Bipolar I Disorder
This patient has Bipolar I disorder, which is diagnosed based on the occurrence of at least one manic episode, with no requirement for depressive episodes to ever occur. 1, 2
Diagnostic Criteria
The American Academy of Child and Adolescent Psychiatry explicitly states that Bipolar I disorder requires the occurrence of a manic (or mixed) episode with duration of at least 7 days, unless hospitalization is required, and episodes of depression are not required for the diagnosis. 1
- Most patients with Bipolar I disorder will experience major or minor depressive episodes during their lifespan, but this is not a diagnostic requirement. 1, 2
- The key distinguishing feature is the presence of at least one full manic episode lasting ≥7 days or requiring hospitalization. 2
- The episodes must represent a significant departure from the individual's baseline functioning. 1, 2
Why This Is Not Bipolar II
Bipolar II disorder specifically requires both major depressive episodes AND hypomanic episodes (lasting ≥4 days), with no history of full manic or mixed episodes. 2 Since this patient has experienced full manic episodes requiring hospitalization, Bipolar II is excluded by definition.
Clinical Context
- The recurrent hospitalizations for manic episodes confirm the severity and episodic nature of the illness, which is consistent with the classic adult presentation of Bipolar I disorder. 3
- The absence of depressive episodes does not change the diagnosis or suggest an atypical presentation—it simply reflects the natural heterogeneity of Bipolar I disorder. 1, 2
- Approximately 75% of symptomatic time in bipolar disorder typically consists of depressive episodes, but some patients predominantly or exclusively experience manic episodes. 4
Important Diagnostic Pitfall
Do not wait for a depressive episode to occur before making the diagnosis of Bipolar I disorder. The presence of recurrent manic episodes alone is sufficient and definitive for this diagnosis. 1, 2