Understanding Bipolar I
“The bipolar I disorder criteria represent the modern understanding of the classic manic-depressive disorder or affective psychosis described in the nineteenth century, differing from the classic description only to the extent that neither psychosis nor the lifetime experience of a major depressive episode is a requirement.” (Diagnostic and Statically Manual V - DSM V, page 123.)
In diagnosing bipolar I there are three episodes that will need to be considered, Manic Episode, Hypomanic Episode, and Major Depressive Episode. Each have multiple certain criteria that has to be met in order to reach a diagnosis.
A brief definition of a Manic Episode according to the DSM V: “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week and present most of the day, nearly every day (or any duration if hospitalization is necessary.”
A brief definition of a Hypomanic Episode according to the DSM V: “A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.”
A brief definition of a Major Depressive Episode according to the DSM V: “Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.”
The mean age at onset of the first manic, hypomanic, or major depressive episode is approximately 18 years for bipolar I disorder. However, since we are considering the course of development for children we need to remember that all children develop at different rates. So, each child should be judged according to his or her own baseline. Onset occurs throughout the life cycle, including first onsets in the 60’s and 70’s. More than 90% of individuals who have a single manic episode go on to have recurrent mood episodes. Approximately 60% of manic episodes occur immediately before a major depressive episode. For some individuals that have multiple mood episodes within one year should be diagnoses as bipolar I, with rapid cycling.
Bipolar I is more common in high-income than in low-income countries. A family history of bipolar disorder is one of the strongest and most consistent risk factors. Females are more likely to experience rapid cycling and mixed states, and to have patterns of comorbidity that differ from those of males, including higher rates of lifetime eating disorders. Females are more likely to experience depressive symptoms than males. They also have a higher lifetime risk of alcohol use disorder than males.
The lifetime risk of suicide in individuals with bipolar disorder is estimated to be at least 15 times that of the general population. In fact, bipolar disorder may account for ¼ of all completed suicides.
Bipolar I can be treated with proper medication and psychotherapy.