Bipolar I disorder

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Bipolar I disorder
Other namesManic-depressive disorder, bipolar affective disorder
Mood shift.png
Image representation of mood instability in Bipolar I disorder
Specialty Psychiatry
Symptoms Mood instability, psychosis in some cases
Complications Suicide, self-harm
Usual onset15-25 years of age
Causes Complex
Risk factors Family history
Diagnostic method By psychiatric evaluation
Differential diagnosis Other bipolar disorders, borderline personality disorder, antisocial personality disorder
TreatmentPharmacotherapy such as mood stabilizers, antipsychotics; supplemental psychotherapy
Medication Lithium, anticonvulsants, antipsychotics
Frequency~1% of the global population is affected
Deaths15-20% die by suicide [1]

Bipolar I disorder (also referred to as BD-I or type one bipolar disorder) is a type of bipolar spectrum disorder characterized by the occurrence of at least one manic episode. [2] [3] Symptoms of bipolar I disorder typically begin at age 15-25 years of age, with depression being the most common initial symptom [4] . People may also have one or more depressive episodes. [5] Typically, manic episodes can last at least 7 days for most of each day to the extent that the individual may need medical attention, while the depressive episodes last at least 2 weeks. [6] The prevalence of bipolar disorders is about 1% worldwide. [7]

Contents

Signs and Symptoms

Bipolar I disorder is characterized by severe, recurrent mood changes and behavioral changes. [8] A manic episode is a key feature of bipolar I disorder and is required for diagnosis of bipolar I disorder. [9] Hypomanic episodes, major depressive episodes, and psychotic features may also be present but are not necessary for diagnosis. [9]

Graph illustrating mood fluctuations in bipolar disorders Bipolar disorder subtypes comparison between Bipolar I, II disorder and Cyclothymia.svg
Graph illustrating mood fluctuations in bipolar disorders

Manic Episode

A manic episode is a distinct period of time, lasting at least 1 week and for most of the day, where an individual experiences persistent, irritable mood, and or persistent euphoria or elation that is disproportionately out of norm. [10] These symptoms are severe, and causes either significant impairment in an individual's life or require hospitalization. [10] Furthermore, these symptoms and changes are not caused by medications, illicit substances, or another medical condition. [10]

Hypomanic Episode

Similar to mania, hypomanic episodes involve distinct periods of time where an individual experiences persistent, increased energy, euphoria, elation, or irritable mood that is disproportionately out of norm. [9] They differ in severity of impairment and symptom duration. [9] A hypomanic episode lasts a minimum of 4 days in a row and for most of the day and does not require hospitalization or involve psychotic symptoms. [9]

Depressive Episode

A depressive episode involves depressed mood and/or anhedonia (lack of interest or pleasure) in addition to other symptoms of depression that lasts for at least 2 weeks. [9] Other symptoms of depression include unintentional weight changes, changes in appetite, sleep disruption (lack of sleep or excessive sleep), restlessness or slowness, lack of energy, difficulty concentrating, and suicidal ideation. [9]

Psychosis

Most people with bipolar disorder experience psychosis during their lifetime, with one half to two-thirds of people experiencing it. [11] Symptoms of psychosis include delusions, hallucinations, or both. Delusions are more common than hallucinations in bipolar disorder. Psychotic symptoms occur more frequently during manic or mixed episodes. Having psychotic episodes indicates a more severe illness. People with psychosis have poor insight and more agitation, anxiety, and hostility. Psychotic symptoms are more common in bipolar type I compared to bipolar type II. [11]

Risk Factors

Currently, there are no single, clear causes of bipolar disorder. [12] However, there are evidence that suggest there may be a genetic component that contribute to the development of bipolar disorder. [12] Studies from identical twins suggest that there is a 5-10% lifetime risk (about seven times greater compared to the general population) of developing bipolar disorder if there is a first-degree relative diagnosed with bipolar disorder. [12] Bipolar disorder appears to be more common in high-income countries compared to low-income countries, and higher rates of bipolar I disorder are seen in individuals that are separated, divorced, or widowed compared to those who are married or never married. [9]

Diagnosis

The essential feature of bipolar I disorder is a clinical course characterized by the occurrence of one or more manic episodes or mixed episodes. [13] One episode of mania is sufficient to make the diagnosis of bipolar disorder. Often, individuals have had one or more major depressive episodes and may or may not have a history of major depressive disorder. [14] Because depression is typically one of the first symptoms of bipolar disorders, the initial diagnosis of bipolar disorder may be delayed. [7]

Episodes of substance-induced mood disorder due to the direct effects of a medication, or other somatic treatments for depression, substance use disorder, or toxin exposure, or of mood disorder due to a general medical condition need to be excluded before a diagnosis of bipolar I disorder can be made. Bipolar I disorder requires confirmation of only 1 full manic episode for diagnosis, but may be associated with hypomanic and depressive episodes as well. [3] In contrast, diagnosis for bipolar II disorder does not include a full manic episode; instead, it requires the occurrence of both a hypomanic episode and a major depressive episode. [3] Serious aggression has been reported to occur in one out of every ten major, first-episode, BD-I patients with psychotic features, the prevalence in this group being particularly high in association with a recent suicide attempt, alcohol use disorder, learning disability, or manic polarity in the first episode. [15]

Bipolar I disorder often coexists with other disorders including PTSD, substance use disorders, and a variety of mood disorders. [16] [17] Studies suggest that psychiatric comorbidities correlate with further impairment of day-to-day life. [18] Up to 40% of people with bipolar disorder also present with PTSD, with higher rates occurring in women and individuals with bipolar I disorder. [16] A diagnosis of bipolar 1 disorder is only given if bipolar episodes are not better accounted for by schizoaffective disorder or superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or a psychotic disorder not otherwise specified. [19]

Medical assessment

Regular medical assessments are performed to rule-out secondary causes of mania and depression. [20] These tests include complete blood count, glucose, serum chemistry/electrolyte panel, thyroid function test, liver function test, renal function test, urinalysis, vitamin B12 and folate levels, HIV screening, syphilis screening, and pregnancy test, and when clinically indicated, an electrocardiogram (ECG), an electroencephalogram (EEG), a computed tomography (CT scan), and/or a magnetic resonance imagining (MRI) may be ordered. [20] Drug screening includes recreational drugs, particularly synthetic cannabinoids, and exposure to toxins.

Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV-TR)

Dx code #DisorderDescription
296.0xBipolar I disorderSingle manic episode
296.40Bipolar I disorderMost recent episode hypomanic
296.4xBipolar I disorderMost recent episode manic
296.5xBipolar I disorderMost recent episode depressed
296.6xBipolar I disorderMost recent episode mixed
296.7Bipolar I disorderMost recent episode unspecified

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)

In May 2013, American Psychiatric Association released the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). There are several proposed revisions to occur in the diagnostic criteria of Bipolar I Disorder and its subtypes. For Bipolar I Disorder 296.40 (most recent episode hypomanic) and 296.4x (most recent episode manic), the proposed revision includes the following specifiers: with psychotic features, with mixed features, with catatonic features, with rapid cycling, with anxiety (mild to severe), with suicide risk severity, with seasonal pattern, and with postpartum onset. [21] Bipolar I Disorder 296.5x (most recent episode depressed) will include all of the above specifiers plus the following: with melancholic features and with atypical features. [21] The categories for specifiers will be removed in DSM-5 and criterion A will add or there are at least 3 symptoms of major depression of which one of the symptoms is depressed mood or anhedonia. [21] For Bipolar I Disorder 296.7 (most recent episode unspecified), the listed specifiers will be removed. [21]

The criteria for manic and hypomanic episodes in criteria A & B will be edited. Criterion A will include "and present most of the day, nearly every day", and criterion B will include "and represent a noticeable change from usual behavior". These criteria as defined in the DSM-IV-TR have created confusion for clinicians and need to be more clearly defined. [22] [23]

There have also been proposed revisions to criterion B of the diagnostic criteria for a Hypomanic Episode, which is used to diagnose For Bipolar I Disorder 296.40, Most Recent Episode Hypomanic. Criterion B lists "inflated self-esteem, flight of ideas, distractibility, and decreased need for sleep" as symptoms of a Hypomanic Episode. This has been confusing in the field of child psychiatry because these symptoms closely overlap with symptoms of attention deficit hyperactivity disorder (ADHD). [22]

ICD-10

Differential Diagnosis

When evaluating an individual for bipolar I disorder, other psychiatric conditions that mimic or present with similar symptoms to bipolar I disorder must be considered. It is possible that some of these may be co-occurring with bipolar I disorder. [9]

Management

Medication

Pharmacotherapy is the primary method of managing bipolar disorder, with multiple medications and combinations available. [24] Medications used may vary depending on the side effect profile and patient preference as well as the phase of bipolar disorder being managed (acute mania, bipolar depression, mixed states, or maintenance relapse prevention). [24]

  1. Lithium (has a narrow therapeutic range and typically requires monitoring). [25] It has suicide-protective effects, with approximately 60% reduction in suicide risk compared to placebos in mood disorders. [26]
  2. Anticonvulsants, such as valproate, [27] carbamazepine, or lamotrigine
  3. Atypical antipsychotics, such as quetiapine, [28] [29] risperidone, olanzapine, lurasidone, or aripiprazole
  4. Combination therapies such as lithium or valproate with antipsychotics [24]

A review of validated treatment guidelines for bipolar disorder by international bodies was published in 2020. [30]

Usage of antidepressants alone in the treatment of bipolar disorders is not recommended. [31] However, antidepressants may be used to supplement mood stabilizers or second-generation antipsychotics (adjuvant therapy). [32] [33] There has been concerns that usage of antidepressants may cause individuals to switch to mania (sometimes referred to as antidepressant-induced mania). [33] Current studies have not shown clear differences in significant risk of switching to mania between different antidepressants when compared to placebos. [33]

Neuromodulation

Electroconvulsive therapy (ECT), a type of brain stimulation therapy where seizures are electrically induced in anesthetized patients for therapeutic effect may be used for bipolar depression [34]

Adjuvant Psychotherapy

Patients with bipolar disorder may benefit from supplemental psychotherapy (such as cognitive behavioral therapy) in reducing recurrences and stabilizing depressive phases. [35] Interventions that target sleep regulation and mood monitoring, as well as efforts to reduce stigma, are beneficial in improving their quality of life. [24]

Treatment Challenges

Patients with bipolar disorder may struggle with non-adherence to pharmacological treatment; long-acting injectable antipsychotics maybe beneficial with adherence to some patients. [36]

Prognosis

Bipolar I usually has a poor prognosis, which is associated with substance abuse, psychotic features, depressive symptoms, and inter-episode depression. [37] A manic episode can be so severe that it requires hospitalization. An estimated 63% of all BP-I related mania results in hospitalization. [38] The natural course of BP-I, if left untreated, leads to episodes becoming more frequent or severe over time. [39] The absolute risk of suicide is highest for BP-I than all other mood and mental disorders. [40] Approximately 15-20% of people with bipolar disorder die by suicide, with 30-60% making at least one attempt. [1] The attempts use more lethal means than those among the general population. [41] Individuals with BP-I typically have a shorter life expectancy compared to the general population, with estimates suggesting a reduction of 11 to 20 years. [42] With proper treatment, individuals with BP-I can, however, lead a healthy lifestyle. [43]

Education

Psychosocial interventions can be used for managing acute depressive episodes and for maintenance treatment to aid in relapse prevention. [44] This includes psychoeducation, cognitive behavioural therapy (CBT), family-focused therapy (FFT), interpersonal and social rhythm therapy (IPSRT), and peer support. [44]

Information on the condition, importance of regular sleep patterns, routines and eating habits and the importance of compliance with medication as prescribed. Behavior modification through counseling can have positive influence to help reduce the effects of risky behavior during the manic phase. Additionally, the lifetime prevalence for bipolar I disorder is estimated to be 1%, while bipolar spectrum disorder has been estimated to affect as much as 6% of people. [45]

See also

References

  1. 1 2 Gergel, Tania; Adiukwu, Frances; McInnis, Melvin (1 October 2024). "Suicide and bipolar disorder: opportunities to change the agenda". The Lancet Psychiatry. 11 (10): 781–784. doi:10.1016/S2215-0366(24)00172-X. ISSN   2215-0366. PMID   38885666.
  2. ↑ "The Two Types of Bipolar Disorder". Psych Central.com. Archived from the original on 6 August 2013. Retrieved 25 November 2015.
  3. 1 2 3 Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association., American Psychiatric Association. DSM-5 Task Force. (Fifth ed.). Arlington, VA. 2013. ISBN   978-0-89042-559-6. OCLC   847226928.{{cite book}}: CS1 maint: location missing publisher (link) CS1 maint: others (link)
  4. ↑ Nierenberg, Andrew A.; Agustini, Bruno; Köhler-Forsberg, Ole; Cusin, Cristina; Katz, Douglas; Sylvia, Louisa G.; Peters, Amy; Berk, Michael (10 October 2023). "Diagnosis and Treatment of Bipolar Disorder". JAMA. 330 (14): 1370–1380. doi:10.1001/jama.2023.18588. ISSN   0098-7484. PMID   37815563. Archived from the original on 14 November 2025.
  5. ↑ "Bipolar Disorder: Who's at Risk?". Archived from the original on 19 April 2009. Retrieved 22 November 2011.
  6. ↑ "Bipolar Disorder - National Institute of Mental Health (NIMH)". www.nimh.nih.gov. Archived from the original on 5 August 2018. Retrieved 16 March 2024.
  7. 1 2 Oliva, Vincenzo; Fico, Giovanna; De Prisco, Michele; Gonda, Xenia; Rosa, Adriane R.; Vieta, Eduard (January 2025). "Bipolar disorders: an update on critical aspects". The Lancet Regional Health. Europe. 48 101135. doi:10.1016/j.lanepe.2024.101135. ISSN   2666-7762. PMC   11732062 . PMID   39811787.
  8. ↑ Mari, Jair; Dieckmann, Luiz Henrique Junqueira; Prates-Baldez, Daniel; Haddad, Michel; Rodrigues da Silva, Naielly; Kapczinski, Flavio (5 November 2024). "The efficacy of valproate in acute mania, bipolar depression and maintenance therapy for bipolar disorder: an overview of systematic reviews with meta-analyses". BMJ Open. 14 (11): e087999. doi:10.1136/bmjopen-2024-087999. ISSN   2044-6055. PMC   11552594 . PMID   39500601.{{cite journal}}: CS1 maint: article number as page number (link)
  9. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). Washington: American psychiatric association. 2013. pp. 123–154. ISBN   978-0-89042-554-1.
  10. 1 2 3 Black, Donald W. (4 May 2020). "Chapter 6 Mood Disorders". Introductory Textbook of Psychiatry (7th ed.). USA: American Psychiatric Association Publishing (published 28 July 2020). ISBN   978-1-61537-413-7.{{cite book}}: CS1 maint: date and year (link)
  11. 1 2 Chakrabarti, Subho; Singh, Navdeep (19 September 2022). "Psychotic symptoms in bipolar disorder and their impact on the illness: A systematic review". World Journal of Psychiatry. 12 (9): 1204–1232. doi: 10.5498/wjp.v12.i9.1204 . ISSN   2220-3206. PMC   9521535 . PMID   36186500.
  12. 1 2 3 Rowland, Tobias A.; Marwaha, Steven (September 2018). "Epidemiology and risk factors for bipolar disorder". Therapeutic Advances in Psychopharmacology. 8 (9): 251–269. doi:10.1177/2045125318769235. ISSN   2045-1253. PMC   6116765 . PMID   30181867.
  13. ↑ Phillips, Mary L; Kupfer, David J (11 May 2013). "Bipolar disorder diagnosis: challenges and future directions". Lancet. 381 (9878): 1663–1671. doi:10.1016/S0140-6736(13)60989-7. ISSN   0140-6736. PMC   5858935 . PMID   23663952.
  14. ↑ "Online Bipolar Tests: How Much Can You Trust Them?". DepressionD. Archived from the original on 13 January 2012. Retrieved 7 January 2012.
  15. ↑ Khalsa, Hari-Mandir K.; Baldessarini, Ross J.; Tohen, Mauricio; Salvatore, Paola (11 August 2018). "Aggression among 216 patients with a first-psychotic episode of bipolar I disorder". International Journal of Bipolar Disorders. 6 (1): 18. doi: 10.1186/s40345-018-0126-8 . ISSN   2194-7511. PMC   6161985 . PMID   30097737.
  16. 1 2 Cerimele, Joseph M.; Bauer, Amy M.; Fortney, John C.; Bauer, Mark S. (May 2017). "Patients With Co-Occurring Bipolar Disorder and Posttraumatic Stress Disorder: A Rapid Review of the Literature". The Journal of Clinical Psychiatry. 78 (5): e506–e514. doi:10.4088/JCP.16r10897. ISSN   1555-2101. PMID   28570791.
  17. ↑ Hunt, Glenn E.; Malhi, Gin S.; Cleary, Michelle; Lai, Harry Man Xiong; Sitharthan, Thiagarajan (December 2016). "Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis". Journal of Affective Disorders. 206: 331–349. doi:10.1016/j.jad.2016.07.011. ISSN   1573-2517. PMID   27476137.
  18. ↑ Léda-Rêgo, Gabriela; Studart-Bottó, Paula; Sarmento, Stella; Cerqueira-Silva, Thiago; Bezerra-Filho, Severino; Miranda-Scippa, Ângela (1 February 2023). "Psychiatric comorbidity in individuals with bipolar disorder: relation with clinical outcomes and functioning". European Archives of Psychiatry and Clinical Neuroscience. 273 (5): 1175–1181. doi:10.1007/s00406-023-01562-5. ISSN   0940-1334. PMID   36725737. S2CID   256501014.
  19. ↑ "Bipolar Disorder Residential Treatment Center Los Angeles". PCH Treatment. Archived from the original on 31 March 2012. Retrieved 25 November 2015.
  20. 1 2 Bobo, William V. (October 2017). "The Diagnosis and Management of Bipolar I and II Disorders: Clinical Practice Update". Mayo Clinic Proceedings. 92 (10): 1532–1551. doi: 10.1016/j.mayocp.2017.06.022 . ISSN   0025-6196. PMID   28888714.
  21. 1 2 3 4 American Psychiatric Association (22 May 2013). Diagnostic and Statistical Manual of Mental Disorders . American Psychiatric Association. doi:10.1176/appi.books.9780890425596. ISBN   978-0-89042-555-8.
  22. 1 2 Issues pertinent to a developmental approach to bipolar disorder in DSM-5. American Psychiatric Association. 2010.
  23. ↑ Diagnostic and Statistical Manual of Mental Disorders (4th ed. text revision). Washington, DC: American Psychiatric Association. 2000. pp. 345–392.
  24. 1 2 3 4 Singh, Balwinder; Swartz, Holly A; Cuellar-Barboza, Alfredo B; Schaffer, Ayal; Kato, Tadafumi; Dols, Annemieke; Sperry, Sarah H; Vassilev, Andrea B; Burdick, Katherine E; Frye, Mark A (August 2025). "Bipolar disorder". The Lancet. 406 (10506): 963–978. doi:10.1016/S0140-6736(25)01140-7. ISSN   0140-6736. PMC   12340982 . PMID   40712624.
  25. ↑ Burgess, S.; Geddes, J.; Hawton, K.; Townsend, E.; Jamison, K.; Goodwin, G. (2001). "Lithium for maintenance treatment of mood disorders". The Cochrane Database of Systematic Reviews (3) CD003013. doi:10.1002/14651858.CD003013. ISSN   1469-493X. PMC   7005360 . PMID   11687035.
  26. ↑ Dome, Peter; Rihmer, Zoltan; Gonda, Xenia (24 July 2019). "Suicide Risk in Bipolar Disorder: A Brief Review". Medicina (Kaunas, Lithuania). 55 (8): 403. doi: 10.3390/medicina55080403 . ISSN   1648-9144. PMC   6723289 . PMID   31344941.
  27. ↑ MacRitchie, Karine; Geddes, John; Scott, Jan; Haslam, D. R.; Silva De Lima, Mauricio; Goodwin, Guy (2003). "Valproate for acutre mood episodes in bipolar disorder | Cochrane" . Cochrane Database of Systematic Reviews (1) CD004052. doi:10.1002/14651858.CD004052. PMID   12535506. Archived from the original on 6 July 2018. Retrieved 9 March 2016.
  28. ↑ Datto, Catherine (11 March 2016). "Bipolar II compared with bipolar I disorder: baseline characteristics and treatment response to quetiapine in a pooled analysis of five placebo-controlled clinical trials of acute bipolar depression". Annals of General Psychiatry. 15 9. doi: 10.1186/s12991-016-0096-0 . PMC   4788818 . PMID   26973704.
  29. ↑ Young, Allan (February 2014). "A Randomised, Placebo-Controlled 52-Week Trial of Continued Quetiapine Treatment in Recently Depressed Patients With Bipolar I And Bipolar II Disorder". World Journal of Biological Psychiatry. 15 (2): 96–112. doi:10.3109/15622975.2012.665177. PMID   22404704. S2CID   2224996.
  30. ↑ Verdolini, Norma; Hidalgo-Mazzei, Diego; Del Matto, Laura; Muscas, Michele; Pacchiarotti, Isabella; Murru, Andrea; Samalin, Ludovic; Aedo, Alberto; Tohen, Mauricio; Grunze, Heinz; Young, Allan H. (22 December 2020). "Long-term treatment of bipolar disorder type I: A systematic and critical review of clinical guidelines with derived practice algorithms". Bipolar Disorders. 23 (4): 324–340. doi:10.1111/bdi.13040. ISSN   1399-5618. PMID   33354842. S2CID   229693238.
  31. ↑ Nierenberg, Andrew A.; Agustini, Bruno; Köhler-Forsberg, Ole; Cusin, Cristina; Katz, Douglas; Sylvia, Louisa G.; Peters, Amy; Berk, Michael (10 October 2023). "Diagnosis and Treatment of Bipolar Disorder: A Review". JAMA. 330 (14): 1370–1380. doi:10.1001/jama.2023.18588. ISSN   1538-3598. PMID   37815563.
  32. ↑ Hirschfeld, R. M. (1 December 2014). "Differential diagnosis of bipolar disorder and major depressive disorder". Journal of Affective Disorders. Advances in the Diagnosis and Treatment of Bipolar Depression. 169: S12–S16. doi:10.1016/S0165-0327(14)70004-7. ISSN   0165-0327. PMID   25533909.
  33. 1 2 3 Oliva, Vincenzo; De Prisco, Michele; La Spina, Enrico; Paolucci, Sofia; Fico, Giovanna; Anmella, Gerard; Hidalgo-Mazzei, Diego; Murru, Andrea; Pompili, Maurizio; Fornaro, Michele; Solmi, Marco; Yildiz, Ayşegül; Leucht, Stefan; Vieta, Eduard; Radua, Joaquim (September 2025). "Switch to mania after acute antidepressant treatment for bipolar depression: a systematic review and network meta-analysis of randomised controlled trials". eClinicalMedicine. 87 103413. doi:10.1016/j.eclinm.2025.103413. ISSN   2589-5370. PMID   40823496. Archived from the original on 8 August 2025.
  34. ↑ Mutz, Julian (February 2023). "Brain stimulation treatment for bipolar disorder". Bipolar Disorders. 25 (1): 9–24. doi:10.1111/bdi.13283. ISSN   1399-5618. PMC   10210071 . PMID   36515461.
  35. ↑ Miklowitz, David J.; Efthimiou, Orestis; Furukawa, Toshi A.; Scott, Jan; McLaren, Ross; Geddes, John R.; Cipriani, Andrea (1 February 2021). "Adjunctive Psychotherapy for Bipolar Disorder: A Systematic Review and Component Network Meta-analysis". JAMA Psychiatry. 78 (2): 141–150. doi:10.1001/jamapsychiatry.2020.2993. ISSN   2168-6238. PMC   7557716 . PMID   33052390.
  36. ↑ Tohen, Mauricio; Goldberg, Joseph F.; Hassoun, Youssef; Sureddi, Suresh (16 June 2020). "Identifying Profiles of Patients With Bipolar I Disorder Who Would Benefit From Maintenance Therapy With a Long-Acting Injectable Antipsychotic". The Journal of Clinical Psychiatry. 81 (4). doi: 10.4088/JCP.OT19046AH1 . ISSN   1555-2101. PMID   32558403. S2CID   219923839.
  37. ↑ Jain, A.; Mitra, P. (2023). "Bipolar Disorder". StatPearls. PMID   32644424. Archived from the original on 23 March 2023. Retrieved 14 March 2023.
  38. ↑ De Zelicourt, M.; Dardennes, R.; Verdoux, H.; Gandhi, G.; Khoshnood, B.; Chomette, E.; Papatheodorou, M. L.; Edgell, E. T.; Even, C.; Fagnani, F. (2003). "Frequency of hospitalisations and inpatient care costs of manic episodes: In patients with bipolar I disorder in France". Pharmacoeconomics. 21 (15): 1081–1090. doi:10.2165/00019053-200321150-00002. PMID   14596627. S2CID   41439636.
  39. ↑ "Bipolar Disorder – Fact Sheet". Archived from the original on 19 May 2023. Retrieved 14 March 2023.
  40. ↑ Kim, Hyewon; Jung, Jin Hyung; Han, Kyungdo; Jeon, Hong Jin (2025). "Risk of suicide and all-cause death in patients with mental disorders: a nationwide cohort study". Molecular Psychiatry. 30 (7): 2831–2839. doi:10.1038/s41380-025-02887-4. PMC   12185347 . PMID   39843548.
  41. ↑ Dome, P.; Rihmer, Z.; Gonda, X. (2019). "Suicide Risk in Bipolar Disorder: A Brief Review". Medicina. 55 (8): 403. doi: 10.3390/medicina55080403 . PMC   6723289 . PMID   31344941.
  42. ↑ Kessing, L. V.; Vradi, E.; Andersen, P. K. (2015). "Life expectancy in bipolar disorder". Bipolar Disorders. 17 (5): 543–548. doi:10.1111/bdi.12296. PMID   25846854.
  43. ↑ "Living Well with Bipolar Disorder". 7 May 2019. Archived from the original on 15 March 2023. Retrieved 15 March 2023.
  44. 1 2 Yatham, Lakshmi N.; Kennedy, Sidney H.; Parikh, Sagar V.; Schaffer, Ayal; Bond, David J.; Frey, Benicio N.; Sharma, Verinder; Goldstein, Benjamin I.; Rej, Soham; Beaulieu, Serge; Alda, Martin (2018). "Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder". Bipolar Disorders. 20 (2): 97–170. doi:10.1111/bdi.12609. ISSN   1399-5618. PMC   5947163 . PMID   29536616.
  45. ↑ Merikangas, Kathleen R.; Akiskal, Hagop S.; Angst, Jules; Greenberg, Paul E.; Hirschfeld, Robert M.A.; Petukhova, Maria; Kessler, Ronald C. (1 May 2007). "Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication". Archives of General Psychiatry. 64 (5): 543–552. doi:10.1001/archpsyc.64.5.543. ISSN   0003-990X. PMC   1931566 . PMID   17485606.
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