Assessing and Treating Bipolar Disorder

This article explores what Bipolar Disorder is, how to identify its symptoms and diagnose it, and what some of the common treatment approaches are.

Related articles: Assessing and Treating Depression, Assessing and Treating Anxiety, Assessing and Treating Trauma.

Overview of Bipolar Disorder

Bipolar disorder, previously known as manic-depressive illness, is a mental health condition characterised by extreme mood swings that go beyond normal fluctuations in mood. These mood swings typically involve episodes of mania or hypomania and depression. The condition affects approximately 2.6% of the adult population worldwide.

Bipolar disorder is classified into several subtypes, including bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related condition due to another medical condition, and other specified and unspecified bipolar and related disorders. Each subtype is distinguished by the duration, frequency, and severity of the mood episodes, as well as the presence or absence of psychotic symptoms.

Bipolar I disorder is a severe form of bipolar disorder and is diagnosed when a person experiences at least one manic episode, which is a distinct period of abnormally elevated or irritable mood, energy, and activity that lasts for at least one week. The episode must be severe enough to cause significant impairment in social, occupational, or other areas of functioning. In some cases, the person may also experience depressive episodes.

Bipolar II disorder is diagnosed when a person experiences at least one major depressive episode and at least one hypomanic episode, which is a milder form of mania that lasts for at least four consecutive days. It is no longer considered less severe than bipolar I disorder, due to the burden of depression and because the instability of mood for individuals with bipolar II disorder is often accompanied by serious impairment in work and social functioning during the depressive phase.

Cyclothymic disorder is a milder form of bipolar disorder that involves cyclical mood swings between periods of hypomania and mild depression. The symptoms are less severe than those of bipolar I or II disorder and do not meet the criteria for a major depressive episode.

The exact cause of bipolar disorder is not fully understood, but it is believed to be the result of a combination of genetic, environmental, and neurobiological factors. Genetic factors are thought to account for approximately 80% of the risk for developing the disorder. Environmental factors such as stress, trauma, and substance use can trigger or worsen episodes.

Bipolar disorder is a complex and challenging mental health condition that requires a comprehensive and individualised approach to treatment. Mental health clinicians need to be knowledgeable about the different subtypes of bipolar disorder, their symptoms, and the various treatment options available to help individuals manage their symptoms and improve their quality of life.

Defining Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision, (DSM-5-TR) notes that bipolar and related disorders are found between the chapters on schizophrenia spectrum and other psychotic disorders and depressive disorders in the DSM in recognition of their place as a bridge between those two diagnostic classes in terms of symptomatology, family history, and genetics.

Bipolar and related disorders are a group of mood disorders that involve manic or hypomanic episodes, with or without major depressive episodes. Manic episodes are defined as distinct periods of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week or requiring hospitalisation. Hypomanic episodes are similar but less severe than manic episodes and do not cause marked impairment in social or occupational functioning; they do not necessitate hospitalisation. Major depressive episodes involve persistent feelings of sadness, hopelessness, or loss of interest in activities for at least two weeks.

The DSM-5-TR recognises three primary subtypes of bipolar disorder: bipolar I disorder, bipolar II disorder, and cyclothymic disorder. Bipolar I disorder is characterised by one or more manic or mixed episodes, with or without major depressive episodes. Bipolar II disorder is characterised by one or more major depressive episodes and at least one hypomanic episode, but never a manic episode. Cyclothymic disorder is characterised by numerous periods of hypomanic and depressive symptoms, but these symptoms do not meet the criteria for a full manic or depressive episode.

The DSM-5-TR also recognises: substance/medication-induced bipolar and related disorder, bipolar and related disorder due to another medical condition, other specified bipolar and related disorders, and unspecified bipolar and related disorders for cases that do not meet the full criteria for any of the specific bipolar disorder subtypes above. These other specified and unspecified bipolar and related disorders are classified based on the severity, frequency, and duration of mood episodes, as well as the presence or absence of psychotic symptoms.

What are the symptoms of Bipolar Disorder?

Bipolar disorder is a mental health condition that is characterised by episodes of mania or hypomania and depression. The symptoms of bipolar disorder can vary widely between individuals and can also change over time. Here are some of the common symptoms associated with each type of episode:

Manic episode:

• Elevated or irritable mood
• Grandiosity or inflated self-esteem
• Decreased need for sleep
• Increased energy and activity
• Racing thoughts
• Impulsivity and risk-taking behaviour
• Distractibility
• Poor judgment
• Agitation or irritability
• Psychotic symptoms such as delusions or hallucinations (in severe cases)

Hypomanic episode:

• Similar symptoms as a manic episode, but less severe and not causing significant impairment in functioning

Depressive episode:

• Persistent feelings of sadness, hopelessness, or emptiness
• Loss of interest or pleasure in activities
• Fatigue or loss of energy
• Difficulty concentrating, remembering, or making decisions
• Changes in appetite and weight
• Changes in sleep patterns (insomnia or oversleeping)
• Feelings of worthlessness, guilt, or self-blame
• Suicidal thoughts or behaviours

Some people with bipolar disorder may experience a mixed episode, which involves symptoms of both mania and depression. In a mixed episode, a person may feel depressed but also have symptoms such as restlessness, agitation, or racing thoughts.

Some individuals with bipolar disorder may experience periods of stable mood and functioning between episodes. However, others may have chronic or rapid cycling mood episodes, which involve four or more episodes of mania, hypomania, or depression within a 12-month period.

It is also worth mentioning that the symptoms of bipolar disorder can be similar to those of other mental health conditions, such as major depressive disorder, anxiety disorders, and schizophrenia. Therefore, those experiencing any of the above symptoms should seek a professional diagnosis and treatment.

How to diagnose Bipolar Disorder

Bipolar disorder is typically diagnosed by a mental health professional, such as a psychiatrist or psychologist, using a combination of clinical assessment, medical history, and diagnostic criteria.

The diagnostic criteria for bipolar disorder are outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition Text Revision (DSM-5-TR), which is published by the American Psychiatric Association. According to the DSM-5-TR, the diagnosis of bipolar disorder requires the presence of one or more episodes of mania or hypomania, with or without major depressive episodes.

To make a diagnosis of bipolar disorder, a mental health professional will typically conduct a comprehensive evaluation, which may include:

• Clinical interview: The clinician will ask the patient about their symptoms, medical history, and family history of mental health conditions. They may also ask about any medications or substances the patient is currently taking.
• Mood assessment: The clinician will ask the patient to describe their mood and energy level over a period of time, such as the past week or month.
• Psychological testing: The clinician may administer psychological tests to assess the patient’s mood, thoughts, and behaviour.
• Physical exam and lab tests: The clinician may perform a physical exam and order lab tests to rule out any medical conditions that could be causing the symptoms.
• Family history: The clinician may ask about the patient’s family history of mental health conditions, as bipolar disorder can have a genetic component.

Once the clinician has gathered all the necessary information, they will compare the patient’s symptoms and history to the diagnostic criteria for bipolar disorder in the DSM-5-TR. If the patient meets the criteria for a bipolar disorder diagnosis, the clinician will develop a treatment plan, which may include medication, psychotherapy, and lifestyle changes.

Note that bipolar disorder can be a complex condition to diagnose, as it can be confused with other mental health conditions, such as major depressive disorder, anxiety disorders, and schizophrenia. Therefore, those experiencing any symptoms of bipolar disorder should seek a professional diagnosis.

Common treatment approaches for Bipolar Disorder

Bipolar disorder is a complex mental health condition that requires a comprehensive and individualised treatment plan. Treatment for bipolar disorder usually involves a combination of medication, psychotherapy, and lifestyle changes. Here are some common treatments:

• Medication: Medication is typically the first-line treatment for bipolar disorder. Mood stabilisers such as lithium and anticonvulsants such as valproic acid or carbamazepine are commonly used to manage mood episodes. Atypical antipsychotics such as olanzapine, quetiapine, risperidone, and aripiprazole may also be prescribed to manage symptoms of mania or depression. Sometimes antidepressants may also be used, but with caution as they can trigger manic episodes in some people.

• Psychotherapy: Psychotherapy can help individuals with bipolar disorder learn coping skills and strategies for managing their symptoms. Cognitive-behavioural therapy (CBT) is a common therapy that can help individuals identify negative thoughts and behaviours and learn how to replace them with more positive ones. Interpersonal and Social Rhythm Therapy (IPSRT) may also be used to help stabilise daily routines and sleep patterns.

• Lifestyle changes: Lifestyle changes can help manage symptoms of bipolar disorder. A regular sleep schedule, a healthy diet, regular exercise, and stress reduction techniques like yoga or mindfulness meditation can help stabilise mood and manage symptoms.

• Support groups: Support groups can be a valuable resource for individuals with bipolar disorder. These groups can provide a sense of community and support and help individuals learn from others who have experienced similar challenges.

Clients/patients need to take into account that treatment for bipolar disorder can be a long-term process, and it may take some time to find the right combination of medications and therapy. Additionally, some individuals may need to manage their symptoms throughout their lifetime. However, with proper treatment, many individuals with bipolar disorder can manage their symptoms and lead fulfilling lives.

Common comorbidities with Bipolar Disorder

Bipolar disorder is often associated with comorbidities, which can complicate diagnosis and treatment. Here are some of the common comorbidities with bipolar disorder:

• Substance use disorders: Substance use disorders, including alcohol and drug use disorders, are common in people with bipolar disorder. Substance use can trigger or worsen mood episodes and increase the risk of suicide.
• Anxiety disorders: Anxiety disorders, including generalised anxiety disorder, panic disorder, and social anxiety disorder, are common in people with bipolar disorder. Anxiety can worsen mood symptoms and interfere with daily functioning.
• Attention-deficit/hyperactivity disorder (ADHD): ADHD is a common comorbidity in people with bipolar disorder. The symptoms of ADHD, including impulsivity, distractibility, and hyperactivity, can overlap with the symptoms of mania or hypomania.
• Eating disorders: Eating disorders, such as anorexia nervosa and bulimia nervosa, are more common in people with bipolar disorder than in the general population. Eating disorders can co-occur with mood episodes or may be triggered by changes in weight or body image.
• Personality disorders: Personality disorders, such as borderline personality disorder, are more common in people with bipolar disorder. Personality disorders can complicate the diagnosis and treatment of bipolar disorder and can affect interpersonal relationships and overall functioning.
• Cardiovascular disease: These comorbidities can vary widely between individuals and may require specific treatment approaches in addition to those for bipolar disorder. Therefore, it is important for mental health professionals to be aware of the potential for comorbidity in individuals with bipolar disorder and to screen for these conditions as part of the diagnostic process.

Bipolar Disorder courses

The following MHA courses discuss Bipolar Disorder and may interest you:

• Diagnosing Bipolar Disorders
• The Psychopharmacology of Bipolar Depression
• Creativity & Suicide Prevention: A Healing Journey

Note: Mental Health Academy members can access 500+ CPD/OPD courses, including those listed above, for less than $1/day. If you are not currently a member, click here to learn more and join.

Key takeaways

• Bipolar disorder, previously known as manic-depressive illness, is a mental health condition characterised by extreme mood swings that go beyond normal fluctuations in mood.
• Bipolar disorder is classified into several subtypes, including bipolar I disorder, bipolar II disorder, cyclothymic disorder, substance/medication-induced bipolar and related disorder, bipolar and related condition due to another medical condition, and other specified and unspecified bipolar and related disorders.
• The symptoms of bipolar disorder can vary widely between individuals and can also change over time. Manic episode symptoms include: elevated or irritable mood; inflated self-esteem; increased energy and activity; impulsivity and risk-taking behaviour; poor judgement. Hypomanic episode symptoms are similar to manic symptoms, but less severe and not causing significant impairment in functioning. Depressive episode symptoms include: Persistent feelings of sadness, hopelessness, or emptiness; Loss of interest or pleasure in activities; Fatigue or loss of energy; Difficulty concentrating, remembering, or making decisions; Changes in appetite, weight and sleep patterns; suicidal thoughts or behaviours.
• Bipolar disorder is typically diagnosed by a mental health professional, such as a psychiatrist or psychologist, using a combination of clinical assessment, medical history, and diagnostic criteria.
• Treatment for bipolar disorder usually involves a combination of medication, psychotherapy, and lifestyle changes.
• Bipolar disorder is often associated with comorbidities, which can complicate diagnosis and treatment. These include: Substance use disorders; anxiety disorders; ADHD; eating disorders; personality disorders; and cardiovascular disease..