Bipolar Disorder

Bipolar disorderFrom Wikipedia, the free encyclopedia Jump to: navigation, search "Manic depression" redirects here. For other uses, see Manic depression (disambiguation). Bipolar disorder Classification and external resources Many people involved with the arts, such as Vincent van Gogh, are believed to have suffered from bipolar disorder ICD-10 ICD-9 OMIM DiseasesDB MedlinePlus eMedicine MeSH F31. 296.80 125480 309200 7812 001528 med/229 D001714 Bipolar disorder or manic-depressive disorder, which is also referred to as bipolar affective disorder or manic depression, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or more depressive episodes. The elevated moods are clinically referred to as mania or, if milder, hypomania. Individuals who experience manic episodes also commonly experience depressive episodes, or symptoms, or mixed episodes in which features of both mania and depression are present at the same time.[1] These episodes are usually separated by periods of "normal" mood; but, in some individuals, depression and mania may rapidly alternate, which is known as rapid cycling. Extreme manic episodes can sometimes lead to such psychotic symptoms as delusions and hallucinations. The disorder has been subdivided into bipolar I, bipolar II, cyclothymia, and other types, based on the nature and severity of mood episodes experienced; the range is often described as the bipolar spectrum. Data from the United States on lifetime prevalence varies; but it indicates a rate of around 1% for bipolar I, 0.5%–1% for bipolar II or cyclothymia, and 2%–5% for subthreshold cases meeting some, but not all, criteria. The onset of full symptoms generally occurs in late adolescence or young adulthood. Diagnosis is based on the person's self-reported experiences, as well as observed behavior. Episodes of abnormality are associated with distress and disruption and an elevated risk of suicide, especially during depressive episodes. In some cases, it can be a devastating long-lasting disorder. In others, it has also been associated with creativity, goal striving, and positive achievements. There is significant evidence to suggest that many people with creative talents have also suffered from some form of bipolar disorder.[2] Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizer medications and, sometimes, other psychiatric drugs. Psychotherapy also has a role, often when there has been some recovery of stability. In serious cases, in which there is a risk of harm to oneself or others, involuntary commitment may be used. These cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder.[citation needed] People with bipolar disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having schizophrenia, another serious mental illness.[3] The current term "bipolar disorder" is of fairly recent origin and refers to the cycling between high and low episodes (poles). A relationship between mania and melancholia had long been observed, although the basis of the current conceptualisation can be traced back to French psychiatrists in the 1850s. The term "manic-depressive illness" or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all kinds of mood disorder. German psychiatrist Karl Leonhard split the classification again in 1957, employing the terms unipolar disorder (major depressive disorder) and bipolar disorder. Contents [hide] • 1 Signs and symptoms ○ ○ ○ ○ ○ 1.1 Depressive episode 1.2 Manic episode 1.3 Hypomanic episode 1.4 Mixed affective episode 1.5 Associated features 2.1 Genetic 2.2 Childhood precursors 2.3 Life events and experiences • 2 Causes ○ ○ ○ ○ ○ ○ • ○ ○ ○ • ○ ○ • ○ ○ ○ ○ • ○ ○ • • • • • 2.4 Neural processes 2.5 Melatonin activity 2.6 Psychological processes 3.1 Clinical scales 3.2 Criteria and subtypes  3 Diagnosis 3.2.1 Rapid cycling 3.3 Challenges 4.1 Psychosocial 4.2 Medication 5.1 Functioning 5.2 Recovery 5.3 Recurrence 5.4 Morbidity 6.1 Children 6.2 Older age 4 Management 5 Prognosis 6 Epidemiology 7 History 8 Society and culture ○ ○ 8.1 Cultural references 9.1 Cited texts 9 References 10 Further reading 11 External links Signs and symptoms Bipolar disorder is a condition in which people experience abnormally elevated (manic or hypomanic) and, in many cases, abnormally depressed states for periods of time in a way that interferes with functioning. Bipolar disorder has been estimated to afflict more than 5 million Americans—about 1 out of every 45 adults.[4] It is equally prevalent in men and women and is found across all cultures and ethnic groups.[5] Not everyone's symptoms are the same, and there is no simple physiological test to confirm the disorder. Bipolar disorder can appear to be unipolar depression. Diagnosing bipolar disorder is often difficult, even for mental health professionals. What distinguishes bipolar disorder from unipolar depression is that the affected person experiences states of mania and depression. Often bipolar is inconsistent among patients because These persons generally have increased energy and tend to become more active than usual. At more extreme phases of bipolar I. Depressive episode Main article: Major depressive episode Signs and symptoms of the depressive phase of bipolar disorder include persistent feelings of sadness. is how the disorder is classified. lack of motivation. self-loathing. guilt. Hypomania can be difficult to diagnose because it may masquerade as mere happiness. with thoughts experienced as racing. Mania is generally characterized by a distinct period of an elevated.[7] Many people in a manic state experience severe anxiety and are very irritable (to the point of rage). problems concentrating. though it carries the same risks as mania. depersonalization. however. less if hospitalization is required. chronic pain (with or without a known cause). Their behavior may become aggressive. expansive. and morbid suicidal ideation. People may feel they have been "chosen" and are "on a special mission" or have other grandiose or delusional ideas. the individual often will deny that anything is wrong.[9] What might be called a "hypomanic event". apathy or indifference. particularly alcohol or other depressants. as well as other symptoms. disturbances in sleep and appetite. Thus. the individual may become psychotic. where thinking is affected along with mood. if not accompanied by complementary depressive episodes ("downs". or a break with reality. a condition also known as severe bipolar depression with psychotic features. a person must experience this state of elevated or irritable mood. They may indulge in substance abuse. intolerant. and sufferers may go on spending sprees or engage in behavior that is quite abnormal for them. a person in a manic state can begin to experience psychosis. and decreased need for sleep.some people feel depressed more often than not and experience little mania whereas others experience predominantly manic symptoms. Many people experience signature hypersexuality.[6] In severe cases.[8] Hypomanic episode Main article: Hypomanic episode Hypomania is generally a mild to moderate level of mania. Manic episode Main article: Mania Mania is the signature characteristic of bipolar disorder and. pressure of speech and activity. shyness or social anxiety. for at least one week. characterized by optimism. Hypomania may feel good to the person who experiences it. etc. have delusions or hallucinations. or hopelessness. hypomania does not inhibit functioning like mania[citation needed]. irritability. even when family and friends learn to recognize the mood swings. anxiety. cocaine or other stimulants. while others are euphoric and grandiose. To be diagnosed with mania according to the Diagnostic and Statistical Manual of Mental Disorders (DSM). and a person in a manic state may be easily distracted. or intrusive. fatigue and loss of interest in usually enjoyable activities. depending on its severity. isolation. or irritable mood state. anger. loneliness. is not typically deemed as problematic: The "problem" arises when . Attention span is low. loss of interest in sexual activity. People commonly experience an increase in energy and a decreased need for sleep.). A person's speech may be pressured. They do not. Judgment may become impaired. Generally. Some people have increased creativity while others demonstrate poor judgment and irritability. Sexual drive may increase. People may feel out of control or unstoppable. or sleeping pills. Many people with hypomania are actually in fact more productive than usual. [19][20][21] Goals A series of authors have described mania or hypomania as being related to a high motivation to achieve. more importantly. and by definition there are periods of depression with difficulty in motivation and functioning. and rage). although it is unclear in which direction the cause lies or whether both conditions are caused by a third unknown factor. and sometimes high achievement. Indeed. morbid and/or suicidal ideation. do not show neuropsychological deficits on most tests. pressured speech. of course.[15] Creativity Main article: Creativity and mental illness Bipolar disorder has been associated with people involved in the arts but it is an ongoing question as to whether many creative geniuses had bipolar disorder. in terms of group averages. temperament has been hypothesized to be one such factor. confusion. can become emotionally dysregulated and involve the development of mania. the most elementary definition of bipolar disorder is an often "violent" or "jarring" state of essentially uncontrollable oscillation between hyperthymia and dysthymia.[16][17][18] Some studies have found a significant association between bipolar disorder and creativity. irritability.mood changes are uncontrollable and. but so was high performance in arithmetic reasoning. but so was the poorest performance. or happiness. functioning is superior. persecutory delusions. agitation. One study indicated that the pursuit of goals. On some tests. cognitive deficits on some measures of sustained attention. volatile or "mercurial". insomnia.[23] Causes .[22] Individuals may have low self-esteem and difficulties in social adjustment. Cognitive functioning Reviews have indicated that most individuals diagnosed with bipolar disorder.[14] A 2005 study of young adult males found that poor performance on visuospatial tasks was associated with a higher rate of developing bipolar disorder. encouraged by sometimes achieving them. but who are euthymic (not experiencing major depression or mania). which is.[10] Associated features Associated features are clinical phenomena that often accompany the disorder but are not part of the diagnostic criteria for the disorder. perfectly normal.[12][13] A 2010 study found that "excellent performance" at school at age 15–16 was associated in males with a higher rate of developing bipolar disorder. executive function and verbal memory.[11] and sub-threshold mood states and psychiatric medications may account for some deficits. racing thoughts. this behavior is typically called hyperthymia. paranoia. fatigue. ambitious goal-setting. impulsiveness. panic. aggressiveness or belligerence. restlessness. a mixed state is a condition during which symptoms of mania and clinical depression occur simultaneously (for example. anxiety.[11] Meta-analyses have indicated. however. however. If unaccompanied by depressive counterpart episodes or otherwise general irritability. Mixed affective episode Main article: Mixed state (psychiatry) In the context of bipolar disorder. by averaging the variable findings of many studies. full major depressive episodes. glutamate (DAOA and DTNBP1). the (probandwise) concordance rates in modern studies have been consistently put at around 40% in monozygotic twins (same genes). compared to 0 to 10% in dizygotic twins. It was also suggested that individual genes are likely to have only a small effect and to be involved in some aspect related to the disorder (and a broad range of "normal" human behavior) rather than the disorder per se.[25] There is overlap with unipolar depression and if this is also counted in the co-twin the concordance with bipolar disorder rises to 67% (Mz) and 19% (Dz).[42] Childhood precursors Some limited long-term studies indicate that children who later receive a diagnosis of bipolar disorder may show subtle early traits such as subthreshold cyclical mood abnormalities. using a different methodology.[24] A combination of bipolar I.The causes of bipolar disorder likely vary between individuals. independent of attention deficit hyperactivity disorder. but the results are not consistent and often not replicated. while none of the previously identified loci were replicated. DISC1 and BDNF).[29] (Genetic linkage studies may be followed by fine mapping searching for the phenomenon of linkage disequilibrium with a single gene. There may be hypersensitivity and irritability.[29] Findings did include a single-nucleotide polymorphism in DGKH. and possibly ADHD with mood fluctuation. on chromosome 6q and on 8q21.[36][37][38][39][40] Advanced paternal age has been linked to a somewhat increased chance of bipolar disorder in offspring. with different genes being implicated in different families. suggested an association with ANK3 and CACNA1C.[25] Genetic Genetic studies have suggested many chromosomal regions and candidate genes appearing to relate to the development of bipolar disorder. The overall heritability of the bipolar spectrum has been put at 0. dopamine (DRD4 and SLC6A3).[41] A review seeking to identify the more consistent findings suggested several genes related to serotonin (SLC6A4 and TPH2).[32] and a single-nucleotide polymorphism in MYO5B. with a relatively lower ratio for bipolar II that likely reflects heterogeneity. as well as environmental influence. Recent meta-analyses of linkage studies detected either no significant genome-wide findings or.[28] the linkage studies have been inconsistent. and cell growth and/or maintenance pathways (NRG1. only two genome-wide significant peaks.[34] Diverse findings point strongly to heterogeneity. For bipolar I. using this approach causative DNA base pair changes have been reported for the genes P2RX7[30] and TPH1[citation needed]).[44][45][46] Life events and experiences .[33] A comparison of these studies. then DNA sequencing. thought to be related to calcium and sodium voltage-gated ion channels.[27] Although the first genetic linkage finding for mania was in 1969. Twin studies have been limited by relatively small sample sizes but have indicated a substantial genetic contribution.[43] A history of stimulant use in childhood is found in high numbers of bipolar patients and has been found to cause an earlier onset of bipolar disorder and a worse clinical course. combined with a new study. There is some disagreement whether the experiences are necessarily fluctuating or may be chronic.[26] The relatively low concordance between dizygotic twins brought up together suggests that shared family environmental effects are limited. although the ability to detect them has been limited by small sample sizes.[35] Numerous specific studies find various specific links.71. consistent with a hypothesis of increased new genetic mutations. Genome-wide association studies have also not brought a consistent focus — each has identified new loci. II and cyclothymia produced concordance rates of 42% vs 11%.[31] a locus in a gene-rich region of high linkage disequilibrium (LD) on chromosome 16p12. although noting a high risk of false positives in the published literature. and more co-occurring disorders such as PTSD. and that individual psychosocial variables may interact with genetic dispositions. Eventually.[49] Early experiences of adversity and conflict are likely to make subsequent developmental challenges in adolescence more difficult. In addition. it was concluded that the relatively small number of significant findings was perhaps surprising. as they do for onsets and recurrences of unipolar depression. a mood episode can start (and become recurrent) by . and are likely a potentiating factor in those at risk of developing bipolar disorder.[42] There is fairly consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes.Evidence suggests that environmental factors play a significant role in the development and course of bipolar disorder.5 times more likely to have deep white matter hyperintensities.[48] The total number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without. Two fairly consistent abnormalities found in a meta-analysis of 98 MRI or CT neuroimaging studies were that groups with bipolar disorder had lateral ventricles which were on average 17% larger than control groups. Some studies have found anatomical differences in areas such as the amygdala. and were 2. or perhaps heterogeneity has obscured other differences. despite 25 years of research involving more than 7.[43] Neural processes Hyperintensities (bright areas on MRI scans above) are 2. Given the size of the meta-analysis.5 times more likely to occur in bipolar disorder Researchers hypothesize that abnormalities in the structure and/or function of certain brain circuits could underlie bipolar and other mood disorders.[52] The "kindling" theory asserts that people who are genetically predisposed toward bipolar disorder can experience a series of stressful events. studies continue to report conflicting findings and there remains considerable debate over the neuroscientific findings.[53] each of which lowers the threshold at which mood changes occur.[50] prefrontal cortex[51] and hippocampus. a worse course.[47] There have been repeated findings that between a third and a half of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood. and that there may be genuinely limited structural change in bipolar disorder. However. it was noted that averaged associations found at the level of multiple studies may not exist for an individual. which is associated on average with earlier onset. particularly events stemming from a harsh environment rather than from the child's own behavior.000 MRI scans. [58] It has also been shown in humans that valproic acid. there is mixed evidence as to whether relevant life events are found more often in early than later episodes. The existing evidence has been described as patchy in terms of quality but converging in a consistent manner. but results from a complex interaction between internal and external variables unfolding over time. increases transcription of melatonin receptors[59] and decreases eye melatonin-receptor sensitivity in healthy volunteers[60] while low-dose lithium. and their social world (including striving to meet high standards despite it causing distress) that may make them vulnerable during changing mood states in the face of relevant life events. Symptoms are often subthreshold and likely continuous with normal experience. another mood stabilizer. irritability/aggression and sometimes psychosis.). related to planning.[56] causing cyclical periods of poor neuron firing (depression) and hyper sensitive neuron firing (mania).[11] Many sufferers report inexplicably varied cyclical patterns.[54] Recent research in Japan hypothesizes that dysfunctional mitochondria in the brain may play a role [55] Other recent research implicates issues with a sodium ATPase pump. There is some suggestion that the mood variation in bipolar disorder may not be cyclical as often assumed. The latter increase and lead to increased activity levels. often along a theme of feeling criticised. There is some indication that once mania has begun to develop. Psychological processes Psychological studies of bipolar disorder have examined the development of a wide range of both the core symptoms of psychomotor activation and related clusterings of depression/anxiety. emotional regulation and attentional control. including criticism from significant others.[61] The extent to which melatonin alterations may be a cause or effect of bipolar disorder are not fully known. Negative social reactions or advice may be taken less notice of. bipolar patients exhibited no hypersensitivity to light. This may only apply for type one. recovered. time. but type two apparently results from a large confluence of factors. and a person may be more caught up in their own thoughts and interpretations. social stressors. There is evidence of hypothalamic-pituitary-adrenal axis (HPA axis) abnormalities in bipolar disorder due to stress. nor completely random. subtle frontal-temporal and subcortical difficulties in some individuals. etc.[citation needed] Melatonin activity It has been suggested that a hypersensitivity of the melatonin receptors in the eye could be a reliable indicator of bipolar disorder. there is an overall increase in activation levels and impulsivity. In small studies. a mood stabilizer. patients diagnosed as bipolar reliably showed a melatonin-receptor hypersensitivity to light during sleep. in healthy volunteers. however. can further contribute. but doesn't alter melatonin synthesis. in studies called a trait marker. There are also indications that individuals may hold certain beliefs about themselves.[57] Another study showed that drug-free.[62] Diagnosis .itself. causing a rapid drop in sleeptime melatonin levels compared to controls. the more so if there is disruption in circadian rhythms or goal attainment events. may play a role. increased hedonic tone. as it is not dependent on state (mood. In addition. Once (hypo)mania has developed. with isolated sub-clinical symptoms of mania such as increased energy and racing thoughts. decreases sensitivity to light when sleeping. The findings suggest that the period leading up to mania is often characterized by depression and anxiety at first. their internal states. Assessment is usually done on an outpatient basis. bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. social worker.[67][68] Clinical scales The Bipolar Spectrum Diagnostic Scale (BSDS)[69] was developed by Ronald Pies. hours or days. drug intoxication. metabolic disturbance. In bipolar disorder. The DSM-IV-TR lists three specific subtypes and one for non-specified:[72] Bipolar I disorder .Diagnosis is based on the self-reported experiences of an individual as well as abnormalities in behavior reported by family members. and a CT scan of the head to exclude brain lesions. An initial assessment may include a physical exam by a physician. the term refers to the cyclic episodes of elevated and depressed mood which generally last weeks or months. There are several other mental disorders which may involve similar symptoms to bipolar disorder. minutes. These depend on both the presence and duration of certain signs and symptoms. Nassir Ghaemi MD. a systemic infection or chronic disease. clinical psychologist or other clinician in a clinical assessment. The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders. due to response to external psychosocial and intrapsychic stressors. friends or co-workers.[71] In DSM-IV-TR and ICD-10. though noting they often coexist. and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems. Investigations are not generally repeated for relapse unless there is a specific medical indication. admission to an inpatient facility is considered if there is a risk to oneself or others. the current version being DSM-IV-TR. There are 19 question items and two sections on the English version of the BSDS. as well as prevailing in research studies. these may arise or subside suddenly and dramatically and last for seconds.[64] Some hold that borderline personality disorder represents a subthreshold form of mood disorder. The BSDS arose from Pies's experience as a psychopharmacology consultant. MD and was later refined and tested by S. appetite disturbance and nonreactive mood. There are lists of criteria for someone to be so diagnosed.[70] Criteria and subtypes There is no clear consensus as to how many types of bipolar disorder exist. and syphilis or HIV infection. Both borderline personality and bipolar disorder can involve what are referred to as "mood swings". currently the ICD-10.[63] schizoaffective disorder. schizophreniform disorder and borderline personality disorder. The scale was validated in its original version and demonstrated a high sensitivity. whereas the mood in dysthymia of borderline personality remains markedly reactive and sleep disturbance not acute. These include schizophrenia. An EEG may be used to exclude epilepsy. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions. Although there are no biological tests which confirm bipolar disorder.[65][66] while others maintain the distinctness. tests may be carried out to exclude medical illnesses such as hypo. MPH and colleagues.or hyperthyroidism. known as emotional dysregulation. followed by secondary signs observed by a psychiatrist. A bipolar depression is generally more pervasive with sleep. nurse. where he was frequently called on to manage cases of "treatment-resistant depression". brief druginduced psychosis. The term in borderline personality refers to the marked lability and reactivity of mood. do not usually cause severe social or occupational impairment.[75] There is a low-grade cycling of mood which appears to the observer as a personality trait.[74] However.One or more manic episodes.[73] A depressive or hypomanic episode is not required for diagnosis. even though there is now increased public awareness of this mental health condition in popular magazines and health websites. and the type of the most recent episode. lasting three to six months.[77] Rapid cycling Most people who meet criteria for bipolar disorder experience a number of episodes.[citation needed] Hypomanic episodes do not go to the full extremes of mania (i.4 to 0.7 per year. Cyclothymia A history of hypomanic episodes with periods of depression that do not meet criteria for major depressive episodes. the "with full interepisode recovery" specifier applies if there was full remission between the two most recent episodes.[82] That treatment lag is apparently not decreasing.e. manic. Bipolar II disorder No manic episodes. and this can make bipolar II more difficult to diagnose.[78][79] Rapid cycling. but one or more hypomanic episodes and one or more major depressive episode. The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive. Screening tools such as the Hypomanic Check List Questionnaire (HCL-32)[84] have been developed to assist the quite often difficult detection of bipolar II disorders. Challenges The experiences and behaviors involved in bipolar disorder are often not understood by individuals or recognized by mental health professionals. hypomanic or mixed episodes are required to have occurred during a 12-month period. . Despite this increased focus. For example. One definition of ultra-ultra rapid cycling is defining distinct shifts in mood within a 24to-48-hour period. It is defined as having four or more episodes per year and is found in a significant fraction of individuals with bipolar disorder.[83] An individual may appear simply depressed when they are seen by a health professional. and are without psychosis). on average 0. however. but it frequently occurs.[80] There are references that describe very rapid (ultra-rapid) or extremely rapid[81] (ultra-ultra or ultradian) cycling. diagnosed when the disorder does not fall within a specific subtype. so diagnosis may sometimes be delayed for 10 years or more. and interferes with functioning. Subcategories specify whether there has been more than one episode. a bipolar II diagnosis is not a guarantee that they will not eventually suffer from such an episode in the future. The bipolar I and II categories have specifiers that indicate the presentation and course of the disorder. This can result in misdiagnosis of Major Depressive Disorder and harmful treatments. is a course specifier that may be applied to any of the above subtypes.[76] Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient. Bipolar Disorder NOS (Not Otherwise Specified) This is a catchall category. crippling depression. since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing.. individuals are still commonly misdiagnosed. to be published in 2013. although can still occur. This can be voluntary or (if mental health legislation allows and varying state-to-state regulations in the USA) involuntary (called civil or involuntary commitment). or change into another. anyone with a history of (hypo)mania and depression has bipolar disorder whatever their current or future functioning and vulnerability. Hospitalization may be required especially with the manic episodes present in bipolar I.[11] Flux is the fundamental nature of bipolar disorder. panic disorder. or attention-deficit/hyperactivity disorder. Some who show some bipolar symptoms tend to have a rapid-cycling or mixed-cycling pattern that may not meet DSM-IV criteria. intensive outpatient programs. Individuals may stay in one subtype. visits from members of a community mental health team or Assertive Community Treatment team. further complicating the diagnosis. This has been described as "an ethical and methodological issue".[89] The diagnosis of bipolar disorder in children is particularly challenging. 2006). there is also a long-standing issue in the research literature as to whether a categorical classificatory divide between unipolar and bipolar depression is actually valid. supported employment and patient-led support groups. The diagnostic subtypes of bipolar disorder are thus static descriptions—snapshots. The diagnosis of bipolar disorder can be complicated by coexisting psychiatric conditions such as obsessive-compulsive disorder.[94] Following (or in lieu of) a hospital admission. and the purposeful busy activity of mania. Management Main article: Treatment of bipolar disorder There are a number of pharmacological and psychotherapeutic techniques used to treat Bipolar Disorder.[90] In addition. mood. perhaps—of an illness in continual flux. will likely include further and more accurate sub-typing (Akiskal and Ghaemi.[95] . A careful longitudinal analysis of symptoms and episodes. social phobia. enriched if possible by discussions with friends and family members. This is considered especially problematic given that brief hypomanic episodes are widespread among people generally and not necessarily associated with dysfunction. thought. it can be difficult to distinguish between ageappropriate restlessness.[93] As yet there is very little evidence-based research to guide management of bipolar in the elderly as opposed to adults in general.[92] In the elderly.[87] Individuals with the illness have continual changes in energy.[85][86] It has been noted that the bipolar disorder diagnosis is officially characterised in historical terms such that. Substance abuse may predate the appearance of bipolar symptoms. support services available can include drop-in centers. as it means no one can be considered as being recovered (only "in remission") from bipolar disorder according to the official criteria. recognition and treatment of bipolar disorder may be complicated by the presence of dementia or the side effects of medications being taken for other conditions. and controversial.[88] The DSM-V. Individuals may use self-help and pursue a personal recovery journey.[91] Further complicating the diagnosis. is crucial to establishing a valid treatment plan where these comorbidities exist. over the course of their illness. These are sometimes referred to partial-inpatient programs. technically. is that abused or traumatized children can seem to have bipolar disorder when they are actually reacting to horrors in their lives. or whether it is more accurate to talk of a continuum involving dimensions of depression and mania. Long-term inpatient stays are now less common due to deinstitutionalization. and activity. sleep. the fidgeting of children with ADHD.However. with a great diversity of symptoms and varying degrees of severity. which is the first anticonvulsant shown to be of benefit in bipolar depression. or in the one case. most mood stabilizers are of limited effectiveness in depressive episodes.[102] also used as an anticonvulsant.[101] while almost as widely used is sodium valproate. recognizing episode triggers. while lithium is the only drug proven to reduce suicide in bipolar patients. These two drugs comprise several unrelated compounds which have been shown to be effective in preventing relapses of manic. and.[105] The use of antidepressants in bipolar disorder has been debated. and treatment during the acute phase can be a particular challenge. especially if no mood stabiliser is used.Psychosocial Psychotherapy is aimed at alleviating core symptoms.[103] Treatment of the agitation in acute manic episodes has often required the use of atypical antipsychotic medications. unless there is adjunctive treatment with a mood stabilizer. however. reducing negative expressed emotion in relationships. family-focused therapy. with some studies reporting a worse outcome with their use triggering manic. and psychoeducation have the most evidence for efficacy in regard to relapse prevention. The first known and "gold standard" mood stabilizer is lithium. recognizing prodromal symptoms before full-blown recurrence. olanzapine and chlorpromazine. Other anticonvulsants used in bipolar disorder include carbamazepine. Rapid cycling can be induced or made worse by antidepressants. More recently. and lamotrigine.[97] Some clinicians emphasize the need to talk with individuals experiencing mania. reportedly more effective in rapid cycling bipolar disorder.[108] Recent research indicates that triacetyluridine may help improve symptoms of bipolar disorder. while interpersonal and social rhythm therapy and cognitive-behavioural therapy appear the most effective in regard to residual depressive symptoms.[110] . to develop a therapeutic alliance in support of recovery.[104] A head-to-head randomized control trial in 2005 has also shown olanzapine monotherapy to be as effective and safe as lithium in prophylaxis. hypomanic or mixed episodes.[99][100] Lamotrigine has been found to be best for preventing depressions. olanzapine and quetiapine have been approved as effective monotherapy for the maintenance of bipolar disorder. such as quetiapine. Most studies have been based only on bipolar I. However. practicing the factors that lead to maintenance of remission[96] Cognitive behavioural therapy.[98] Medication Sodium valproate is a common mood stabilizer The mainstay of treatment is a mood stabilizer medication such as lithium carbonate or lamotrigine.[109] Clinical studies have shown that Omega 3 fatty acids may have beneficial effects on bipolar disorder. depressive episodes.[106][107] One large-scale study found that depression in bipolar disorder responds no better to an antidepressant with mood stabilizer than it does to a mood stabilizer alone. Persons with bipolar disorder may have periods of normal or near normal functioning between episodes.[113] Another study confirmed the seriousness of the disorder as "the standardized all-cause mortality ratio among patients with BD is increased approximately two-fold. resulting in the person feeling they are stifled or that the medicine isn't working. et al. which includes exercise. sleep and eating behaviors. and an elevated risk of suicide. Either way.[111] Ultimately one's prognosis depends on many factors. functioning was on average poor. 6). with the right dose of each. 2006 J Clin Psych. 2006 Bipolar Disorders 8. and a regulated stress level. in turn. relapse is likely to occur if the medicine is discontinued. which. as effective treatment may result in the reduction of manic symptoms and/or the medicine can be mood blunting or sedative. its usefulness is likely minimal and side effects. medication is needed to enable this. several of which are within the control of the individual. especially during depressive episodes. it is important for someone with a bipolar disorder to understand they should continue to take the medicine. such as significant cognitive impairment. mood. Unfortunately. Such factors may include: the right medicines. However. a positive relationship with a competent medical doctor and therapist. When medication causes a reduction in symptoms or complete remission. Chengappa. Subthreshold symptoms were generally still substantially impairing. During periods of major depression or mania (in BPI).[114] Recovery . comprehensive knowledge of the disease and its effects. Bipolar disorder can be a severely disabling medical condition. This can be complicated. however. Functioning between episodes was on average good — more or less normal. et al. as well as having a plan in conjunction with one's doctor for how to manage subtle changes that might indicate the beginning of a mood swing. Some people find that keeping a log of their moods can assist them in predicting changes. such as being very aware of small changes in one's energy. many individuals with bipolar disorder can live full and satisfying lives. except for hypomania (below or above threshold) which was associated with improved functioning. undermine its efficacy (Kushner. There are obviously other factors that lead to a good prognosis as well. Quite often. Because bipolar disorder can have a high rate of both under-diagnosis and misdiagnosis[citation needed]. it is often difficult for individuals with the condition to receive timely and competent treatment. Prognosis For many individuals with bipolar disorder a good prognosis results from good treatment." Bipolar disorder is currently regarded "as possibly the most costly category of mental disorders in the United States. with depression being more persistently associated with disability than mania." Episodes of abnormality are associated with distress and disruption.Also. results from an accurate diagnosis. It is an off-label use when used to treat bipolar disorder. topiramate is an anticonvulsant often prescribed as a mood stabilizer. nutrition. and good physical health.[112] Functioning A recent 20-year prospective study on bipolar I and II found that functioning varied over time along a spectrum from good to fair to poor. the most common drugs being alcohol. and 19% switched phases without recovery. further emphasizing the lethality of the disorder. but too much stress still causes relapse. The standardized mortality ratio from suicide in BD is estimated to be approximately 18 to 25.[118] This theorizes that a close friend could notice which moods.A naturalistic study from first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years. They can then take planned steps to slow or reverse the onset of illness. and actions that will prevent symptoms from getting worse. cardiovascular disease) is the single largest cause of premature and excess deaths in BD. However. taking a lower dosage of a mood stabilizer can lead to relapse into mania. Being under. Inadequate stress management and poor lifestyle choices. and mania. excessive stress can cause the individual to relapse. or take action to prevent the episode from being damaging. Medication raises the stress threshold somewhat. Studies show that tobacco smoking induces a calming effect on most bipolar people. based on the occurrence of idiosyncratic prodromal events.[119] Morbidity According to an article in Psychiatric Times by McIntyre et al. behaviours. An inconsistent sleep schedule can aggravate symptoms. It has been found that too little sleep can lead to mixed states/mania. dysphoria.[117] • • • • Recurrence can be managed by the sufferer with the help of a close friend. or thoughts typically occur at the outset of bipolar episodes. 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery.or over-medicated. A newly established and rapidly growing database indicates that mortality due to chronic medical disorders (eg. while higher doses can cause destabilization into mixed-states or mania.[116] Recurrence The following behaviors can lead to depressive or manic recurrence:[citation needed] • • Discontinuing or lowering one's dose of medication. A very high percentage of bipolar people may smoke for this reason."[120] . Taking a lower dosage of an antidepressant may cause the patient to relapse into depression. Too much sleep can be an indicator that depression is returning. 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). "Mortality studies have documented an increase in all-cause mortality in patients with BD (Bipolar Disorder). thinking processes. Generally. Caffeine can cause destabilization of mood toward irritability.[115] Many therapists treat individuals with bipolar I and II by helping them identify the return of symptoms. Often bipolar individuals are subject to self-medication. Anecdotal evidence seems to suggest that lower dosages of caffeine can have effects ranging from anti-depressant to mania-inducing. activities.. diazepam/sleeping tablets and marijuana. If unmedicated. 1. especially during mixed states such as dysphoric mania and agitated depression. 2007[which?]). Major depressive disorder and bipolar disorder are currently classified as separate disorders. no data less than 180 180–186 186–190 190–195 210–215 215–220 220–225 225–230 230–235 195–200 200–205 205–210 The lifetime prevalence of bipolar disorder type I. and 2. Including subthreshold diagnostic criteria.000 inhabitants in 2002.8 percent experience a manic episode at least once (the diagnostic threshold for bipolar I) and 0. with the anxiety disorders present across the spectrum.[122] Persons suffering from bipolar II have high rates of suicide compared to persons suffering from other mental health conditions.[126] Late adolescence and early adulthood are peak years for the onset of bipolar disorder. According to Hagop Akiskal. has generally been estimated at 2%.4% for subthreshold symptoms.4%. which includes at least a lifetime manic episode. postpartum depression.[125] There are conceptual and methodological limitations and variations in the findings.Most people with bipolar disorder never attempt suicide or complete it.1 percent of the population. Also included in this view is premenstrual dysphoric disorder. In addition.D. M. and there is evidence that sufferers of this disorder spend proportionally much more of their life in the depressive phase of the illness than their counterparts with bipolar I Disorder (Akiskal & Kessler.[124] A more recent analysis of data from a second US National Comorbidity Survey found that 1% met lifetime prevalence criteria for bipolar 1. adding up to a total of 6. Epidemiology Disability-adjusted life year for bipolar disorder per 100.. responses to single items from such interviews may suffer limited validity. and postpartum psychosis. This view helps to explain . and they can be severely disrupted. Major Depressive episodes are part of the bipolar II experience. at the one end of the spectrum is bipolar type schizoaffective disorder. however. diagnosis and prevalence rates are dependent on whether a categorical or spectrum approach is used. an additional 5. This is 10 to more than 20 times that of the general population.[121] Bipolar disorder can cause suicidal ideation that leads to suicidal. Prevalence studies of bipolar disorder are typically carried out by lay interviewers who follow fully structured/fixed interview schemes.1% for bipolar II. Some researchers increasingly view them as part of an overlapping spectrum that also includes anxiety and psychosis. The annual average suicide rate in males and females with diagnosed bipolar disorder is 0.[123] A reanalysis of data from the National Epidemiological Catchment Area survey in the United States.[127][128] These are critical periods in a young adult's social and vocational development. including Major Depression. suggested that 0. Concerns have arisen about the potential for both underdiagnosis and overdiagnosis. were classed as having a bipolar spectrum disorder.4 percent. such as one or two symptoms over a short time-period. and at the other end is recurrent unipolar depression.5 a hypomanic episode (the diagnostic threshold for bipolar II or cyclothymia). in turn. particularly in regard to the differential diagnosis of bipolar disorder. In a cohort of bipolar disordered adults.5% had onset between the ages of five and nine.3% had onset before age 10. since that time.why many people who have the illness do not have first-degree relatives with clear-cut "bipolar disorder".000 in 1994 to 800. neurobiological. However. On the other hand. However. but who have family members with a history of these other disorders. Loranger and Levine [132] retrospectively evaluated 200 adult bipolar patients and found that 0. but also indicated that it may be rare. and conduct disorder in children and adolescents. assumptions regarding behavior. That. Another factor is that the "consensus" regarding the diagnosis in the pediatric age group seems to apply only to the USA. In these papers. On the one hand. so the applicability of this work to current views of bipolar disorder is uncertain. treatment and longitudinal research studies [142][143][144][145] have concluded that this disorder can be validly diagnosed in children and adolescents. may also play a role. The study calculated the number of psychiatric visits increased from 20.[134] which suggested that childhood bipolar disorder was uncommon. However. as far back as the 1920s. genetic. Goodwin and Jamison [133] found that 0. Anthony and Scott's criteria differed from those currently in use. systematic reviews of diagnostic. and continues to increase. This literature supported the existence of childhood onset mania. the recent consensus from the scientific community (see above) will have educated clinicians about the nature of the disorder and the methods for diagnosis and treatment in children. The British National Institute on Health and Clinical Excellence (NICE) guidelines on bipolar disorder in 2006 [148] specifically described the broadened criteria used in the USA to diagnose bipolar disorder in children as suitable "only for research" and "were not convinced that evidence currently exists to support the everyday clinical use of (pediatric bipolar phenotype) diagnoses" which increase the "risk that medicines may be used to inappropriately . ADHD. or 1% of the [population] under age 20. Children Main article: Bipolar disorder in children In professional classifications such as the American Psychiatric Association's Diagnostic and Statistical Manual (DSM) [129] or the World Health Organization's International Classification of Diseases (ICD)[130] bipolar disorder is classified with adult onset disorders.[135][136] Studies in clinics using these criteria show that up to 20% of youth referred to psychiatric clinics have bipolar disorder. rather than that the incidence of the disorder has increased. Kraepelin [131] showed in a retrospective study of 900 manic-depressive adults that 0. The data suggest that doctors had been more aggressively applying the diagnosis to children. the validity of an early-onset form of bipolar disorder had been debated in the late 20th century. This consensus of the scientific community is also seen in the appearance of practice parameters for the disorder from the American Academy of Child and Adolescent Psychiatry[146] Findings indicate that the number of American [children] and [adolescents] treated for bipolar disorder increased 40-fold from 1994 to 2003.[147] The reasons for this increase in diagnosis are unclear. only three of 60 cases (5%) of purported childhood bipolar disorder met their criteria for bipolar disorder.4% had onset of symptoms before the age of ten. This idea was supported by a review of 28 papers by Anthony and Scott.000 in 2003. In a study of 898 adults with bipolar disorder.[137][138][139] Many of these children required hospitalization due to the severity of their disorder [140][141] Because of these diagnostic uncertainties. Population and community studies using DSM criteria show that about 1% of youth may have bipolar disorder. should increase the rate of diagnosis. meaning relaxed or loose. on January 31. The basis of the current conceptualisation of manic-depressive illness can be traced back to the 1850s. or a mixture of black and yellow bile. mania was viewed as arising from an excess of yellow bile. the antipsychotic drugs sometimes prescribed for the treatment of bipolar disorder may increase risk to health including heart problems. A 2002 German survey [149] of 251 child and adolescent psychiatrists (average 15 years clinical experience). meaning "bile" or "gall". meaning to produce great mental anguish. insights and research" [155] highlight several controversies and suggest the science still lacks consensus with regard to bipolar disorder diagnosis in the pediatric age group. that older bipolar patients had first experienced symptoms at a later age. however.[165] History Main article: History of bipolar disorder Variations in moods and energy levels have been observed as part of the human experience since time immemorial. and chole/χολη.[163] Thus. Although accurately diagnosing all disorders in children is important. bipolar disorder is a very disabling disorder which leads to many impairments in children.[166] indicative of the term's origins in preHippocratic humoral theories. There is also some weak evidence that mania is less intense and there is a higher prevalence of mixed episodes. The words "melancholia" (an old word for depression) and "mania" have their etymologies in Ancient Greek. and death. found only 8% had ever diagnosed a pre-pubertal case of bipolar disorder in their careers. or may have been diagnosed with bipolar disorder at an early age and still meet criteria. or become manic only after recurrent depressive episodes.[164] Older age There is a relative lack of knowledge about bipolar disorder in late life. Within the humoral theories.treat a bipolar diathesis that does not exist. and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic poetry and mythologies (Angst and Marneros 2001)."(p526). The linguistic origins of mania. although there may be a reduced response to treatment. Overall there are likely more similarities than differences from younger adults. that later onset of mania is associated with more neurologic impairment. for bipolar disorder. There is evidence that it becomes less prevalent with age but nevertheless accounts for a similar percentage of psychiatric admissions. meaning "black". including the Greek word ‘ania’. There are at least five other candidates. diabetes. 1854. and ‘manos’. and that there is probably a greater degree of variation in presentation and course. that substance abuse is considerably less common in older groups. A similar survey of 199 child and adolescent psychiatrists (av 15 years clinical experience) in Australia and New Zealand [150] also found much lower rates of diagnosis than in the USA and a consensus that bipolar disorder was overdiagnosed in children and youth in the USA. Several etymologies are proposed by the Roman physician Caelius Aurelianus. On the one hand. are not so clear-cut. Concerns about overdiagnosis in the USA have also been expressed by American child & adolescent psychiatrists [151][152][153][154] and a series of essays in the book "Bipolar children: Cutting-edge controversy.[138] [139][160][161][162] psychosis [138][139][161][162] and suicide. for instance individuals may develop new-onset mania associated with vascular changes. including cognitive impairment. it is critical. which would contextually approximate to an excessive relaxing of the mind or soul (Angst and Marneros 2001). liver failure.[156] On the other hand. parents and patients need to weight the potential risks and benefits when treating this disorder. physicians. The word melancholia is derived from melas/μελας.[157][158][159] psychiatric hospitalization. Jules Baillarger described to the French Imperial Academy of . after noting that periods of acute illness. which he termed folie à double forme (‘dual-form insanity’).(Sedler 1983) The two bitterly disputed as to who had been the first to conceptualise the condition.[167] Two weeks later. Detective Luke Harris (Gary Sweet) is portrayed as having bipolar disorder and shows how his paranoia interfered with his work. Matt Damon displays bizarre behavior including recklessness and grandiosity. He said that he left the sessions convinced he had the condition.[175] In the progressive metal band Dream Theater song Six Degrees of Inner Turbulence. TV specials. as well as some paranoia. influenced by the legacy of Adolf Meyer who had introduced the paradigm illness as a reaction of biogenetic factors to psychological and social influences. manic or depressive. Touched with Fire (1993). talk shows. a rock musical. Jones (Richard Gere) swings from a manic episode into a depressive phase and back again. As research for the role. profiled her own bipolar disorder in her memoir An Unquiet Mind (1995). grandiosity. Sweet visited a psychiatrist to learn about manic-depressive illness. and . He coined the term manic depressive psychosis.[173] Several films have portrayed characters with traits suggestive of the diagnosis that has been the subject of discussion by psychiatrists and film experts alike. he was also the first to introduce the terms bipolar (for those with mania) and unipolar (for those with depressive episodes only). spending time in a psychiatric hospital and displaying many of the features of the syndrome. These concepts were developed by the German psychiatrist Emil Kraepelin (1856–1926).[171] Society and culture Cultural references See also: List of people affected by bipolar disorder Kay Redfield Jamison. Next to Normal.[174] In The Mosquito Coast (1986). using Kahlbaum's concept of cyclothymia.[169] The term "manic-depressive reaction" appeared in the first American Psychiatric Association Diagnostic Manual in 1952. concerns a mother who struggles with worsening bipolar disorder and the effect her illness has on her family. who. Matt Damon portrays a manic-depressive whistleblower and FBI informant in The Informant!. Tom Wilkinson portrays a manic-depressive lawyer in Michael Clayton.[170] Subclassification of bipolar disorder was first proposed by German psychiatrist Karl Leonhard in 1957. About to Crash. increased goal-directed activity and mood lability.[176] MTV's True Life: I'm Bipolar. describes a girl with bipolar disorder. a clinical psychologist and Professor of Psychiatry at the Johns Hopkins University School of Medicine. Jones (1993). and public radio shows. in which Mr. In the Australian TV drama Stingers. In Mark Whitacre. 1854.[168] categorized and studied the natural course of untreated bipolar patients. Jean-Pierre Falret presented a description to the Academy on what was essentially the same disorder.Medicine a biphasic mental illness causing recurrent oscillations between mania and depression.[172] In her book. for example the BBC's The Secret Life of the Manic Depressive. on February 14. Allie Fox (Harrison Ford) displays some features including recklessness. she argued for a connection between bipolar disorder and artistic creativity. were generally punctuated by relatively symptomfree intervals where the patient was able to function normally. the lyric of the first movement. A notable example is Mr. and designated folie circulaire (‘circular insanity’) by him. 1001/archpsyc. O. A public service announcement (PSA) aired after the episode. U. 5. ^ NIMH · What are the symptoms of bipolar disorder? 4.com/health/bipolar-disorder/DS00356/DSECTION=2. Demler. ^ Frederick K Goodwin and Kay R Jamison. raising public awareness. http://www.617. ^ "Bipolar Disorder: NIH Publication No. and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R)". RC. ^ Kessler.the greater willingness of public figures to discuss their own bipolar disorder.mayoclinic. a character from the popular BBC soap EastEnders. Merikangas. but Bernadette chose not to take medication for it. she suffers from bipolar disorder.mayoclinic. "Dysfunctional assumptions in bipolar disorder". doi:10. Mayo Clinic. "Bipolar disorder: Tests and diagnosis". PMID 15023494. ^ Basco. 2009. On April 7.viii 2. Elliot Stabler's daughter. Wright. He has severe mood swings when off his medication.S. PMC 2847357.org/cgi/content/full/62/6/617.[citation needed] In King of the Hill.[179] In Law & Order: Special Victims Unit. KR. directing teens and young adults to the Child and Adolescent Bipolar Foundation website for information and to chat with other teens. "Epidemiology".. http://www. it is revealed that Kahn. was presented with a Special Achievement Award at the 2003 British Soap Awards for the role. EE (2005).[177] Stacey Slater. the actor who played Jimmy. ISBN 1-59385-162-6. http://archpsyc. Oxford University Press. ISBN 0-19-503934-3. Monica Ramirez. Kathleen Stabler. Revised 2008 8. has been diagnosed with bipolar disorder.[citation needed] References 1. After losing her friend Danielle Jones. The Bipolar Workbook: Tools for Controlling Your Mood Swings. Smith. It is later revealed that Elliott's mother. 1990. Journal of Affective Disorders 79 (1-3): 193–199. . also suffered with the disorder.6. ^ NIMH · Bipolar Disorder: NIH Publication 08-3679.[179] Dean Sullivan. being extremely happy and energetic one day and completely depressed to the point of losing all hope of living the next. ^ "Bipolar Disorder: Signs and symptoms".62. PMID 15939839. 7.Manic-Depressive Illness Chapter 7. Walters. K. and the character had to come to terms with the prospect that. ^ Lam. doi:10. National Institutes of Health. Chiu.amaassn. 95-3679". The high-profile storyline was developed as part of the BBC's Headroom campaign. the nighttime drama 90210 on the CW network. September 1995. ^ Mayo Clinic staff. N. have focused on psychiatric conditions. severity. MayoClinic. p.[178] The Channel 4 soap Brookside had earlier featured a story about bipolar disorder when the character Jimmy Corkhill was diagnosed with the condition. Jean Slater.com. edit 3.com/health/bipolar-disorder/DS00356/DSECTION=tests-anddiagnosis. suffers from bipolar disorder. D. Bernadette. 2006. 6. Stacey began acting strangely. WT.. Arch Gen Psychiat 6 (6): 617–27. (2004). aired a special episode where the character Silver was diagnosed with bipolar disorder. Retrieved 2010-07-19 9. like her mother. thereby. "Prevalence. Hank's neighbor. has been diagnosed with the disorder.1016/S01650327(02)00462-7. Souery D. 10.ajp. Linotte S.161.htm. 16. "High concordance of bipolar I disorder in a nationwide sample of twins". Acta Psychiatr Scand Suppl. ^ Tiihonen J.archive. ^ Santosa et al. Br J Psychiatry 196 (2): 109–15. http://www. "Mania and dysregulation in goal pursuit: a review". Boudreau VG. PMID 16677713 13.1016/j. PMID 15780691. 2007.2004.10. doi:10. PMID 15642648. PMID 16199837.bp. ^ Robinson LJ. HowStuffWorks. Retrieved September 8. The ascent into mania: A review of psychological processes associated with the development of manic symptoms.pueblo.(434):17– 26. R.http://web. doi:10. Goswami U. 1993.10. March 2008. .108. PMID 15023484. ^ "Bipolar Disorder: Complications". Psychiatr Hung. J Affect Disord. et al. (February 2010).ajp.85(1–2):207–15.1192/bjp. (2006) A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder.21(4):288–94. & Pedley.11. ^ "Mad Genius". "Premorbid intellectual functioning in bipolar disorder and schizophrenia: results from a cohort study of male conscripts". PMID 15465978.060368.1016/S0165-0327(02)00347-6.1176/appi. http://people. 24.howstuffworks. 20. Clinical Psychology Review. J Affect Disord. (April 2004). 15. p 353 19. Free Press. Yatham LN. 21. et al. 2005 March. Volume 28. Kaprio J. Clin Psychol Rev 25 (2): 241–62.1176/appi. PMID 17126406. Am J Psychiatry 162 (10): 1904–10.002. 1990. PMID 17170470.com/mad-genius3. Gallagher P. 2006 November 23. 23. Cnattingius S. doi:10.com/health/bipolar-disorder/DS00356/DSECTION=7. Moore PB. creative controls. ^ Kieseppä T. (October 2005). Creativity and mental illness. Haukka J. ^ Rihmer et al. Am J Psychiatry 161 (10): 1814–21. W. ^ Jamison. Young AH. Enhanced creativity in bipolar disorder patients: A controlled study. "Excellent school performance at age 16 and risk of adult bipolar disorder: national cohort study". 17. Partonen T. K R. ^ Blairy S.1904. Oxford University Press. Henriksson M. J Affect Disord. Lönnqvist J (October 2004). pp 83 ff. Pages 494–520 PMID 17825463 12. 11. ^ MacCabe JH. ^ Johnson SL (February 2005).cpr. et al. PMID 20118454. "Social adjustment and self-esteem of bipolar patients: a multicentric study". Touched with Fire. Manic-Depressive Illness. Haukka J. and Jamison.93(1–3):105–15.162. 2006. F. 22. K R. PMID 17688459 (Note: The full text of this study discloses pharmaceutical company funding) 14. Temperamental commonalities and differences in euthymic mood disorder patients. Thompson JM. 18. and healthy controls. 2008. J Affect Disord 79 (1–3): 97–103.org/web/20080429204140/http://www. ^ Goodwin. ^ a b c d Mansell.gsa.1814. doi:10.htm. ^ Torres IJ. doi:10. ^ Nowakowska et al. Issue 3. Ferrier IN. 2006 July.gov/cic_text/health/ bipolar/bipolar. (2007) Neuropsychological functioning in euthymic bipolar disorder: a meta-analysis. Mayo Clinic.mayoclinic. Lambe MP. J.. 661–678. 31.org/cgi/content/abstract/60/5/497. Unity or heterogeneity? J Affect Disord. J. McInnis. P. 1056–1058 35. DOI: 10. Cooke.25. Choudhury. Y.31 region points to P2RX7 as a susceptibility gene to bipolar affective disorder. DOI: 10. Kalsi. Shink E. R.000 cases of seven common diseases and 3. Part III: Bipolar Disorder. Cardno. V. Chambert et al.1038/sj. Puri. Tremblay M. Lewis CM. L.. Curtis and H. Andrew.1001/archpsyc. H. et al. and Muller-Myhsok B. ^ a b Edvardsen J. T. "Family history studies-V The genetics of Mania. "Molecular genetics of bipolar disorder and depression.000 shared controls Nature. Bordeleau L. M. (2007). ^ Sklar. R.mp. Onstad S. D. B.1038/nature05911 33. S. Yoon. 27. Røysamb E. Jones I. http://archpsyc. W. Gill M. 197–207.106(3):229–40. Ferreira. D. PMID 12802785 36. L. Gurling (2006). ^ Baum. ^ Ferreira. Ruderfer1. A. (2008) Collaborative genome-wide association analysis supports a role for ANK3 and CACNA1C in bipolar disorder Nature Genetics 40. Levinson DF. & Sebastian Zöllner Psychiatric genetics: progress amid controversy Nature Reviews Genetics 9. Smoller. Skre I.60. . (2008) Heritability of bipolar spectrum disorders. A. N. 49–62." Am J Med Genet B Neuropsychiatr Genet 141(1): 36–43.E. ^ McGuffin. Holsboer F. Katz.4002151 34. P. PMID 17692389 26. "Fine mapping of a susceptibility locus for bipolar and genetically related unipolar affective disorders.4002012 32. J. (2006)." American Journal of Psychiatry l25: l358–1369. 13(2). Detera- Wadleigh. Macciardi. "Analysis of single-nucleotide polymorphisms in genes in the chromosome 12Q24. A. S. Fan. Clayton and G. M. McIntyre. F. Labbe M.. PMID 12742871." Am J Med Genet B Neuropsychiatr Genet. 527–540 (July 2008) | doi:10. et al. Warsh (2006). Archives of General Psychiatry 60 (5): 497–502. "The Heritability of Bipolar Affective Disorder and the Genetic Relationship to Unipolar Depression". (2008).1038/sj.497." Psychiatry Clin Neurosci 61(1): 3–19. with bipolar disorder. G. M. I.. Li. Parikh..R. M.1038/nrg2381 30. R. 73. et al.. Craddock N. Detera-Wadleigh SD.mp. J. Harvey M.. Melvin G. Winokur (1969). M. Bass. Perlis. Torgersen S. F. Whole-genome association study of bipolar disorder Molecular Psychiatry DOI: 10. "Association of the putative susceptibility gene. A genome-wide association study implicates diacylglycerol kinase eta (DGKH) and several other genes in the etiology of bipolar disorder Molecular Psychiatry.3. S. Meng. ^ a b Margit Burmeister.. Stadler H. ^ Reich.. Rochette D.. A. P. to a region containing the C21ORF29 and TRPM2 genes on chromosome 21q22. 2008 March. PMID 17239033 28. J. D. P. J. Am J Hum Genet.." Mol Psychiatry 11(2): 134–142 37. P. (2003) Genome Scan Meta-Analysis of Schizophrenia and Bipolar Disorder. Genome-wide association study of 14. (2008).. A. 29. T. Nurnberger JI Jr. Sham. Raymond C. Lygren S.5. C. K. M.amaassn. G. Kennedy and J. Hughes. doi:10... A (2003). Oien PA. (2007). ^ Xu.. Lawrence.. ^ Burton. K. O’Donovan. R. Gagne B. J. ^ Segurado R.. P. 447(7145). V. ^ Barden N. Jones et al.. Villeneuve A. ^ Kato. ^ McQuillin. S. P.. Rijsdijk. transient receptor potential protein melastatin type 2. doi:10. "Association study of Wnt signaling pathway genes in bipolar disorder". Niemeier RT. http://www. new potential candidates and future directions. Kelsoe JR. Arch.psychiatryonline.785. Lichtenstein.amaassn. doi:10. Willour VL (July 2008).38. 41. Miklowitz and Kiki D. Neeren AM.1016/S0165-0327(01)00336-6. Hultman. Robert M Post Course of bipolar illness after history of childhood trauma The Lancet. PMID 12128245.html. "Prior stimulant treatment in adolescents with bipolar disorder: association with age at onset". Issue 9516. ^ Frans.1399-5618. and developmental risk factors. 20(3): 881–897. http://ajp. Mol Psychiatry.7. Reichenberg.com/article. 2008 August. Walshaw PD. Hauger RL. A. Alexander M. Volume 367.163.1017/S0954579408000424. Dev Psychopathol. McElroy SL. ^ Alloy LB. "Severity of bipolarity in hospitalized manic adolescents with history of stimulant or antidepressant treatment". ^ a b David J. McElroy SL. ^ Gabriele S Leverich a. Hendricks W. 2006 doi:10. J Affect Disord 70 (3): 323–7.25(8):1043–75. Chan Prevention of Bipolar Disorder in At-Risk Children: Theoretical Assumptions and Empirical Foundations Dev Psychopathol.com/resolve/openurl? genre=article&sid=nlm:pubmed&issn=13985647&date=2001&volume=3&issue=2&spage=53. ^ Barrett TB.1001/archpsyc.1149. PMID 16140445 48. "Psychotic and manic-like symptoms during stimulant treatment of attention deficit hyperactivity disorder".' genes.65.1034/j. http://archpsyc.. Langstrom. 2008.65(9):1034–1040. Belmonte PL. cognitive. ^ Zandi PP. ^ Emma Young (2006).x.4001268. "Evidence that a single-nucleotide polymorphism in the promoter of the G protein receptor kinase 3 gene is associated with bipolar disorder". PMID 11333062. http://www. doi:10. Retrieved 2006. Molecular Psychiatry 8 (5): 546–57. doi:10.mp. Remick RA.org/cgi/content/full/65/7/785. 46. 44. ^ DelBello MP.org/cgi/content/full/163/7/1149. 45. Psychiatry 65 (7): 785–93. (2008) Advancing Paternal Age and Bipolar Disorder Arch Gen Psychiatry. N. http://linkinghub.13(8):742–71.ajp. ^ Ross RG (July 2006). ^ a b Serretti A & Mandelli L.1038/sj.030201.com/mp/journal/v8/n5/abs/4001268a. Sadovnick AD. 39. (2008) The genetics of bipolar disorder: genome 'hot regions. E. Kennedy JL. P. Keck PE. Urosevic S.nature. 47.1016/S0140-6736(06)68450-XCite .7..elsevier. Bipolar Disord 3 (2): 53–7.. PMID 12808434. Sandin. doi:10.interscience. Clin Psychol Rev.com/retrieve/pii/S0165032701003366.. C. 40.2001. DelBello MP. April 1. Pages 1040–1042. ^ Soutullo CA.1176/appi. doi: 10. Gen. PMID 16816217. Am J Psychiatry 163 (7): 1149–52. S.newscientist. 2005 December. (2005) The psychosocial context of bipolar disorder: environmental. 2008. 42.. PMID 18606951. Ochsner JE (August 2002). Nusslock R. New Scientist. "New gene linked to bipolar disorder". Abramson LY.ns?id=dn8572&feedId=online-news_rss20. (May 2003). PMID 18332878 43. Soutullo CA.wiley. http://www3. Strakowski SM (April 2001). Shaw SH. ^ Manic-depressive illness FK Goodwin.03457.4001711. Yerevanian BI.mp. Ph. Psychiatry Res 38 (1): 13–9. ISBN 978-1594540592. (1999). Int. 58." Archives of General Psychiatry. ^ Stork C. 16. Norman TR (June 2005). Norman TR (July 2005). Molecular Psychiatry 10 (2): 900–919. U. 52. Focus on Bipolar Disorder Research. 55. ^ Whalley LJ. PMID 15841104. King D. "Novel targets for valproic acid: up-regulation of melatonin receptors and neurotrophic factors in C6 glioma cells".2005. 65. Nurnberger JI. "Meta-analysis. ^ Louisa D. "Low doses of lithium carbonate reduce melatonin light sensitivity in healthy volunteers". 53. doi:10. J. and the HPA Axis.26. 57. Stress. PMID 4003592. ^ Kempton. J. ^ Hallam KT. Lyn Y. ^ Castro LM. ^ Pope HG (1983). ^ Lewy AJ. 61.1038/sj. Renshaw PF (July 2005).1017/S1461145704004894. Am J Psychiatry 142 (6): 725–7. KR Jamison – 1990 – Oxford University Press New York 63. ^ Brian Koehler. Bennie J (July 1991). Neuropsychopharmacol. Wehr TA (June 1985). Shering A. PMID 15850501. and Meta-regression of 98 Structural Imaging Studies in Bipolar Disorder. Olver JS. Bipolar Disorder. 64. Alloy." Archives of General Psychiatry.1111/j.org/cgi/pmidlookup?view=long&pmid=4003592. 95 (5): 1227–36.bipolardatabase.J. Nova Science Publishers. PMID 13594184. drug-free. Lemmi H (February 1985). Hospital and Community Psychiatry 34: 322–28. http://ajp. Grandin. doi:10. S. pp. et al. Abramson (2007) Childhood Stressful Life Events and Bipolar Spectrum Disorders Journal of Social and Clinical Psychology.M.D. ^ Akiskal HS. PMID 1658841. "Supersensitivity to light: possible trait marker for manic-depressive illness". Brown. 108–110.npp.1521/jscp. McGrath C. 60. 2005. bipolar patients". Gallant M.2007. Olver JS. doi:10. 26 (4) pp460–478 doi: 10. DelBello. doi:10. K. "Mitochondrial dysfunction in bipolar disorder: evidence from magnetic resonance spectroscopy research". The International Society for the Psychological Treatment Of Schizophrenia and Other Psychoses. ^ Prefrontal Cortex in Bipolar Disorder Neurotransmitter. Database. "The nosologic status of borderline personality: clinical and polysomnographic study". M..R. 51. Neuropsychopharmacology 30 (7): 1400–4.psychiatryonline.1471-4159.net.460 50. 62. Sax.4. J. doi:10. Davis GC. PMID 16313512. Niles LP (December 2005). "Distinguishing bipolar disorder from schizophrenia in clinical practice: guidelines and case reports". ^ Malcomb R. pp. "Melatonin response to bright light in recovered.49. 8 (2): 255–9.W. 59. Basso (2004).. Michael R.1300739. "Brain magnetic resonance imaging of structural abnormalities in bipolar disorder. M. 65:1017–1032 see also MRI database at www. Geddes. Lauren B. ^ Strakowski. Neurochem. ^ Link and reference involving kindling theory 54. Ettinger. "Effect of sodium valproate on nocturnal melatonin sensitivity to light in healthy volunteers". 56.1038/sj.P.x. ^ Goodwin & Jamison. et al.1016/0165-1781(91)90048-T. Perini T. ^ Hallam KT. Horgan JE.. (2008).org. Am J . 56:254–60. 1399-5618.nature.x. "The borderline syndrome:Is it a variant of schizophrenia or affective disorder?". PMID 15541068. HM (1998).1016/j. Biological Psychiatry 48 (6): 445–457. 79. J Affect Disord. S. ^ DSM-IV-TR. S. doi:10. Bipolar Disorders 6 (6): 523–529. Jonas JM.html.org/cgi/pmidlookup?view=long&pmid=3970243. PMID 2857532. doi:10. Am J Psychiatry 142 (3): 277–288. and long term follow up study". Diagnostic criteria for 296. CB. 69.psychiatryonline. doi:10. PMID 3970243. R (September 15. http://archpsyc. PMID 11018218. . PMID 6849616. 73. Clinically Useful Psychiatric Scales: Bipolar Spectrum Diagnostic Scale. "Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States". ^ DSM-IV-TR. Faedda. Eshleman.2005. Longitudinal course specifiers for mood disorders. Arch Gen Psychiatry 40 (12): 1319–1323. TH (1983). Young. 80. PMID 6651467.8 (inactive 2008-06-25). KA. PMID 8279933. ^ Pope HG Jr. Selloro. 66. McGonagle. http://ajp. ^ Papolos. family history. 67. 2000. 81. PMID 16488021.mp. 76. Veit. M.84:273–277.12. 71. "The DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: evidence that they lie on a dimensional spectrum". 2009. Gunderson JG (1983).1. DF. Sensitivity and specificity of a new bipolar spectrum diagnostic scale. GL. doi:10. "Rapid cycling bipolar disorder: historical overview and focus on emerging treatments". Lachman.jad.1038/sj.13 Cyclothimic Disorder.org/cgi/content/abstract/51/1/8. Arch Gen Psychiatry 40 (1): 23–30. ^ Psychiatric Times. Saito. 72. S. "The interface between borderline personality disorder and affective disorder". http://www. "The validity of DSM-III borderline personality disorder: A phenomenologic.89 Bipolar II Disorder.Psychiatry 142 (2): 192–8.1016/S00063223(00)00909-4.com/mp/journal/v3/n4/abs/4000410a. HU. J. ^ Kessler. 68. Benazzi F (May 2006). text revision (DSM-IV-TR) ed. 92 (1): 45–54.amaassn. 2005. T. Kendler. 77. "Historical perspectives and natural history of bipolar disorder". "Ultra-ultra rapid cycling bipolar disorder is associated with the low activity catecholamine-Omethyltransferase allele". ^ McGlashan. Bipolar Disorder. Not Otherwise Specified (NOS). ^ American Psychiatric Association. 70.4000410. ^ DSM-IV-TR. ^ Angst. PMID 9702745. Molecular Psychiatry 3 (4): 346–349. Wittchen. Hughes. Hudson JI. ^ Mackin. Bipolar I Disorder. ^ Ghaemi N. AH (2004). 75. 2000). Cohen BM.51. ^ DSM-IV-TR. ISBN 0-89042-025-4. Diagnostic criteria for 301. ^ DSM-IV-TR.035.1001/archpsyc.1111/j. Archives of General Psychiatry 51 (1): 8–19. ^ Akiskal HS. J Affect Disord. 4th. P. Zhao. Elliott GR (1985). Diagnostic and Statistical Manual of Mental Disorders. treatment response. doi:10.2004. ^ Gunderson JG.00156. Retrieved March 9. 78. Nelson. 74. KS (1994). RC. 2004.ajmc.. (2005) Existential despair and bipolar disorder: the therapeutic alliance as a mood stabilizer.com/Article. 92. 59(2):137–47 PMID 16170918 99. Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. Goodwin GM (February 2004). "Bipolar Disorder: How long does it usually take for someone to be diagnosed for bipolar disorder?". Ghaemi SN. ^ Trinh NH. 429. Feldman K. Cuellar. P 307-339 PMID 15792852 doi = 10.cfm?Menu=1&ID=2969. C. 1999. ^ S. Wolfe R.52(1):14–21. ^ Depression and Bipolar Support Alliance: About Mood Disorders 88.psychiatrictimes. "Long- term lithium therapy for bipolar disorder: systematic review and meta-analysis of . [dead link] 83. 1990. Jamison K. How well do psychosocial interventions work in bipolar disorder? Can J Psychiatry. (2006) Psychiatric services for people with severe mental illness across western Europe: what can be generalized from current knowledge about differences in provision. ^ Hypomanic Check List Questionnaire (HCL-32) 85. PMID 16445476 95. SR.com/bipolardisorder/article/10168/54481. "Comorbidity in Bipolar Disorder: The Complexity of Diagnosis and Treatment". Ultra-rapid and ultradian cycling in bipolar affective illness. Schapiro Bipolar Disorders in Children and Adolescents J Pediatr Health Care. Nassir Ghaemi (2001). ^ Havens LL. 168. Hawton K. Johnson and Ray Winters (2005) Distinctions between bipolar and unipolar depression Clinical Psychology Review. ^ McGurk.1016/j. ^ Becker T. costs and outcomes of mental health care? Acta Psychiatrica Scandinavica Supplement. Burgess S.. March. Basco & Rush. 91. ^ Kranowitz. 84. Johnson & Leahy. 3. 89. ^ Benazzi F. Psychiatric Times. Am J Psychother. http://www. 97. ^ Zaretsky AE. Pascaris A (2007).12.familyaware. 90. "Misdiagnosis of Bipolar Disorder". PMID 17230047 87. ^ Amy K.cpr.asp. PMID 17329468 96.19(3):131–141. & Parikh SV. Rizvi S. Retrieved February 20.com/display/article/10168/1391541. Am J Psychiatry. ^ Roy H. Mueser KT. ^ Sagman D and Tohen M (2009). Frank. Perlis (2005). 94. 2005. http://www. Miklowitz & Goldstein. "Bipolar Disorder in the Elderly: Differential Diagnosis and Treatment". (2007) Is there a continuity between bipolar and depressive disorders? Psychother Psychosom 76(2):70-6. 9–16.S. Vol 25. http://www. ^ (Lam et al. British Journal of Psychiatry. 314–323. ^ Geddes JR. 2007.002 86. 2005.psychiatrictimes.82.2004. 2007. ^ Naomi A. R. May. Retrieved February 20. 1997. Forester B (2007). Sheri L. Kilian R. & Post.org/expertprofiles/drghaemi4. http://www.164(3):437–41. 2005. Psychiatric Times 24 (14). January. (2007). (1996). American Journal of Managed Care. ^ Bipolar labels for children stir concern – The Boston Globe 93. 98. ^ Goodwin & Jamison. ^ "Treatment of refractory and rapid-cycling bipolar disorder".. Schettler Pamela J. 106.162. #13. Science News.edu/class/spring2004/cmsc434/teams/rise/Introduction. (2005) Psychosocial disability in the course of bipolar I and II disorders : A prospective. (2002). Geddes JR. Greil W.^ Calabrese JR.google. cs.cochrane. 112... Aksikal Hagop S.^ Tohen M.com/? id=s4dVLeND9l0C&lpg=PP1&dq=riding%20the%20roller%20coaster%2C%20living %20with%20mood&pg=PA26#v=onepage&q=. (2007) Effectiveness of Adjunctive Antidepressant Treatment for Bipolar Depression New England Journal of Medicine.[dead link] Official Zyprexa Website.wpic..htm.ajp. MD. . doi:10. PMID 14754766. . Monaghan E. doi:10.org/reviews/en/ab004052. Placebo- Controlled Trial | Treatments 111. Ascher JA..umd. "A double-blind placebo-controlled study of lamotrigine monotherapy in outpatients with bipolar I depression.1176/appi.^ Bipolar surprise: mood disorder endures antidepressant setback. 113. March 31. Sachs GS. 2007.^ Bergen M (1999).1176/appi.^ Omega 3 Fatty Acids in Bipolar Disorder A Preliminary Double-blind. "Olanzapine versus lithium in the maintenance treatment of bipolar disorder: a 12-month. Retrieved February 16. 2008.randomized controlled trials".cs. vol. Maser Jack D. http://books. Am J Psychiatry 161 (2): 217–22. Am J Psychiatry 162 (7): 1281–90. (abstract) "Valproate for acute mood episodes in bipolar disorder". Calabrese JR (July 2005).^ Macritchie K. controlled clinical trial".CD004052. 105. Goodwin G. ISBN 9781896836317. Endicott Jean. PMID 15994710.^ "Introduction". (2000) Systematic overview of lithium treatment in acute mania.^ Judd Lewis L. GS. 104. ISSN 1464-780X.umd. 101.ajp.7.htm#trtref. 171. Wood Lake Publishing Inc. J Clin Psychiatry 60 (2): 79–88. http://www. Leon Andrew C.edu/stanley/1stbipconf/bipolar2. Bowden CL. doi:10. de Lima M.1176/appi. PMID 10084633. Keller Martin B.1002/14651858. Li Wan Po A.161.217.ajp. http://www.html (abstract).1. Scott J. p. 107.. The Cochrane Database of Systematic Reviews (John Wiley and Sons. de Oliveira IR.2. Mitchner L (January 2004). 103. doi:10. "What is a "mood stabilizer"? An evidence- based response". Volume 356:1711–1722 (Abstract). 108.^ Results for Triacetyluridine tau decreases depressive symptoms and increases brain ph in bipolar patients 110. double-blind.196 109. PMID 14702242.^ Poolsup N. Coryell William. PMID 12535506. Rudd GD (February 1999).^ Bauer MS. 100.^ Sachs. J Clin Pharm Ther 25: 139–156 PMID: 10849192 102. et al. Ltd. Riding the Roller Coaster: Living with Mood Disorders. http://www. randomized. Am J Psychiatry 161 (1): 3–18. Haslam D.) (2): CD004052. Solomon David A.edu.161.pitt.3.1281. Lamictal 602 Study Group".^ Now Approved: ZYPREXA for maintenance therapy for bipolar disorder. Akiskal. "Bipolar disorder is a potentially fatal disease". Baldessarini RJ. Australian and New Zealand of Psychiatry 39 (4): 235–43.1440-1614.^ Merikangas KR. McCarthy E. McIntyre. 2003 December. PMID 11545667. Petukhova M. BMJ 318 (7177): 149–53. Limb K (January 1999). http://archpsyc. "Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment". NL (April 2005).^ Roger S. Khalsa HM. MD. Joanna K.2005. 1322– 1330 114.psychiatrictimes. 119. Greenberg PE. Boyd JH. Locke BZ (1988).1001/archpsyc. Soczynska. HS (January 2003). "Bipolar Disorder: Defining Remission and Selecting Treatment".com/cgi/pmidlookup?view=long&pmid=9888904.^ Christie KA. PMID 9888904. Burke JD Jr.01559.com/article/showArticle. 121. http://linkinghub. 125. XXIII. L. Journal of Affective Disorders 73 (1–2): 123–31. Strakowski SM. MPH. MD. 2006. Goldberg. J. Two Trees Media 2000. Hennen J.160(12):2099-107. N.^ Kelly. Kessler RC. (abstract) "Epidemiologic evidence for early onset of mental disorders and higher risk of drug . doi:10. The Bipolar Workbook: Tools for Controlling Your Mood Swings. Ekbom. MD. Sparén. Regier DA. (2003) The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence Am J Psychiatry. "Excess Mortality in Bipolar and Unipolar Disorder in Sweden". 11. longitudinal study Archives of General Psychiatry.^ Judd. Gebre-Medhin P.^ Tohen M. 124. PF.x. Joseph F. 126. (2007) Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication Arch Gen Psychiatry. ISBN 1-59385-162-6.elsevier. Correia. No. 62. 116.^ Phelps.58.9. doi:10. A.^ Bipolar Disorder webpage from ADAM Illustrated Health Encyclopedia at About. Archives of General Psychiatry 58 (9): 844– 850.^ Ösby.1111/j.postgradmed. PMID 15777359. May.com 118.jhtml? articleId=193400986.64(5):543–52. http://www. PMC 27688. Federico. Vol. 115. Bipolar and the Art of Roller-coaster Riding. Salvatore P.1016/S0165-0327(02)00332-4. Pedersen. Lewis L. doi:10. vol.amaassn. Zarate CA Jr.^ Soldani.com/issues/2005/02_05/comm_citrome. http://bmj. 2005 120. http://www. Morriss R. "Mania in the Swedish Twin Registry: criterion validity and prevalence". pp.comparative. October 2006. Angst J. p2 117. Psychiatric Times. Hirschfeld RM. U.844.com/retrieve/pii/S0165032702003324.^ Basco.org/cgi/content/abstract/58/9/844. "The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases". PMID 12507745.htm. Akiskal HS. Rae DS.^ Psychopathologic Correlates of Suicidal Ideation in Major Depressive Outpatients: Is It All Due to Unrecognized (Bipolar) Depressive Mixed States? 123. Tarrier N. no12. Monica Ramirez. P (2001). and Jakub Konarski. M. (2006) Bipolar Disorder: Particle or Wave? DSM Categories or Spectrum Dimensions? Psychiatric Times 127. Sullivan.. [dead link] 122. Brandt..^ Leslie Citrome.^ Perry A. Mick.^ Goodwin and Redfield Jamison (1990) Childhood and Adolescence. Gold and Radke- Yarrow (2004) A prospective study of the association among impaired executive functioning. 128. 129.^ Weller. 1 53–72 135. and the development of bipolar disorder. Mundy and Mennin (1995) Mania- like symptoms suggestive of childhood onset bipolar disorder in clinically referred children.psychiatryonline. Ablon. Biederman. Dev Psychopathol.^ Goodwin & Jamison. Wiggs.org/cgi/content/abstract/145/8/971 (abstract). Tucker and Fristad (1986) Mania in prepubertal children: Has it been underdiagnosed? Journal of Affective Disorders. Faraone.^ World Health Organization (1979) International classification of diseases. Klein and Seeley (1995) Bipolar disorders in a community sample of older adolescents: Prevalence.^ Anthony and Scott (1960) Manic-depressive psychosis in childhood. and course. 11 151–154 138. 6 293–300 . Faraone. Biederman.^ Loranger and Levine (1978) Age at onset of bipolar affective illness.^ American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition Text Revision (DSM-IV-TR). Mennin and Faraone (1995) A pilot family study of childhood-onset mania. 53 931–934 143.^ a b c Wozniak. http://www. 132. Wilens and Wozniak (2003) Current concepts in the validity. Althoff. Kiely. 34 454–463 137. 9th ed.^ a b c Wozniak. International Journal of Neuropsychopharmacology. Archives of General Psychiatry. 34 867– 876 139. 58 562–8 136. Am J Psychiatry. Ronsaville. 159 307–9. 186–209 134.^ Kraepelin (1921) Manic-Depressive Insanity and Paranoia. Journal of the American Academy of Child and Adolescent Psychiatry. Carlson. 131. 16 461–76 142. Weller. Martinez. Journal of Child Psychology and Psychiatry. Mundy. comorbidity. Mojtabai and Schwartz (2002) Age at onset. Journal of the American Academy of Child and Adolescent Psychiatry.abuse in young adults". p. Journal of the American Academy of Child and Adolescent Psychiatry.^ Biederman. 35 1345–1348 133.^ Biederman (2003) Pediatric bipolar disorder coming of age.ajp. diagnosis and treatment of paedatric bipolar disorder. Derks and Faraone (2005) The prevalence and genetic architecture of CBCL-juvenile bipolar disorder.^ Lewinsohn. Spencer. Biological Psychiatry. Rettew. and two-year outcome in psychotic bipolar disorder. Klimes-Dougan.^ Carlson. Am J Psychiatry 145 (8): 971–975. 121. Biological Psychiatry. 141. Manic- Depressive Illness. phenomenology. 34 1577–1583 140. Retrieved July 1. Bromet. childhood psychopathology. PMID 3394882. 1–943 130. childhood attentional problems.^ Hudziak. 2007.^ Meyer. Driessens. adolescents. Mental health and children: Too often the system conspires to treat behavioural problems with pills. Caetano. Do child psychiatrists in Germany diagnose bipolar disorders in children and adolescents? Result from a survey. Bearden. 149. Meyer S. (September 2007) "National trends in the outpatient diagnosis and treatment of bipolar disorder in youth. Pine and Leibenluft (2005) Memory and learning in pediatric bipolar disorder.^ McClellan J. National clinical practice guidelines number 38: Bipolar disorder: the management of bipolar disorder in adults. London: National Collaborating Centre for Mental Health. Journal of Clinical Psychiatry. 6: 426 – 431 150. 46 107–125 147. Child and Adolescent Mental Health.^ (2007) Practice Parameter for the Assessment and Treatment of Children and Adolescents With Bipolar Disorder. Los Angeles Times Dec 14. Journal of the American Academy of Child and Adolescent Psychiatry. Koßmann-Böhm S. Snow. Phenomenology and diagnosis of bipolar disorder in children. Praeger press. Treland. (in press) 151.amazon.^ Geller and Tillman (2005) Prepubertal and early adolescent bipolar I disorder: review of diagnostic validation by Robins and Guze criteria. Child & adolescent psychiatry: the increased diagnosis of “juvenile bipolar disorder”: what are we treating? Psychiatr Serv 2005.^ USATODAY. Pliszka. Bipolar Disord.144. Childhood in America series.^ Meyer TD. J Am Acad Child Adolesc Psychiatry.com – New antipsychotic drugs carry risks for children 157. 2007. Dickstein.story 155. Allison S. Commentary: treatment guidelines for child and adolescent bipolar disorder. 66 Suppl 7 21–28 146. 64(9):1032–9. Olfson M.^ Bipolar Children: Cutting-edge controversy. 2004. children and adolescents in primary and secondary care." Archives of General Psychiatry. 36 1168– 1176 145. Bipolar Disorders. The paediatric bipolar hypothesis: the view from Australia and New Zealand. Jiang H. 18:939–969 152. Charney. J Am Acad Child Adolesc Psychiatry. PMID 17768268 148. 7 546–54 158.^ Harris J.^ Parry P. 2008 available at: http://www.^ Moreno C. insights and research.^ McClure. Schmidt AB. Laje G. http://www.^ Glahn. Westport CT.com/Bipolar-Children-Cutting-Edge-ControversyChildhood/dp/0275997308/ref=sr_1_11?ie=UTF8&s=books&qid=1245833103&sr=8-11 156. Fonseca. Hunter.^ Carlson G. Blanco C.latimes. Olvera and Soares (2005) Declarative memory impairment in pediatric bipolar disorder. Towbin. Najt.^ Geller and Luby (1997) Child and adolescent bipolar disorder: A review of the past 10 years. 56: 529 – 531 153. Journal of the American Academy of Child and Adolescent Psychiatry 2005.com/news/opinion/commentary/la-oe-williams142008dec14. Schlottke PF.^ Laurel Williams.^ National Institute of Health and Clinical Excellence (2006).0.3774809. and adults: Complexities and developmental issues Development and Psychopathology 2006. 44 461–9 . 44: 236–239 154. editor Sharna Olfman. Furber G. co. 2009.^ Goldstein.org/90210. Valeri. Henry George and Robert Scott (1980).^ Robinson DJ (2003). Reel Psychiatry:Movie Portrayals of Psychiatric Conditions. Ablon and Faraone (1993) Prepubertal mania revisited.^ a b Wozniak.^ Depp CA. Olvera.nlm. http://www. ISBN 0-19-910207-4.ncbi. New York: The Free Press: Macmillian. Kiely. 150 years on". Theordore (1996). II and bipolar NOS patients.6(5):343–67. Inc. Harral. Schenkel. 166.^ Millon. New York: Knopf. BBC. New York: John Wiley and Sons. 91 33–7 162. Gill. Scientific Proceedings of the Annual Meeting of the American Academy of Child and Adolescent Psychiatry 163. 2007. Retrieved 2008-04-12. Mick. Journal of Affective Disorders.. Hatch. 167. pp. 163 286–93 160.^ Goodwin & Jamison.^ a b Caetano. Axelson. p. Retrieved February 20. 168. 171. http://www.bpkids. 290. Birmaher. Hill. . 175. Emil (1921) Manic-depressive Insanity and Paranoia ISBN 0-405-07441- 7 170.shtml. pp.^ Jamison. Brent and Keller (2005) History of suicide attempts in pediatric bipolar disorder: factors associated with increased risk. 84–85 176. Ryan. Pliszka and Soares (2006) Association of psychosis with suicidality in pediatric bipolar I. 177.^ Bipolar Phases in Children[dead link] 164.^ "Circular insanity. ISBN 0-684-83183X. Bipolar Disord.^ Jamison. A Greek-English Lexicon (Abridged Edition). Touched With Fire: Manic-Depressive Illness and the Artistic Temperament. Port Huron. 2006..^ "Child and Adolescent Bipolar Foundation special 90210 website".^ Kraepelin.^ Pavuluri.uk/health/tv_and_radio/secretlife_index. J Affect Disord. Hunt. Leonard. Jeste DV.nih. Najt. Bowden. Biederman.gov/pubmed/15506718. Michigan: Rapid Psychler Press. 7 525–35 165. 2009. Retrieved April 7. Wozniak. Am J Psychiatry. Kay Redfield (1996). Kay Redfield (1995). 2004 October. ISBN 0-471-01186-X. Bridge. CABF.^ Liddell.^ "The Secret Life of the Manic Depressive". 83 207–214 161.^ Biederman.^ Goodwin & Jamison.bbc. 78–81. United Kingdom: Oxford University Press. p62 172. Markowitz. ISBN 0-330-34651-2. Aryal. 174. Fazio and Faraone (2004) Absence of gender differences in pediatric bipolar disorder: Findings from a large sample of referred youth. Disorders of Personality: DSM-IV-TM and Beyond.^ Robinson (Reel Psychiatry:Movie Portrayals of Psychiatric Conditions).159. http://www. 173. Hunter. pp. 60–61. Kwon. (2004) Bipolar disorder in older adults: a critical review Bipolar Disord. Chiappetta. ISBN 1-894328-07-8. Strober. An Unquiet Mind: A Memoir of Moods and Madness. Herbener and Sweeney (2006) Neurocognitive function in unmedicated manic and medicated euthymic pediatric bipolar patients. 169. 2009). Paul. Jamison KR (1990).shtml. BBC Press Office. Liverpool Echo (Mirror Group Newspapers). Emil. ISBN 0-7434-4659-3. Further reading Contemporary first-person accounts • • • Simon. Rachael (May 14. National Institute of Mental Health website NICE Bipolar Disorder clinical guidelines from the U. Lizzie. Manic-Depressive Illness. 2004. Crazy. ISBN 0-399-15313-6. Scattershot: My Bipolar Family.178.K. Pete. Lesley (March 5. Lovelace. ISBN 0-89862-128-3 Managing bipolar disorder • • • Bipolar disorder in children Classic works on bipolar disorder • • External links • • • Bipolar Disorder overview from the U. Electroboy: A Memoir of Mania.^ "EastEnders' Stacey faces bipolar disorder". 2008. 2009. Berk. Vermilion. Acquainted with the Night: A Parent's Quest to Understand Depression and Bipolar Disorder in His Children. Dennis Greenberger.co. Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression. New York: Oxford University Press.uk/pressoffice/pressreleases/stories/2009/05_may/14/stacey. ISBN 0-19-503934-3. Detour: My Bipolar Road Trip in 4-D. http://www. 2002. ISBN 0-525-95078-8. Living with Bipolar. Goodwin FK. Jamison KR (2007). 2002. 179. ISBN 0-375-50358-7. A father's account of his son's bipolar disorder. May 14. National Institute for Health and Clinical Excellence website Bipolar Disorder at the Open Directory Project . Cited texts • • Goodwin FK. Kraepelin. David. Retrieved May 28. ISBN 9780091924256.bbc. 2002. New York: G.S. Raeburn. 2008. 2009. but a work of major historical importance). P. 2006. Mind Over Mood: Cognitive Treatment Therapy Manual for Clients by Christine Padesky. ISBN 0-19513579-2. New York: Oxford University Press. Andy. Behrman. 2003). New York: Dutton Adult. New York: Simon and Schuster. Putnam's Sons. 2nd Edition. New York: Random House. Earley.^ a b Tinniswood. 1921. "The Brookie boys who shone at soap awards show". Manic-depressive Insanity and Paranoia ISBN 0-405-07441-7 (English translation of the original German from the earlier eighth edition of Kraepelin's textbook — now outdated. Bipolar II. Dysthymia. Folie à deux) [hide] Mood (affective) Mania · Bipolar disorder (Bipolar I. schizotypal and delusional Psychosis (Schizoaffective disorder. Atypical depression. Schizophreniform disorder.[show] v•d•e Mental and behavioral disorders (F · 290–319) [show] Neurological/symptomatic Mild cognitive impairment · Alzheimer's disease · Multi-infarct dementia · Pick's Dementi disease · Creutzfeldt–Jakob disease · Huntington's disease · Parkinson's disease · AIDS a dementia complex · Frontotemporal dementia · Sundowning. Bipolar NOS) · Depression (Major depressive disorder. substance abuse. drug abuse and substance-related disorders Intoxication/Drug overdose · Physical dependence · Substance dependence · Rebound effect · Double rebound · Withdrawal [show] Schizophrenia. Seasonal affective disorder. Wandering Other Delirium · Post-concussion syndrome · Organic brain syndrome [show] Psychoactive substances. Cyclothymia. Brief reactive psychosis) · Schizophrenia (Disorganized schizophrenia. Delusional disorder. PTSD) Adjustment Adjustment disorder with depressed mood disorder . stress-related and somatoform Phobia Anxiety disorder Other Agoraphobia · Social anxiety/Social phobia (Anthropophobia) · Specific phobia (Claustrophobia) · Specific social phobia Panic disorder/Panic attack · Generalized anxiety disorder · OCD · stress (Acute stress reaction. Melancholic depression) [show] Neurotic. Globus m disorder pharyngis) · Neurasthenia · Mass Psychogenic Illness Dissociative Dissociative identity disorder · Psychogenic amnesia · Fugue state · disorder Depersonalization disorder [show] Physiological/physical behavioral Eating disorder Anorexia nervosa · Bulimia nervosa · Rumination syndrome · NOS Nonorgani c (Nonorganic hypersomnia.Somatization disorder · Body dysmorphic disorder · Hypochondriasis · Nosophobia · Somatofor Da Costa's syndrome · Psychalgia · Conversion disorder (Ganser syndrome. Trichotillomania. Nightmare) disorders Sexual sexual desire (Hypoactive sexual desire disorder. Dyspareunia) Postnatal Postpartum depression · Postnatal psychosis [show] Adult personality and behavior Sexual and Sexual maturation disorder · Ego-dystonic sexual orientation · Sexual relationship gender disorder · Paraphilia (Voyeurism. n Premature ejaculation) · pain (Vaginismus. Other Pyromania) · Body-focused repetitive behavior · Factitious disorder (Munchausen syndrome) [show] Mental disorders diagnosed in childhood Mental retardation X-Linked mental retardation (Lujan-Fryns syndrome) . Nonorganic insomnia) · Parasomnia (REM behavior sleep disorder. Hypersexuality) · sexual arousal dysfunctio (Female sexual arousal disorder) · Erectile dysfunction · orgasm (Anorgasmia. Night terror. Fetishism) identit y Personality disorder · Impulse control disorder (Kleptomania. sysi/epon. p. m. RAD. Bipolar II. s). 296) H i s Emil Kraepelin · Karl Leonhard · John Cade · Mogens Schou · Frederick K. spvo drug(N5A/5B/5C/6A/6B/6D) [show] v•d•e Mood disorder (F30–F39. a. Goodwin · Kay t Redfield Jamison o r y S y m p Hallucination · Delusion · Emotional dysregulation (Anhedonia. Insomnia) · Psychosis · Racing thoughts o m s S Bipolar disorder (Bipolar I. DAD) · Tic disorder behavioral (Tourette syndrome) · Speech (Stuttering. proc.Psychological development Specific · Pervasive (developmental disorder) ADHD · Conduct disorder (ODD) · emotional disorder (Separation anxiety Emotional and disorder) · social functioning (Selective mutism. Suicidal ideation) · tsleep disorder (Hypersomnia. Dysphoria. Cluttering) · Movement disorder (Stereotypic) [show] Symptoms and uncategorized Catatonia · False pregnancy · Intermittent explosive disorder · Psychomotor agitation · Sexual addiction · Stereotypy · Psychogenic non-epileptic seizures · Klüver-Bucy syndrome M: PSO/PSI mepr dsrd (o. Bipolar NOS) · Cyclothymia · Dysthymia · Major p depressive disorder · Schizoaffective disorder e Mania · Mixed state · Hypomania · Major depressive episode · Rapid cycling c t r . d. p. u m Carbamazepine · Gabapentin · Lamotrigine · Oxcarbazepine · Topiramate · T Anticonvulsants Valproic acid (Sodium valproate. m. p.wikipedia. Lithium citrate. p. s). sysi/epon. proc. a. Valproate semisodium) r e Other mood Lithium pharmacology (Lithium carbonate. spvo drug(N5A/5B/5C/6A/6B/6D) Retrieved from "http://en. d. Lithium sulfate) · a stabilizers Antipsychotics t m e Clinical psychology · Electroconvulsive therapy · Involuntary commitment · Nonn Light therapy · Psychotherapy · Transcranial magnetic stimulation pharmaceutical t · Cognitive behavioral therapy R e l Affective spectrum · List of people affected by bipolar disorder · Bipolar disorder in children · a Book:Bipolar Disorder t e d M: PSO/PSI mepr dsrd (o.org/wiki/Bipolar_disorder" Categories: Bipolar disorder | Disability | Mental illness diagnosis by DSM and ICD Hidden categories: Pages with DOIs broken since 2008 | All articles with dead external links | Articles with dead external links from March 2010 | Articles with dead external links from June 2010 | Wikipedia semi-protected pages | All articles with unsourced statements | Articles with unsourced statements from June 2010 | Articles with unsourced statements from September 2010 | Articles with unsourced statements from November 2008 | Articles with unsourced statements from February 2009 | Articles with unsourced statements from March 2009 | All articles with specifically-marked weasel-worded phrases | Articles with specifically-marked weasel-worded phrases from March 2009 | Articles with unsourced statements from May 2010 | Articles with unsourced statements from July 2010 | Articles with inconsistent citation formats Personal tools • • • • Views New features Log in / create account Article Discussion Namespaces Variants • Read . • • Actions Search View source View history Top of Form Special:Search Bottom of Form Navigation • • • • • • • • • • • Toolbox Main page Contents Featured content Current events Random article About Wikipedia Community portal Recent changes Contact Wikipedia Donate to Wikipedia Help What links here Related changes Upload file Special pages Permanent link Cite this page Create a book Download as PDF Printable version Afrikaans ‫العربية‬ Български Interaction • • • • • • • • • • • • Print/export Languages . • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Català Česky Cymraeg Dansk Deutsch Eesti Ελληνικά Español Esperanto Euskara ‫فارسی‬ Français Galego 한국어 िहनदी Hrvatski Italiano ‫עברית‬ Lietuvių Magyar Македонски ‫مصرى‬ Nederlands 日本語 Norsk (bokmål) Norsk (nynorsk) Occitan Polski Português Română Русский Simple English Slovenčina Slovenščina Српски / Srpski . . additional terms may apply. Inc. Text is available under the Creative Commons Attribution-ShareAlike License. See Terms of Use for details. Contact us Privacy policy About Wikipedia Disclaimers • • • • • • • • .• • • • • • Suomi Svenska Tagalog Türkçe Українська 中文 This page was last modified on 9 September 2010 at 21:17. a non-profit organization. Wikipedia® is a registered trademark of the Wikimedia Foundation.