1. Bipolar Disorder

2. Hallmark of Bipolar Disorder Defined by manic symptoms – Elevated, expansive or irritable mood (or any combination of these moods) plus (at least 3 or at least 4 if the mood is irritability) Decreased need for sleep, racing thoughts, rapid speech, inflated self-esteem (grandiosity), impulsive reckless behavior, increased energy and activity, distractability

3. Mania versus Hypomania Symptoms of mania must last at least one week or be interrupted by emergency treatment or hospitalization Hypomania lasts for at least 4 days and results in a distinct change in functioning but not impairment. Manic and depressive episodes can occur simultaneously in a mixed episode – A mixed episode must last at least one week and patients must fulfill criteria for a major depressive episode and a manic episode At least 40% of bipolar patients have a mixed episode at some point in their illness

4. Bipolar Subtypes Bipolar I: Presence of a single manic or mixed episode that is not substance induced (no depression required). – Unipolar mania rates are between 25%-33% in community samples but ~10% in clinical samples; – Most patients eventually have depressive episodes Bipolar II – Major depressive episodes alternating with hypomanic episodes – 1 in 10 bipolar II patients eventually develops a full manic or mixed episode over a 10 year follow-up period (converting to a bipolar I).

5. Cyclothymia Two or more years of alterations between hypomania and depressive symptoms but the alterations fall short of the meeting full criteria

6. Epidemiology Approximately 4% of the population has bipolar I or II disorder Cyclothymia affects 4.2 % of the general population Major depressive illness is four times more prevalent than bipolar disorder Approximately 1% of high school students met criteria for bipolar I or bipolar II

7. Age of Onset Median age of onset for bipolar disoder is 25 years old Based on the National Comorbidity Survey replication, 25% of patients had onset by age 17 Earlier age of onset is associated with rapid cyclying

8. Sociodemographic Characteristics Women and men have relatively equal rates of bipolar I disorder; Women are more likely to have bipolar II disorder Women are more likely to experience rapid cycling

9. Risk for Suicide Suicide in bipolar disorder is at least 15 times higher than in the general population and four times higher than major depression Approximately 50% of patients with bipolar disoder attempt suicide during their lifetime; 15%-20% die by suicide

10. Diathesis/Personality/Stress: Bipolar Depression Diathesis Heritability ranges from 59% - 87% Concordance for MZ twins is 57% Females more at risk than males (for bipolar II) Family history of bipolar disorders or unipolar disorders Increase focus on neurotransmitter systems  Monoamine Dysreg  Overactive Norepinephrine  Excess in Dopamine Personality  Hyperactive  Impulsive  Sensation Seeking (in response to threats)  Neuroticism  More sensitive to rewards (e.g. goal attainments) Stressor  Negative life events  Low social support  High expressed emotion (criticism, hostility, emotional overinvolvment)  Sleep deprivation (for mania)