Defining and validating bipolar disorder in the preschool period
The strongest predictors of bipolar prodrome appear to be baseline anxiety/depression with proximal affective lability and full or subsyndromal manic symptoms, increasing the risk of bipolar prodrome from 2% (baseline risk due to family history) to 49%.An abnormal behavioral episode may be designated a bipolar disorder after the frequency and type of abnormal mood are considered.At least 1 true manic episode, with or without psychotic features, is the necessary and sufficient criterion for type I bipolar disorder (BPI).A depressive episode is insufficient for this diagnosis, even in the presence of a strong family history of bipolar disorder.Fourth, the mood disturbance is severe enough to cause marked social impairment in occupational functioning, social activities, or relationships with others.Hospitalization may be necessary to prevent harm to self or others or if psychotic features are present.A GWAS study in China differentiated patients with a good response and those with a poor response to lithium with a sensitivity of 93% and showed the strongest association with a response to lithium when the exons, exon-intron boundaries, and part of the promoter of the gene encoding glutamate decarboxylase-like protein 1 ( Go to Bipolar Affective Disorder for complete information on this topic.
Poor insight into one’s disorder or behaviors and poor judgment accompany mania.
Outcome studies show that compared with unipolar depression, bipolar disorder causes more work disability and overall poorer outcome 15 years after an index hospitalized manic episode even when mania is in remission for at least 1 year.
Randomized controlled trials of combination mood stabilizer treatment (more than one mood stabilizer such as atypicals lithium valproate) suggest this may improve outcome by increasing the time to relapse for any mood episode compared with monotherapy as maintenance therapy for Bipolar I.
Hypomania is somewhat similar to true mania but is less severe and less debilitating.
As such, it is defined as an elevated mood during which (1) no hospitalization has ever been necessary, and (2) no state of delusional or other psychotic thinking ever coincided with the elevated mood.Therefore, an episode may be reported as a bipolar disorder with a single manic episode, with recurrent manic episodes, or by the mood state of the most recent episode (eg, depressed, mixed, hypomanic, manic).