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Bipolar I Disorder

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D., edited by Kathryn Patricelli, MA

lonely pathimage by Mukesh Soni (lic)This form of bipolar disorder occurs when a patient has experienced at least one complete full manic episode. The person may have also experienced hypomanic or major depressive episodes before or after the full manic episode.

For mania to be diagnosed, the episode must last for at least one week and be present most of the day, nearly every day. A variety of symptoms are possible during this episode. At least three of the following symptoms need to be present before the diagnosis can be made:

  • an inflated, expansive, grandiose (and possibly delusional) sense of self
  • decreased need for sleep (for example, feeling fully rested after 3 hours of sleep)
  • more talkative than usual or pressure to keep talking
  • the person feels a sensation of racing thoughts (often called a "flight of ideas")
  • distractibility (for example, the person's attention is too easily drawn to unimportant or irrelevant stimuli). This can be reported by the person or observed by others around them
  • an increase in goal-directed activity (purposeful behavior that occurs either socially, at work or school, or sexually), or physical agitation
  • excessive involvement in activities that have a high potential for painful consequences (for example, going on a buying spree, unprotected sex, gambling, poor business investments, etc.)

Additional criteria for mania to be diagnosed include that the mood disturbances:

  • are severe enough to cause a lot of stress or problems with school, work, relationships with others, or daily activities.
  • do not happen because of a medication or substance that was taken, or because of another medical condition that the person has.

One mood episode is said to have occurred when a person shifts from one mood state into another and then back again. Most individuals with bipolar I disorder will shift repeatedly throughout their lives (moving from a depressed state into a manic state, or vice versa and then back again). Multiple months may be spent moving between states, however. Typically, each individual develops a personal pattern of episode timing to their disorder. They will tend to have manic episodes followed by depressive episodes in a characteristic pattern that is unique to them.

Suicide risk is a major concern for Bipolar I Disordered patients. Those with bipolar disorder are 15 times higher than in the general population. Suicidal behavior is most likely to occur during depressive or mixed feature states. During a manic phase, patients may participate in violent behavior, including behavior that would qualify as child and/or spouse abuse, but the risk of intentional suicide is less likely. Substance abuse issues, eating disorders attention-deficit/hyperactivity disorder (ADHD), and anxiety disorders (including panic attacks, social anxiety disorder and specific phobias) may occur with bipolar I disorder.

Both males and females diagnosed with bipolar I disorder tend to experience their first manic, hypomanic, or major depressive episodes around age 18. About 60% of manic episodes occur immediately before a major depressive episode. More than 90% of people who have a single manic episode will go on to have additional mood episodes.

Females with bipolar I disorder are more likely to experience rapid cycle and mixed states. They are also more likely than male patients to have depressive symptoms, and have a higher risk of alcohol use disorder.

Lifetime prevalence rates for Bipolar I Disorder in U.S. samples were 0.6% and ranged from 0.0-0.6% in studies across 11 countries.