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Upon completion of the chapter, the reader will be able to:

  1. Explain the pathophysiologic mechanisms underlying bipolar disorder.

  2. Recognize the symptoms of a manic episode and depressive episode in patients with bipolar disorder.

  3. Identify common comorbidities of bipolar disorder.

  4. Recognize the Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text revision, criteria for bipolar disorder as well as the subtypes of bipolar I disorder, bipolar II disorder, and cyclothymic disorder.

  5. List the desired therapeutic outcomes for patients with bipolar disorder.

  6. Explain the use of drugs as first-line therapy in bipolar disorder, including appropriate dosing, expected therapeutic effects, potential adverse effects, and important drug–drug interactions.

  7. Recommend individualized drug therapy for acute treatment and relapse prevention based on patient-specific data.

  8. Recommend monitoring methods for assessment of therapeutic and adverse effects of drugs used in the treatment of bipolar disorder.

  9. Recommend treatment approaches for special populations of patients with bipolar disorder, including pediatric patients, geriatric patients, and pregnant patients.

  10. Educate patients with bipolar disorder about their illness, drug therapy required for effective treatment, and the importance of adherence.




  • Image not available. Patients presenting with depressive or elevated mood features and a history of abnormal or unusual mood swings should be assessed for bipolar disorder.

  • Image not available. The diagnosis of bipolar disorder is made based on clinical presentation, a careful diagnostic interview, and a review of the history. There are no laboratory examinations, brain imaging studies, or other procedures that confirm the diagnosis.

  • Image not available. Goals of treatment are to reduce symptoms, induce remission, prevent relapse, improve patient functioning, and minimize adverse effects of drug therapy.

  • Image not available. Psychotherapy improves functional outcomes and may help treat or prevent mood episodes.

  • Image not available. The primary treatment modality for manic episodes is mood stabilizing agents or antipsychotic drugs, often in combination.

  • Image not available. The primary treatment for depressive episodes in bipolar disorder is mood stabilizing agents or certain antipsychotic drugs, sometimes combined with antidepressant drugs.

  • Image not available. The primary treatment for relapse prevention is mood stabilizing agents, often combined with antipsychotic drugs.

  • Image not available. Education of the patient regarding benefits and risks of drug therapy and the importance of adherence to treatment must be integrated into pharmacologic management.




Bipolar disorder is a mood disorder characterized by one or more episodes of mania or hypomania, often with a history of one or more major depressive episodes.1 It is a chronicillness with relapses and improvements or remissions. Mood episodes can be manic, depressed, or mixed. They can be separated by long periods of stability or can cycle rapidly. They occur with or without psychosis. Disability and other consequences (e.g., increased risk of suicide) of bipolar disorder can be devastating to patients and their families. Correct diagnosis and treatment are essential as early as possible in the course of the illness to prevent complications and maximize response to treatment.


Patient Encounter, Part 1

Chief Complaint: "My family doctor made me come here. ...

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