What are the signs and symptoms of Bipolar Disorder 1?

Signs and Symptoms of Bipolar Disorder 1

Bipolar Disorder 1 is characterized by distinct episodes of mania and depression, with at least one manic episode required for diagnosis, often causing marked impairment in social or occupational functioning and potentially requiring hospitalization. 1

Manic Episode Symptoms

Manic episodes in Bipolar I Disorder present with the following symptoms:

• Core symptoms:

  • Elevated, expansive, or irritable mood
  • Abnormally increased energy or activity
  • Decreased need for sleep
  • Racing thoughts
  • Pressured speech
  • Grandiosity
  • Increased goal-directed activity
  • Excessive involvement in pleasurable activities with high potential for painful consequences

• Duration requirement: At least 1 week (or any duration if hospitalization is required)

• Severity: Symptoms cause marked impairment in social or occupational functioning 1

• Psychotic features: May include delusions or hallucinations, especially in adolescents 1

Atypical Presentations of Mania

• In younger patients, mania often presents with:
  • More irritability and belligerence rather than euphoria
  • More labile and erratic mood changes
  • Mixed manic-depressive features 1, 2
  • Severe agitation and disorganization 2

Depressive Episode Symptoms

Depressive episodes in Bipolar I Disorder include:

• Fatigue and low energy
• Persistent sad or low mood
• Loss of interest or pleasure
• Changes in appetite or weight
• Sleep disturbances
• Psychomotor agitation or retardation
• Feelings of worthlessness or excessive guilt
• Difficulty concentrating
• Recurrent thoughts of death or suicide 1, 3

Cycling Patterns

Bipolar I Disorder can present with various cycling patterns:

• Rapid cycling: At least 4 distinct mood episodes in 12 months
• Ultra-rapid cycling: Mood cycles as short as 4 hours
• Ultradian cycling: Multiple cycles per day (average 3.7 cycles per day in some pediatric cases) 1

Important Clinical Considerations

• Approximately 75% of symptomatic time in bipolar disorder consists of depressive episodes or symptoms 1, 3
• Depression is the most frequent initial presentation, often leading to misdiagnosis 3
• Age of onset is typically between 15-25 years 3
• Diagnosis is often delayed by approximately 9 years following initial episode 1, 3

Comorbidities and Complications

• High rates of comorbid conditions, especially ADHD and disruptive behavior disorders 1
• Increased rates of anxiety and substance abuse compared to unipolar depression 1
• Life expectancy reduced by 12-14 years 1, 3
• 1.6-2 fold increased risk of cardiovascular mortality 1, 3
• Annual suicide rate approximately 0.9% (compared to 0.014% in general population) 3
• 15-20% of people with bipolar disorder die by suicide 3

Diagnostic Pitfalls

• Failure to screen for past hypomanic episodes in patients presenting with depression 1
• Misdiagnosis of bipolar disorder as schizophrenia in adolescents with psychotic features 1
• Late-onset bipolar disorder may be confused with neurological disorders in elderly patients 4

Key Differences from Bipolar II Disorder

Bipolar II Disorder requires:

• At least one hypomanic episode (less severe than mania)
• At least one depressive episode
• No history of manic episodes 1

Hypomania differs from mania in that it:

• Does not cause marked impairment in functioning
• Does not require hospitalization
• Has no psychotic features 1

Understanding these comprehensive signs and symptoms is crucial for early diagnosis and treatment, which are associated with more favorable outcomes and reduced mortality and morbidity 3.