Bipolar disorder is classified as a mood disorder under the DSM-IV, and it is clinically manifested by episodes of both mania and depression. Estimates place the lifetime prevalence of this disorder at approximately 1-5%, and the age of onset is typically during adolescence or early adulthood[1]. Unlike the high and low mood states generally exhibited by unaffected individuals, episodes of depression and mania are severe enough to impede the ability to function in a social context, and are not necessarily preceded by a specific environmental stressor. It is commonly treated with mood stabilizers such as lithium, which has been used to treat bipolar disorder for over 50 years[2].

The poor prognosis of bipolar disorder places emphasis on the need to review the current literature and address the barriers in improving the illness burden. Approximately 20% of bipolar patients commit suicide[3]. Transitioning from a classification of the symptomatology to its management remains a challenge, and the heterogeneity of bipolar disorder may pose difficulties at the diagnostic level. Relapse remains high, and even with treatment, the susceptibility for suicide is 5 times higher for bipolar individuals[1] Developing effective treatment strategies will likely require both reconciling the diverse symptoms with reliable diagnostic tests, and research initiatives on the etiology of this disorder.


Clinical Characteristics
  • 1. Signs and Symptoms (Saumya Valookaran)
    • 1.1 Mania
    • 1.2 Depression
    • 1.3 Circadian Dysregulation
    • 1.4 Symptom Variability
      • 1.4.1 Symptoms in children
      • 1.4.2 Symptoms in males and females
  • 2. Diagnosis (Anouska Dias)
    • 2.1 Subtypes
    • 2.2 Questionnaires
    • 2.3 Difficulties
  • 3. Treatment (Dalya Jalil)
    • 3.1 Pharmacological treatment
      • 3.1.1 Lithium
      • 3.1.2 Anticonvulsants
      • 3.1.3 Antipsychotics
      • 3.1.4 Antidepressants
    • 3.2 Electroconvulsive therapy (ECT)
    • 3.3 Cognitive-Behavioural Therapy
    • 3.4 Physical treatment/ new research
      • 3.4.1 Repetitive transcranial magnetic stimulation (rTMS)
      • 3.4.2 Vagus nerve stimulation (VNS)

Etiology
  • 4. Pathophysiology (Janine Cajanding)
    • 4.1 Structural and functional abnormalities
      • 4.1.1 Prefrontal cortex
      • 4.1.2 Limbic system
    • 4.2 Mitochondrial dysfunction hypothesis
      • 4.2.1 Altered energy metabolism
      • 4.2.2 Oxidative stress
    • 4.3 Current limitations and future directions
  • 5. Genetics (Marzia Niamah Hussain)
    • 5.1 Genetic Overlap
      • 5.1.1 Family/Twin Studies
      • 5.1.2 Shared genetics with other mental disorders
    • 5.2 Candidate Gene Association Studies
      • 5.2.1 Receptors, Transporters, Channels
    • 5.3 Genome Wide Association Studies


References:
  1. ^ Emilien, G., Septien, L., Brisard, C., Corruble, E. & Bourin, M. Bipolar disorder: how far are we from a rigorous definition and effective management? Prog. Neuropsychopharmacol. Biol. Psych. 31, 975-996 (2007).
  2. ^ Belmaker, R.H. Bipolar disorder. N. Engl. J. Med. 351, 476-486 (2004).
  3. ^ Bauer, M. & Pfennig, A. Epidemiology of bipolar disorders. Epilepsia 46, 8-13 (2005).