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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 in patients with bipolar disorder.

  3. Identify common psychiatric comorbidities of bipolar disorder.

  4. Recognize the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), 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. Identify the optimal use of medications as first-line therapy in bipolar disorder, including appropriate dosing.

  7. Recommend drug therapy for acute treatment of mania and depressive episodes.

  8. Recommend baseline and routine monitoring for assessment of adverse effects of medications used in the treatment of bipolar disorder.

  9. Identify general treatment differences for agents used to treat bipolar disorder in the pediatric population.

  10. Explain why medication education is important for patients with bipolar disorder.


Bipolar disorder is characterized by one or more episodes of mania or hypomania, often with a history of one or more major depressive episodes.1 It is chronic, with recurrent episodes and remissions. Mood episodes can be manic, hypomanic, or depressed. Mood episodes can be further classified with features, like mixed mood features. They can be separated by periods of long stability or cycle rapidly. They occur with or without psychosis. Disability and other consequences (eg, increased risk of suicide) can be devastating to patients and families. Correct and early diagnosis and treatment are essential to prevent complications and maximize response to treatment.


Bipolar disorders are categorized into bipolar I disorder, bipolar II disorder, and other specified and unspecified bipolar and related disorders. Bipolar I disorder is characterized by one or more manic episodes, whereas bipolar II disorder is characterized by at least one hypomanic episode. Both disorders also typically have major depressive episodes.

The lifetime prevalence of bipolar I disorder is estimated at 0.6% of US adults. The lifetime prevalence of bipolar II disorder is about 0.4%. When including the entire spectrum of bipolar disorders, the prevalence is approximately 3%.2

Bipolar I disorder affects men and women equally. Bipolar II, rapid cycling and mixed mood features are more common in women. In all, 78% to 85% of individuals with bipolar disorder report having another Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), diagnosis during their lifetime. The most common comorbid conditions are anxiety, substance use disorder, and impulse control disorders. Medical comorbidities are also common.2

The mean age of onset is 20 years, although onset may occur in early childhood to the mid-40s.1 If onset occurs after age 60, it is probably ...

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