What are the symptoms of bipolar disorder?

Symptoms of Bipolar Disorder

Bipolar disorder is characterized by cyclical mood episodes that include marked euphoria, grandiosity, and irritability during manic phases, and psychomotor retardation, hypersomnia, and often psychotic symptoms during depressive phases. 1

Manic Episode Symptoms

• Mood changes: Marked euphoria, grandiosity, and irritability 1
• Cognitive symptoms: Racing thoughts, flight of ideas, and poor judgment 2
• Behavioral symptoms: Increased psychomotor activity, motor hyperactivity, aggressiveness, and possibly hostility 2
• Sleep disturbance: Reduced need for sleep, which is a hallmark sign 1, 2
• Speech patterns: Pressure of speech 2
• Mood lability: Rapid and extreme mood shifts 1
• Psychotic features: Paranoia, confusion, and/or florid psychosis may be present 1

Depressive Episode Symptoms

• Motor symptoms: Psychomotor retardation (slowed movement and thinking) 1
• Sleep disturbance: Hypersomnia (excessive sleeping) 1
• Suicidality: Significant suicide attempts are common 1
• Psychotic features: Often present during depressive episodes 1
• Severe presentations: May progress to catatonia in severe cases 1

Presentation Differences by Age

In Adults

• Episodes represent a significant departure from baseline functioning 1
• Cyclical nature with distinct episodes 1
• More classic presentation with clearer episode boundaries 1

In Adolescents

• Frequently associated with psychotic symptoms 1
• Markedly labile moods 1
• Mixed manic and depressive features are common 1
• More chronic and refractory to treatment than adult-onset cases 1

In Children

• Changes in mood, energy levels, and behavior are often markedly labile and erratic rather than persistent 1
• Irritability, belligerence, and mixed manic-depressive features are more common than euphoria 1
• High rates of comorbid disruptive disorders 1
• May present with chronic baseline mania in some cases 1
• Rapid cycling is common, with some children experiencing multiple cycles per day (ultradian cycling) 1

Types of Bipolar Episodes

• Manic episode: Lasting at least 7 days (unless hospitalization is required) 1
• Hypomanic episode: Milder elevation lasting at least 4 days 1
• Mixed episode: Period lasting 7+ days with symptoms of both manic and depressive episodes 1
• Rapid cycling: Four or more mood episodes in one year 1
• Ultrarapid cycling: 5-364 cycles per year 1
• Ultradian cycling: More than 365 cycles per year (multiple daily cycles) 1

Warning Signs and Risk Factors

• Premorbid anxiety and dysphoria are common 1
• Approximately 20% of youths with major depression go on to experience manic episodes by adulthood 1
• Risk factors for developing mania in depressed patients include:
  • Depressive episodes with rapid onset, psychomotor retardation, and psychotic features 1
  • Family history of affective disorders, especially bipolar disorder 1
  • History of mania or hypomania after treatment with antidepressants 1

Common Diagnostic Challenges

• Bipolar depression is often misdiagnosed as unipolar depression 3
• Early-onset depression, frequent depressive episodes, family history of serious mental illness, and hypomania/mania symptoms within depressive episodes suggest bipolar disorder 3
• Irritability is especially common during mixed states or rapid cycling 4
• Substance use may simulate mood changes in bipolar disorder 4
• Early diagnosis is challenging as onset is commonly characterized by nonspecific symptoms or mood lability 5

Clinical Course

• Depressive periods are typically more common and lengthier than manic or hypomanic states 4
• Depressive symptoms are the main cause of disability in bipolar disorder 4
• Without treatment, manic episodes typically last 1-3 weeks before normalizing 2
• With appropriate treatment, normalization of manic symptoms may occur within 1-3 weeks 2

Understanding these varied presentations is crucial for early diagnosis and appropriate treatment to reduce morbidity, mortality, and improve quality of life for individuals with bipolar disorder.