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Bipolar disorders comprise recurrent episodes of elevated mood and depression.1 The relapse rate is more than 70% over five years.2 Definitions of the various types of bipolar disorders are provided in Table 13,4; diagnostic criteria are listed in Table 2.3 Hypomania can occur in bipolar I and II disorders, whereas mania, which may include psychosis, appears only in bipolar I disorder. The nature and prognosis of the current episode and the likelihood of future ones can be described with specific attributes3 (Table 33–5).
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Screen all patients 12 years and older for depression, including all pregnant patients in the perinatal period; screening should be implemented with adequate systems in place to support accurate diagnosis, psychotherapy, and follow-up.24,25 | B | Systematic review of randomized controlled clinical trials regarding treatment generalized to screening |
| Lithium, valproic acid (Depakote), and some antipsychotics are effective single agents for acute mania.12 | A | Meta-analysis of randomized studies |
| Effective combination therapies for acute mania include lithium or valproic acid with quetiapine (Seroquel) or risperidone (Risperdal).12 | A | Meta-analysis of randomized studies |
| Quetiapine and cariprazine (Vraylar) are effective single agents for the treatment of acute bipolar depression.12 | A | Meta-analysis of randomized studies |
| Lurasidone (Latuda) combined with lithium or valproic acid is an effective treatment for acute bipolar depression.12 | A | Meta-analysis of randomized studies |
| Lithium, quetiapine, or a combination of quetiapine and lithium or valproic acid is effective for maintenance of bipolar disorder.12 | A | Meta-analysis of randomized studies |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to
Categories and Types of Bipolar Disorders
| Disorder | Definitions |
|---|---|
| Bipolar I disorder | Manic or mixed feature episode with or without psychosis and/or major depression |
| Bipolar II disorder | Hypomanic episode with major depression; no history of mania, but can have a history of hypomania |
| Cyclothymia | Hypomanic and depressive symptoms that do not meet bipolar II disorder criteria, no major depressive episodes, occurring over two years, with no more than two months free of symptoms |
| Bipolar disorder, not otherwise specified | Does not meet... |