

[58] Jamison KR (1993). Touched With Fire: Manicdepressive illness and the artistic temperament. New York:
The Free Press. ASIN B002C47A0K.
[59] Carey B (April 2005). Hypomanias up side distinct but
linked to bipolar disorder. Psychology. New York Times
News Service/The San Diego Union-Tribune.
[60] Sherman JA (2001). Evolutionary Origin of Bipolar Disorder (eobd)". Psycoloquy 12 (028).
[61] Sherman JA (2012). Evolutionary origin of bipolar
disorder-revised: EOBD-R. Medical Hypotheses 78
(1): 113122. doi:10.1016/j.mehy.2011.10.005. PMID
22036090.

[49] Brietzke E, Kauer Sant'anna M, Jackowski A, GrassiOliveira R, Bucker J, Zugman A, Mansur RB, Bressan RA
(December 2012). Impact of childhood stress on psychopathology (PDF). Rev Bras Psiquiatr 34 (4): 4808.
doi:10.1016/j.rbp.2012.04.009. PMID 23429820.

[62] Miklowitz DJ, Chang KD (Summer 2008). Prevention

of bipolar disorder in at-risk children: theoretical
assumptions and empirical foundations..
Development and Psychopathology 20 (3): 88197.
doi:10.1017/s0954579408000424.
PMC 2504732.
PMID 18606036.

[50] Miklowitz DJ, Chang KD (2008). Prevention of bipolar

disorder in at-risk children: Theoretical assumptions and
empirical foundations. Development and Psychopathology 20 (3): 881897. doi:10.1017/S0954579408000424.
PMC 2504732. PMID 18606036.

[63] Khan MA, Akella S (December 2009). CannabisInduced Bipolar Disorder with Psychotic Features: A
Case Report. Psychiatry (Edgmont) 6 (12): 448. PMC
2811144. PMID 20104292.

[51] Murray ED, Buttner N, Price BH. (2012) Depression

and Psychosis in Neurological Practice. In: Neurology
in Clinical Practice, 6th Edition. Bradley WG, Daro
RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. ISBN 1437704344 | ISBN 9781437704341
[52] Lahera G, Freund N, Siz-Ruiz J (JanuaryMarch 2013).
Salience and dysregulation of the dopaminergic system (PDF). Rev Psquiatr Salud Ment 6 (1): 4551.
doi:10.1016/j.rpsm.2012.05.003. PMID 23084802.
[53] Berk M, Dodd S, Kauer-Sant'anna M, Malhi GS, Bourin
M, Kapczinski F, Norman T (2007). Dopamine dysregulation syndrome: implications for a dopamine hypothesis of bipolar disorder. Acta Psychiatr Scanda Suppl
116 (Supplement s434): 4149. doi:10.1111/j.16000447.2007.01058.x. PMID 17688462.
[54] Michael N, Erfurth A, Ohrmann P, Gssling M, Arolt
V, Heindel W, Peiderer B (2003). Acute mania is accompanied by elevated glutamate/glutamine levels within
the left dorsolateral prefrontal cortex. Psychopharmacology 168 (3): 344346. doi:10.1007/s00213-003-1440-z.
PMID 12684737.
[55] Benes FM, Berretta S (2001). GABAergic interneurons: implications for understanding schizophrenia and
bipolar disorder. Neuropsychopharmacology 25 (1):
127. doi:10.1016/S0893-133X(01)00225-1. PMID
11377916.
[56] Phelps JR (2008). Chapter 5: The Big Picture There
Must Be Some Evolutionary Advantage?". The Biologic
Basis of Bipolar Disorder. PsychEducation.org.
[57] Gilbert P (2005). Evolution and depression: Issues and
implications. Psychological Medicine 36 (3): 287297.
doi:10.1017/S0033291705006112. PMID 16236231.

[64] Price AL, Marzani-Nissen GR (March 2012). Bipolar

disorders: a review. Am Fam Physician 85 (5): 48393.
PMID 22534227.
[65] Phillips ML, Kupfer DJ (May 2013). Bipolar disorder
diagnosis: challenges and future directions. Lancet 381
(9878): 166371. doi:10.1016/S0140-6736(13)609897. PMID 23663952.
[66] Perugi, G.; Ghaemi, S. N.; Akiskal, H. (2006).
Bipolar Psychopharmacotherapy.
p.
193.
doi:10.1002/0470017953.ch11. ISBN 9780470017951.
|chapter= ignored (help)
[67] Picardi A (2009). Rating scales in bipolar disorder. Current Opinion in Psychiatry 22 (1): 42
49.
doi:10.1097/YCO.0b013e328315a4d2.
PMID
19122534.
[68] Diagnostic and Statistical Manual of Mental Disorders, 4th
Edition (Text Revision). American Psychiatric Association. p. 2000.
[69] Korn ML. Across the Bipolar Spectrum: From Practice
to Research. Medscape.
[70] Beesdo K, Her M, Leibenluft E, Lieb R, Bauer M, Pfennig A (September 2009). Mood episodes and mood disorders: patterns of incidence and conversion in the rst
three decades of life. Bipolar Disord 11 (6): 63749.
doi:10.1111/j.1399-5618.2009.00738.x. PMC 2796427.
PMID 19689506.
[71] Akiskal HS, Benazzi F (2006). The DSM-IV and ICD10 categories of recurrent [major] depressive and bipolar II disorders: Evidence that they lie on a dimensional
spectrum. Journal of Aective Disorders 92 (1): 4554.
doi:10.1016/j.jad.2005.12.035. PMID 16488021.
[72] DSM-IV 2000.

14

[73] Bipolar Disorder. BehaveNet.

[74] Renk K, White R, Lauer BA, McSwiggan M, Pu
J, Lowell A (February 2014).
Bipolar Disorder
in Children. Psychiatry J 2014 (928685): 119.
doi:10.1155/2014/928685. PMC 3994906. PMID
24800202.
[75] Van Meter AR, Youngstrom EA, Findling RL
(June 2012).
Cyclothymic disorder:
a critical review.
Clin Psychol Rev 32 (4): 22943.
doi:10.1016/j.cpr.2012.02.001. PMID 22459786.
[76] Towbin K, Axelson D, Leibenluft E, Birmaher B
(May 2013). Dierentiating bipolar disorder-not otherwise specied and severe mood dysregulation. J
Am Acad Child Adolesc Psychiatry 52 (5): 46681.
doi:10.1016/j.jaac.2013.02.006. PMC 3697010. PMID
23622848.

12 NOTES

[85] Bassett D (2012). Borderline personality disorder and

bipolar aective disorder. Spectra or spectre? A review. Australian and New Zealand Journal of Psychiatry 46 (4): 327339. doi:10.1177/0004867411435289.
PMID 22508593.
[86] Becker T, Kilian R (2006). Psychiatric services for
people with severe mental illness across western Europe:
What can be generalized from current knowledge about
dierences in provision, costs and outcomes of mental
health care?". Acta Psychiatrica Scandinavica 113 (429):
916. doi:10.1111/j.1600-0447.2005.00711.x. PMID
16445476.
[87] McGurk SR, Mueser KT, Feldman K, Wolfe R, Pascaris
A (2007). Cognitive Training for Supported Employment: 23 Year Outcomes of a Randomized Controlled
Trial. American Journal of Psychiatry 164 (3): 437441.
doi:10.1176/appi.ajp.164.3.437. PMID 17329468.

[77] Longitudinal Course Speciers for Mood Disorders.

BehaveNet.

[88] Lam et al., 1999; Miklowitz & Goldstein, 1997; Frank,

2005.

[78] Angst J, Sellaro R (2000). Historical perspectives and

natural history of bipolar disorder. Biological Psychiatry
48 (6): 445457. doi:10.1016/s0006-3223(00)00909-4.
PMID 11018218.

[89] Leahy & Johnson 2003.

[79] Bauer M, Beaulieu S, Dunner DL, Lafer B, Kupka R

(February 2008). Rapid cycling bipolar disorder
diagnostic concepts. Bipolar Disorders 10 (1 Pt 2):
15362. doi:10.1111/j.1399-5618.2007.00560.x. PMID
18199234.
[80] Tillman R, Geller B (2003). Denitions of Rapid, Ultrarapid, and Ultradian Cycling and of Episode Duration
in Pediatric and Adult Bipolar Disorders: A Proposal
to Distinguish Episodes from Cycles. Journal of Child
and Adolescent Psychopharmacology 13 (3): 267271.
doi:10.1089/104454603322572598. PMID 14642014.
[81] Fountoulakis KN, Kontis D, Gonda X, Yatham LN
(March 2013). A systematic review of the evidence on
the treatment of rapid cycling bipolar disorder. Bipolar
Disord 15 (2): 11537. doi:10.1111/bdi.12045. PMID
23437958.
[82] Baldessarini RJ, Faedda GL, Odani E, Vzquez
GH, Marangoni C, Serra G, Tondo L (May 2013).
Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: a review. J Aect Disord 148 (1): 12935.
doi:10.1016/j.jad.2012.10.033. PMID 23219059.
[83] Sood AB, Razdan A, Weller EB, Weller RA (2005).
How to dierentiate bipolar disorder from attention
decit hyperactivity disorder and other common psychiatric disorders: A guide for clinicians. Current psychiatry
reports 7 (2): 98103. doi:10.1007/s11920-005-0005-8.
PMID 15802085.
[84] Magill CA (2004). The boundary between borderline
personality disorder and bipolar disorder: Current concepts and challenges. Canadian journal of psychiatry.
Revue canadienne de psychiatrie 49 (8): 551556. PMID
15453104.

[90] Basco & Rush 2005.

[91] Zaretsky AE, Rizvi S, Parikh SV (2007). How well
do psychosocial interventions work in bipolar disorder?".
Canadian journal of psychiatry. Revue canadienne de psychiatrie 52 (1): 1421. PMID 17444074.
[92] Havens LL, Ghaemi SN (2005). Existential despair and
bipolar disorder: The therapeutic alliance as a mood stabilizer. American journal of psychotherapy 59 (2): 137
147. PMID 16170918.
[93] Brown KM, Tracy DK (June 2013).
Lithium:
the pharmacodynamic actions of the amazing
ion. Ther Adv Psychopharmacol 3 (3): 16376.
doi:10.1177/2045125312471963.
PMC 3805456.
PMID 24167688.
[94] Cipriani A, Hawton K, Stockton S, Geddes JR (2013).
Lithium in the prevention of suicide in mood disorders:
updated systematic review and meta-analysis. BMJ 346:
f3646. doi:10.1136/bmj.f3646. PMID 23814104.
[95] Post RM, Ketter TA, Uhde T, Ballenger JC (2007).
Thirty years of clinical experience with carbamazepine
in the treatment of bipolar illness: Principles and practice. CNS Drugs 21 (1): 4771. doi:10.2165/00023210200721010-00005. PMID 17190529.
[96] Rapoport SI, Basselin M, Kim HW, Rao JS (October
2009). Bipolar disorder and mechanisms of action of
mood stabilizers. Brain Res Rev 61 (2): 185209.
doi:10.1016/j.brainresrev.2009.06.003. PMC 2757443.
PMID 19555719.
[97] Macritchie K, Geddes JR, Scott J, Haslam D, de
Lima M, Goodwin G (2003).
Reid, Keith, ed.
Cochrane Database of Systematic Reviews. Cochrane
database of systematic reviews (Online) (1): CD004052.
doi:10.1002/14651858.CD004052. PMID 12535506.
|chapter= ignored (help)

15

[98] Geddes JR, Calabrese JR, Goodwin GM (2008). Lam- [111] Sadock, Kaplan & Sadock 2007, p. 388.
otrigine for treatment of bipolar depression: Independent meta-analysis and meta-regression of in- [112] Roger S. McIntyre, MD, Joanna K. Soczynska, and Jakub
Konarski. Bipolar Disorder: Dening Remission and
dividual patient data from ve randomised trials.
Selecting Treatment. Psychiatric Times, October 2006,
The British Journal of Psychiatry 194 (1): 49.
Vol. XXIII, No. 11.
doi:10.1192/bjp.bp.107.048504. PMID 19118318.
[99] van der Loos ML, Klling P, Knoppert-van der Klein EA, [113] Boland EM, Alloy LB (February 2013). Sleep disturbance and cognitive decits in bipolar disorder: toward
Nolen WA (2007). Lamotrigine in the treatment of bipoan integrated examination of disorder maintenance and
lar disorder, a review. Tijdschrift voor psychiatrie 49 (2):
functional impairment. Clin Psychol Rev 33 (1): 3344.
95103. PMID 17290338.
doi:10.1016/j.cpr.2012.10.001. PMC 3534911. PMID
[100] Vasudev K, Macritchie K, Geddes J, Watson S,
23123569.
Young A (2006). Young, Allan H, ed. Cochrane
Database of Systematic Reviews. Cochrane database [114] Judd LL, Akiskal HS (2003). The prevalence and disof systematic reviews (Online) (1):
CD003384.
ability of bipolar spectrum disorders in the US population:
doi:10.1002/14651858.CD003384.pub2.
PMID
Re-analysis of the ECA database taking into account sub16437453. |chapter= ignored (help)
threshold cases. Journal of Aective Disorders 73 (12):
123131. doi:10.1016/s0165-0327(02)00332-4. PMID
[101] Barker 2003, pp. 28485.
12507745.
[102] Cipriani A, Rendell JM, Geddes J (2009). Cipriani, An- [115] Merikangas KR, Akiskal HS, Angst J, Greenberg PE,
drea, ed. Cochrane Database of Systematic Reviews.
Hirschfeld RM, Petukhova M, Kessler RC (2007).
Cochrane database of systematic reviews (Online) (1):
Lifetime and 12-Month Prevalence of Bipolar Spectrum
CD004367.
doi:10.1002/14651858.CD004367.pub2.
Disorder in the National Comorbidity Survey ReplicaPMID 19160237. |chapter= ignored (help)
tion. Archives of General Psychiatry 64 (5): 543552.
doi:10.1001/archpsyc.64.5.543. PMC 1931566. PMID
[103] El-Mallakh RS, Elmaadawi AZ, Loganathan M, Lo17485606.
hano K, Gao Y (July 2010). Bipolar disorder: an
update.
Postgraduate Medicine 122 (4): 2431.
[116] Phelps J (2006). Bipolar Disorder: Particle or Wave?
doi:10.3810/pgm.2010.07.2172. PMID 20675968.
DSM Categories or Spectrum Dimensions?". Psychiatric
Times.
[104] Benzodiazepines for Bipolar Disorder. WebMD.com.
Retrieved 13 February 2013.
[105] Montgomery P, Richardson AJ (Apr 16, 2008). Montgomery, Paul, ed. Omega-3 fatty acids for bipolar disorder. The Cochrane database of systematic reviews (2):
CD005169.
doi:10.1002/14651858.CD005169.pub2.
PMID 18425912.
[106] Bergen 1999.

[117] Farren CK, Hill KP, Weiss RD (December 2012).

Bipolar disorder and alcohol use disorder: a review.
Curr Psychiatry Rep 14 (6): 65966.
doi:10.1007/s11920-012-0320-9.
PMC 3730445.
PMID 22983943.
[118] Ayuso-Mateos, Jose Luis. Global burden of bipolar disorder in the year 2000 (PDF). World Health Organization. Retrieved December 9, 2012.

[107] Judd LL, Akiskal HS, Schettler PJ, Endicott J, Leon AC,
Solomon DA, Coryell W, Maser JD, Keller MB (Dec [119] Kurasaki, Karen S. (2002). Asian American Mental
Health: Assessment Theories and Methods. pp. 1415.
2005). Psychosocial disability in the course of bipolar I
and II disorders: a prospective, comparative, longitudinal
study.. Archives of General Psychiatry 62 (12): 132230. [120] Christie KA, Burke JD, Regier DA, Rae DS, Boyd JH,
Locke BZ (1988). Epidemiologic evidence for early ondoi:10.1001/archpsyc.62.12.1322. PMID 16330720.
set of mental disorders and higher risk of drug abuse
[108] Tohen M, Zarate CA, Hennen J, Khalsa HM, Strakowski
in young adults. The American Journal of Psychiatry
SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ
145 (8): 971975. doi:10.1176/ajp.145.8.971. PMID
(2003). The McLean-Harvard First-Episode Mania
3394882.
Study: Prediction of recovery and rst recurrence. The
American Journal of Psychiatry 160 (12): 20992107. [121] Goodwin & Jamison 2007, p. 1945.
doi:10.1176/appi.ajp.160.12.2099. PMID 14638578.
[122] Monczor M (2010). Bipolar disorder in the elderly.
[109] Jackson A, Cavanagh J, Scott J (2003). A systematic
Vertex (Buenos Aires, Argentina) 21 (92): 275283.
review of manic and depressive prodromes. Journal of
PMID 21188315.
Aective Disorders 74 (3): 209217. doi:10.1016/s0165[123] Liddell & Scott 1980.
0327(02)00266-5. PMID 12738039.
[110] Lam D, Wong G (2005). Prodromes, coping strate- [124] Angst J, Marneros A (December 2001). Bipolarity from
gies and psychological interventions in bipolar disorancient to modern times: conception, birth and rebirth.
ders. Clinical Psychology Review 25 (8): 10281042.
J Aect Disord 67 (13): 319. doi:10.1016/S0165doi:10.1016/j.cpr.2005.06.005. PMID 16125292.
0327(01)00429-3. PMID 11869749.

16

13

REFERENCES

[125] Borch-Jacobsen M (October 2010). Which came rst, [145] McClellan J, Kowatch R, Findling RL (2007).
the condition or the drug?". London Review of Books 32
Practice Parameter for the Assessment and Treat(19): 3133. at the beginning of the 19th century with Esment of Children and Adolescents with Bipolar
quirols aective monomanias (notably lypemania, the
Disorder.
Journal of the American Academy of
rst elaboration of what was to become our modern deChild & Adolescent Psychiatry 46 (1): 107125.
pression)
doi:10.1097/01.chi.0000242240.69678.c4.
PMID
17195735.
[126] Pichot P (2004). Circular insanity, 150 years on. Bulletin de l'Academie nationale de medecine (in French) 188 [146] Anthony, J.; Scott, P. (1960). Manicdepressive
(2): 275284. PMID 15506718..
Psychosis in Childhood.
Journal of Child Psychology and Psychiatry 1: 53. doi:10.1111/j.1469[127] Sedler MJ (1983). Falrets discovery: The origin
7610.1960.tb01979.x.
of the concept of bipolar aective illness. Translated by M. J. Sedler and Eric C. Dessain. The [147] Leibenluft E, Rich BA (2008). Pediatric Bipolar DisorAmerican Journal of Psychiatry 140 (9): 11271133.
der. Annual Review of Clinical Psychology 4: 163187.
doi:10.1176/ajp.140.9.1127. PMID 6351641.
doi:10.1146/annurev.clinpsy.4.022007.141216. PMID
[128] Millon 1996, p. 290.

17716034.

[129] Kraepelin, Emil (1921) Manicdepressive Insanity and [148] Cosgrove VE, Roybal D, Chang KD (April 2013). Bipolar depression in pediatric populations: epidemiology
Paranoia ISBN 0-405-07441-7
and management. Paediatr Drugs 15 (2): 8391.
doi:10.1007/s40272-013-0022-8. PMID 23529869.
[130] Goodwin & Jamison 2007, Chapter 1.
[131] Bipolar Depression: Molecular Neurobiology, Clinical [149] DSM-5 Childhood and Adolescent Disorders Work
Diagnosis and Pharmacotherapy Carlos A. Zarate Jr.,
Group (2010-01-28). Proposed change: ...to the Mood
Husseini K. Manji, Springer Science & Business Media,
Disorders Section of DSM-V (PDF). American Psychi16 Apr 2009
atric Association. Retrieved 2012-02-18.
APA Announces Draft Diagnostic Criteria for DSM-5
[132] The course of bipolar disorder Kate E. A. Saunders and
(PDF) (Press release). American Psychiatric Association.
Guy M. Goodwin, Advances in Psychiatric Treatment
10 February 2010. Retrieved 2012-02-18.
(2010) 16: 318-328 doi:10.1192/apt.bp.107.004903
[150] Vasudev A, Thomas A (July 2010). "'Bipolar disorder' in
[133] DAVID L.DUNNER Interviewed by Thomas A. Ban for
the elderly: whats in a name?". Maturitas 66 (3): 2315.
the ANCP, Waikoloa, Hawaii, December 13, 2001
doi:10.1016/j.maturitas.2010.02.013. PMID 20307944.
[134] Elgie R. Morselli PL (FebMar 2007). Social functioning in bipolar patients: the perception and perspective of [151] Depp CA, Jeste DV (2004). Bipolar disorder in older
adults: A critical review. Bipolar Disorders 6 (5): 343
patients, relatives and advocacy organizations a review.
367. doi:10.1111/j.1399-5618.2004.00139.x. PMID
Bipolar disorders 9 (12): 14457. doi:10.1111/j.139915383127.
5618.2007.00339.x. PMID 17391357.
[135] Jamison 1995.
[136] Joseph 2008.

[152] Trinh NH, Forester B (2007). Bipolar Disorder in the Elderly: Dierential Diagnosis and Treatment. Psychiatric
Times 24 (14).

[137] Robinson 2003, pp. 7881.

[138] Robinson 2003, pp. 8485.
[139] McKinley, Jesse (February 28, 1999). Get That Man
Some Prozac; If the Dramatic Tension Is All in His Head.
The New York Times. Retrieved 3 March 2012.
[140] The Secret Life of the Manic Depressive. BBC. 2006.
Retrieved February 20, 2007.
[141] Child and Adolescent Bipolar Foundation special 90210
website. CABF. 2009. Retrieved April 7, 2009.
[142] EastEnders Stacey faces bipolar disorder. BBC Press
Oce. May 14, 2009. Retrieved May 28, 2009.
[143] Tinniswood, Rachael (May 14, 2003). The Brookie boys
who shone at soap awards show. Liverpool Echo (Mirror
Group Newspapers). Retrieved April 26, 2014.
[144] Catherine Black by Kelly Reilly - Black Box - abc.com.
ABC. Retrieved May 22, 2014.

13 References
Barker, P., ed. (2003). Psychiatric and mental health nursing: the craft and caring. London:
Arnold.
Basco, Monica Ramrez (2005). The bipolar workbook: tools for controlling your mood swings. Guilford Press. ISBN 978-1-59385-162-0.
Basco, Monica Ramirez; Rush, A. John (2005).
Cognitive-Behavioral Therapy for Bipolar Disorder
(Second ed.). New York: The Guilford Press. ISBN
978-1-59385-168-2. OCLC 300306925.
Bergen, M. (1999). Riding the Roller Coaster: Living
with Mood Disorders. Wood Lake Publishing. ISBN
978-1-896836-31-7.

17
Brown, Malcomb R.; Basso, Michael R. (2004). Focus on Bipolar Disorder Research. Nova Science
Publishers. ISBN 978-1-59454-059-2.
Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 1994. ISBN 978-0-89042-061-4.
OCLC 29953039.
Diagnostic and statistical manual of mental
disorders: DSM-IV (4th, text revision ed.).
Washington, DC: American Psychiatric Association. 2000. ISBN 978-0-89042-025-6.
OCLC 742067027.
Joseph, Chris (2008). Manicdotes: Theres Madness
in His Method. London: Austin & Macauley. ISBN
978-1-905609-07-9. Amazon review.
Goodwin, F. K.; Jamison, K. R. (2007). Manic
depressive illness: bipolar disorders and recurrent depression (2nd. ed.). Oxford University Press. ISBN
978-0-19-513579-4. OCLC 70929267.
Jamison, Kay Redeld (1995). An Unquiet Mind: A
Memoir of Moods and Madness. New York: Knopf.
ISBN 978-0-330-34651-1.
Leahy, Robert L.; Johnson, Sheri L. (2003). Psychological Treatment of Bipolar Disorder. New
York: The Guilford Press. ISBN 978-1-57230-9241. OCLC 52714775.
Liddell, Henry George; Scott, Robert (1980). A
Greek-English Lexicon (Abridged ed.). Oxford University Press. ISBN 978-0-19-910207-5.
Millon, Theordore (1996). Disorders of Personality:
DSM-IV-TM and Beyond. New York: John Wiley
and Sons. ISBN 978-0-471-01186-6.
Robinson, D. J. (2003). Reel Psychiatry: Movie
Portrayals of Psychiatric Conditions. Port Huron,
Michigan: Rapid Psychler Press. ISBN 978-1894328-07-4.
Sadock, Benjamin J.; Kaplan, Harold I.; Sadock,
Virginia A. (2007). Kaplan & Sadocks synopsis
of psychiatry: behavioral sciences/clinical ... ISBN
978-0-7817-7327-0.
Yatham, Lakshmi (2010). Bipolar Disorder. New
York: Wiley. ISBN 978-0-470-72198-8.

14

Further reading

Healy, David (2011). Mania: A Short History of

Bipolar Disorder. Baltimore, MD: Johns Hopkins
University Press. ISBN 978-1421403977.

Mondimore, Francis Mark (2014). Bipolar Disorder: A Guide for Patients and Families (3rd. ed.).
Baltimore, MD: Johns Hopkins University Press.
ISBN 978-1421412061.

15 External links
Bipolar Disorder at DMOZ
Bipolar Disorder overview from the U.S. National
Institute of Mental Health website
NICE Bipolar Disorder clinical guidelines from the
U.K. National Institute for Health and Clinical Excellence website

18

16

16
16.1

TEXT AND IMAGE SOURCES, CONTRIBUTORS, AND LICENSES

Text and image sources, contributors, and licenses

Text

Bipolar disorder Source: https://en.wikipedia.org/wiki/Bipolar_disorder?oldid=675941499 Contributors: AxelBoldt, The Cunctator,

Bryan Derksen, Timo Honkasalo, The Anome, Koyaanis Qatsi, Ed Poor, William Avery, Jtoomim, Camembert, Youandme, R Lowry,
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Cribcage, G-Man, Angela, Kingturtle, LouI, Nikai, Triangular, BAxelrod, Smack, Plfarley, Charles Matthews, Timwi, Stone, Denni, Steinsky, IceKarma, Tpbradbury, Jnc, Jose Ramos, Wiwaxia, Curero, Aaronhill, L-Bit, Johnleemk, Lumos3, Branddobbe, Edbeckham, Auric,
Davidds, Hadal, Mandel, ElBenevolente, Seth Ilys, Oobopshark, Dina, Jeremiah, Mourningblade, Connelly, Beefman, Netoholic, Zigger,
Ausir, Peruvianllama, Everyking, Alison, Jfdwol, Guanaco, Skagedal, Ddama, Mboverload, Eequor, Macrakis, Jackol, SWAdair, Golbez,
RayTomes, Gyrofrog, Mmm~enwiki, Gadum, Andycjp, SarekOfVulcan, SURIV, Quadell, Antandrus, Ptypes, Aeconley, Paulscrawl, Bodnotbod, Sam Hocevar, Nup~enwiki, Joyous!, Valproate, Syvanen, BrianWilloughby, BMS, Yonkeltron, Trevor MacInnis, TheObtuseAngleOfDoom, Grunt, Volantwish, Metahacker, Oskar Sigvardsson, AAAAA, Myfanwy, Hadi a, Rich Farmbrough, Rhobite, Guanabot, KittySaturn, Randee15, Rsanchezsaez, Spundun, Ardonik, Autiger, Combuchan, Pavel Vozenilek, Paul August, ESkog, Andrejj, Thnr, Tuxmelvin,
Bcjordan, JoeSmack, Petersam, Elwikipedista~enwiki, Zscout370, Frankieist, Kiand, DS1953, Ascorbic, Nonpareility, Zenohockey, Cedders, Kwamikagami, Barfooz, Sietse Snel, RoyBoy, Dennis Brown, Nickj, Memzy, Markussep, Wareh, Pablo X, CDN99, Bobo192, Circeus,
NetBot, Cmdrjameson, PeteThePill, .:Ajvol:., Wojtek Podgorski, Arcadian, Syd1435, Kjkolb, Pearle, Googie man, Knucmo2, Jumbuck,
Tigrreye, Msh210, Alansohn, Atlant, Clarphimous, WTGDMan1986, Andrewpmk, Sade, AzaToth, Lightdarkness, Mac Davis, Cdc, Malo,
Ombudsman, Rptb1, Wtmitchell, CaseInPoint, SidP, Helixblue, Wtshymanski, Danntm, Vcelloho, Staeiou, Dirac1933, Pethr, SteinbDJ,
Gene Nygaard, Dan East, Ceyockey, Kenyon, Mitc0185, Oleg Alexandrov, Mahanga, Kelly Martin, The JPS, Woohookitty, Banansk, RHaworth, Swamp Ig, LoopZilla, James Kemp, Barrylb, Ferguskane, LeaMaimone, Apokrif, Acerperi, Tabletop, Howabout1, Dolfrog, Bluemoose, Wtfunkymonkey, Avertist, Halcatalyst, Akane~enwiki, Audiodude, Rufous, Sin-man, SqueakBox, Ashmoo, Graham87, WBardwin, Cuchullain, BD2412, Johann Gambolputty~enwiki, Kbdank71, Bikeable, Josh Parris, Sjakkalle, Rjwilmsi, Mayumashu, Tizio, Zcraysh, Seidenstud, Marvmiller, Koavf, Jake Wartenberg, Vary, MarSch, Renamed user 8262690166681, Salleman, Galactiger, Ligulem,
Tdowling, Bubba73, Afterwriting, The wub, Omgwtf, Plastictv, AlisonW, Hermione1980, FlavrSavr, MartinC~enwiki, Fred Bradstadt,
Yamamoto Ichiro, Titoxd, Windchaser, Nihiltres, SouthernNights, RogerKni, Paul foord, RexNL, Gurch, Scottrainey, Travis.Thurston,
TruthInEvidence, Ippittybippitty, Imnotminkus, Mechasheherezada, Valentinian, Celebere, Rogertudor, WriterHound, Rollie, Mr.Rocks,
Ben Tibbetts, The Rambling Man, YurikBot, Wavelength, Hairy Dude, Kollision, Xcrivener, RussBot, Pacaro, Backburner001, Anonymous editor, Jlc46, Splash, Pigman, IanManka, Stephenb, Rintrah, Shell Kinney, Gaius Cornelius, Wimt, Sesquiannual, Draeco, Shanel,
NawlinWiki, Nahallac Silverwinds, Ithacagorges, Wiki alf, Ytcracker, KrisWood, Boneheadmx, Keithonearth, Grafen, John Bokma, NickBush24, Welsh, Joelr31, Irishguy, Johno95, Brian Crawford, Rmky87, Pyroclastic, Moe Epsilon, William Graham, Harley Moore, Nick
C, Tony1, Alex43223, Zwobot, Aaron Schulz, Vlad, Psy guy, Bota47, Nathanp0515, CLW, Tonywalton, Nick123, Deeday-UK, FF2010,
Newagelink, Ali K, Zeppelin4life, Nikkimaria, JuJube, GraemeL, Chickeyd, Whobot, Mais oui!, Jaranda, Dyslexic Q-Thief, Extreme Unction, Allens, Kungfuadam, RG2, Maxamegalon2000, Zvika, Je Silvers, Yesteraeon, Trolleymusic, That Guy, From That Show!, Kpetz,
Looslion, SmackBot, GBarnett, Unschool, Imz, ThreeDee912, CarbonCopy, Steve carlson, Zazaban, Anagnorisis, Anarchist42, Hydrogen
Iodide, Unyoyega, Kilo-Lima, Jagged 85, Setanta747 (locked), ScaldingHotSoup, Jfurr1981, Delldot, Eskimbot, Veesicle, GoOdCoNtEnT, Edgar181, Stevegallery, Pigkeeper, Mifren, Gilliam, Gipsy~enwiki, Ohnoitsjamie, Expo512, Betacommand, Oscarthecat, Drknexus,
ERcheck, Kledsky, Sviemeister, Mirokado, Bluebot, Keegan, Static Universe, Talensis, RDBrown, MK8, Fuzzform, Liamdaly620, Greatgavini, Mdwh, Deli nk, Francesca Allan of MindFreedomBC, Alexwiki, MichaelWheeley, Toughpigs, Royboycrashfan, Tamfang, Sadhaka,
Eye.of.the.dragony, Dlin2007, Ryanandrew, WikiCats, Chan Yin Keen, AWeidman, Rrburke, Katwmn6, Samba6566, Kittybrewster,
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Moop stick, Chrisd87, Craigblock, The Man in Question, Petter73, MarkSutton, Frixa, AwesomeMachine, Justahooligan, Unopeneddoor,
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Rmallins, Cal118, Cydebot, Dr. Ransom, RebelWithoutASauce, Kacunnin, Clayoquot, Anthonyhcole, JFreeman, XcepticZP, Marssociety, Pascal.Tesson, Absentis, Rhmaustin, Mrdarcey, Arabiainfo, Odie5533, Paulraeburn, Tawkerbot4, Naudefj, Doug Weller, DumbBOT, Chrislk02, Jrgetsin, Reelgenius, Nsaum75, Jsg58, Sweens112, Lindsay658, West911, Psych 210, Casliber, Matt Peacock, Mattisse, Thijs!bot, Epbr123, Barticus88, Akb4, Olayak, CopperKettle, Jasonisme, Evmedia, Headbomb, Simeon H, DPeterson, MarkWood,
SomeStranger, Odessaukrain, RFerreira, Arkadiusz Bialak, Sfxdude, CharlotteWebb, SusanLesch, Ratbert42, Dawnseeker2000, Natalie
Erin, J Clear, Escarbot, Eleuther, Razamatazz, Dantheman531, Mentisto, Cyclonenim, AntiVandalBot, Francis1864, Luna Santin, Widefox, Rolgiati, Cteckerman, StringRay, Grams79, Rie, JonesRD, Derekobrien, Tomixdf, Tlabshier, Vendettax, Kent Witham, Nleamy,
Mdz, Princeofexcess, Myanw, SamDavidson, Gkhan, Res2216restar, JAnDbot, Leuko, Husond, RalphLender, Roman clef, Epeeeche,
Davespice, Ribonucleic, Dcooper, Hut 8.5, Hippobabe, LittleOldMe, Conserrnd, Magioladitis, PrimroseGuy, Smeddlesboy, Bongwarrior,
VoABot II, Yannimalliaris, Avjoska, Endgame1, Jay Gatsby, Nessman, Gamkiller, Ling.Nut, Meph256, Rivertorch, Sedmic, CTF83!, Rami
R, Zioroboco, Lasvegaswil, Murmur74, Goodmanjaz, Skew-t, LeaHazel, Aka042, Sideburnstate, Caesarjbsquitti, Shythylacine, Domingo
Portales, JHB, Hekerui, Catgut, Stephabillie, Phospher, Portiaspeace, 28421u2232nfenfcenc, Gefaehrlich, LorenzoB, Ccmen, Ksvaughan2,
DerHexer, Edward321, Teardrop onthere, WinWin4Dubya, Hbent, Stolsvik, Moguaurobanazg, Iceness, Metiiiiiiii, Chrisganeymd,
April.s, ClubOranje, Drjem3, Ineable3000, Yobol, MartinBot, Dokijic, UnrulyMoose, TheHappyHeathen, Kevinmkr, Zach99, Iwanash,
Genesis12~enwiki, TwoTreesMedia, EverSince, Pekaje, Sally wonder, LittleOldMe old, Lilac Soul, LedgendGamer, Djehutimusic, JBC3,
J.delanoy, Berkeley99, Meloolah, Draccon136, Grim Revenant, Rgoodermote, Hans Dunkelberg, Boghog, Uncle Dick, MistyMorn, Xomiaxo, All Is One, Ema111, Grrrlgeek, AquamarineOnion, Adrealtor, Zuejay, Mr Rookles, Codysnigga, Stunz2, Mikael Hggstrm, Aeron
Daly, Floateruss, Belovedfreak, DadaNeem, Aervanath, TheScotch, Ajeeter4, Whetstone333, Juliancolton, STBotD, WJBscribe, DorganBot, Treisijs, Mike V, Sacredpikt, Keenman76, Kaitlin sparks auburn, ForrestLane42, JavierMC, Dorftrottel, Ontopgg, StoptheDatabaseState, Biore007, Nasti~enwiki, Czexican, RJASE1, Ddd1600, Axel92, VolkovBot, DagnyB, Bipolar Researcher, Naomi njw, Leopold
B. Stotch, Leebo, Je G., Sykopomp, AlnoktaBOT, PaulNahay, Bovineboy2008, IceHorse, Philip Trueman, TXiKiBoT, Splashhh, Oshwah, Immortal321, Coder Dan, Cosmic Latte, DeeKenn, Katoa, PizzaBox, Brintsta, Rajsek, Dchall1, Falconian, Qxz, Garrondo, Grace

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E. Dougle, Retiono Virginian, Riganomic, Anna Lincoln, Aogilvie, Reach110, Gnif global, Wiikipedian, Otaku JD, Hunterhogan, JhsBot, Ryanmoet, Bonze blayk, Moaaotearoa, Janers0217, Don't Rain on my Burrito, Roobal, Subzero 600, Penarc, Lanjoe9~enwiki, Fiatlux5762, Blurpeace, Dvmedis, DrVerlucci, Lova Falk, Peapeam, Paul gene, Enviroboy, Burntsauce, MitraE, Wikireader2007, Big b123,
BlackCab, Doc James, AlleborgoBot, Disk Crasher, Michaelsbll, Deconstructhis, Hmwith, Bfpage, SieBot, Moonriddengirl, Sdcoates1978,
Empacher, ToePeu.bot, Sakkura, Dawn Bard, Danierrr, Yuefairchild, RedJessi, Fibo1123581321, Mr.Z-bot, DashaKat, Tiptoety, Lightmouse, Callidior, OKBot, Rosiestep, Maelgwnbot, Spuzzdawg, Mygerardromance, Interestedperson, Florentino oro, Hgurling, Abiola99,
Pinkadelica, Dolphin51, Hordaland, Thepiggz2, MrADHD, Velvetron, Ymalliaris, Rurik16, ClueBot, Danhiel, Userafw, Justin W Smith,
The Thing That Should Not Be, IceUnshattered, F.N. Wombat, AnneBoleyn1536, Pi zero, Gaia Octavia Agrippa, Arakunem, Sting au,
Yuccara, Drmies, Mild Bill Hiccup, Vsenderov, Niceguyedc, Jonund, Seanlcky13, Blanchardb, Lordzuke, Passargea, Kellie bellie lol, CohesionBot, Resoru, Variante~enwiki, Lunchscale, Rawebb, Aseld, Drekool17, Fjeanfox, Skinnydonk, 6afraidof7, Salon Essahj, Thingg,
7, Versus22, Tezero, SoxBot III, Relly Komaruzaman, DumZiBoT, Jengirl1988, BarretB, XLinkBot, AnotherSolipsist, Jytdog, Cminard,
Rom Manic, Rreagan007, Facts707, WikHead, Noctibus, Gazimo, MystBot, Turtledude333, Moniie, Addbot, Xp54321, Cjc22, Jv821,
DOI bot, Nightmareishere, Boomur, Mojomama, Fieldday-sunday, Skyring520, Aboctok, MettanAtem, CanadianLinuxUser, Diptanshu.D, Ekologkonsult, SantaBarbaraKerr, Jpoelma13, This is Paul, Looie496, Pureballa25, Proxima Centauri, Rocketpop, Glane23, Chzz,
AlexW1122, Doniago, Guydrawers, Taopman, Brainmachine, Katharine908, Tide rolls, Luckas Blade, Gail, Zorrobot, Trotter, Luckasbot, Yobot, Granpu, 2D, II MusLiM HyBRiD II, Amirobot, Melaena, Becky Sayles, THEN WHO WAS PHONE?, Albrodax, Happyglee,
Mdw0, AnomieBOT, Mr.Grave, IRP, Glory holes, Piano non troppo, AdjustShift, Aditya, Lopez7.vii, Kingpin13, Ulric1313, Crecy99,
Flewis, Je Muscato, Materialscientist, Citation bot, Freshghter9, Maxis ftw, Basilisk4u, GB fan, Neurolysis, Sirodfrance, ArthurBot,
Quebec99, LilHelpa, Ymsandweiss, NWs Public Sock, EngelbertH, Xqbot, Playpolly, JimVC3, Capricorn42, Ltgeyer, Cypher12, PrevMedFellow, Zeropoint001, Musicles, J04n, GrouchoBot, A dullard, Omnipaedista, Bschlueter, Goldsock, Dgdgbd, Bitsnpieces, RedBeach7, RibotBOT, Cnupur, Earthlyrecovery, CassiasMunch, Sophus Bie, Zaokski, SobaNoodleForYou, Zenshortz, Bytbox, iedas, Kiloranpa2, Cortamears, FrescoBot, Anna Roy, Scoutstr295, Qwaesz, Lothar von Richthofen, VS6507, ArizonaCardinals11, Wschmidtny,
XAaronD, EvilFlyingMonkey, Contentmaven, Guv703, Runalindi, Nedib1, BenzolBot, Srl40214, Charles.hamilton95, Citation bot 1,
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Naturalpsychology, Angelito7, Emeraldames, RjwilmsiBot, Ripchip Bot, Uanfala, Neon Sky, Mophoplz, Pearl Dragon, EmausBot, Eloerc, Pile-Up, Bytelemed, Dadaist6174, Anne2608, Qrsdogg, Jim Michael, HiW-Bot, Manicjedi, Bongoramsey, H3llBot, AManWithNoPlan, Ocaasi, Erianna, Peterwigginout, Nohoguy, Doc murad, Cymbelmineer, Pun, ChuispastonBot, Lindygrey, ClueBot NG, Jnorton7558, Oconnor2, Hadel.tabayoyong, Panda11, LogX, Talgris, KplFlUSA, Parjlarsson, Arvm, North Atlanticist Usonian, Helpful Pixie
Bot, PassingThroughNow, AOCJedi, Wbm1058, Nashhinton, Newmusic2011, Regulov, BG19bot, Pine, Vagobot, Sahara4u, JohnChrysostom, Henriettapussycat, Nj-educator, Exercisephys, Wildcat707, Encyclotadd, Polmandc, Neuropsychiatry, Fuse809, Thempp, RudolfRed,
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Monkbot, FinalAccount, Markdask1, Nilaerturk, Yairchaim, Madmathematicienne, Dr Amal Roy, Alakzi, Nipatel95, Laura N. kerman,
Gogd23 and Anonymous: 1286

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File:Bipolar_disorder_world_map_-_DALY_-_WHO2004.svg Source:
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