Bipolar Disorder: latest advances

Bipolar Disorder: latest advances

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Addressing Bipolar Disorder is a task that might seem simple, however, for all the nuances that it entails, it requires a previous introduction. There is a popular saying that starting the house on the roof is not a good idea, so in this case, we will start from the foundations. The latest data point to the existence of seven types of bipolar disorders, so it will be important to handle certain terminology before entering the subject.

Bipolar disorder is included in the so-called mood disorders. Its main features are around mood swings and the durability of these changes, which in psychology is known as an "episode." If we dig a little deeper, the DSM-V (2013) defines episode as the "Specific period of time - with a beginning and an end - in which certain symptoms appear - specifically, mood alterations".

In the case of bipolar disorder, the distinction between different types of episode is important. So, we found four: major depressive, manic, hypomanic and mixed. But why is it so important to start addressing these concepts? Because bipolar disorder is characterized by the presence of such episodes and mood swings.

A note before starting: DSM-V and ICD-10

To address this issue, different types of specialized bibliography have been used. However, there have been two reference books. The first of them the DSM-V. This is the latest edition of the "Diagnostic and Statistical Manual of Mental Disorders"prepared by the American Psychiatric Association.

The second of these is the ICD-10 classification. In this case it is prepared by WHO and is the "Tenth revision of the international classification of diseases. Mental and behavioral disorders. Clinical description and diagnostic guidelines. "Due to their importance in the classification of disorders and diseases, the latest versions of these two manuals have been used to a greater extent for this article.


  • 1 Major Depressive Episode
  • 2 Manic Episode
  • 3 Hypomanic episode
  • 4 Mixed Episode
  • 5 Bipolar Disorder
  • 6 Etiology
  • 7 Evaluation
  • 8 Treatment

Major Depressive Episode

For at least two weeks, the individual must present at least five of the following symptoms almost daily (one of the symptoms must be 1 or 2 necessarily):

  1. Depressed mood
  2. Marked decrease in interest or capacity for pleasure in all or almost all activities.
  3. Significant weight loss or gain.
  4. Insomnia or hypersomnia.
  5. Agitation or psychomotor slowdown.
  6. Tiredness or loss of energy.
  7. Feelings of excessive or inappropriate uselessness or guilt.
  8. Decreased ability to think or focus as well as indecision.
  9. Recurring thoughts of death. Suicidal ideation.

These types of symptoms interfere with the daily behavior of the sufferer. They are not due to the effects of any substance or disease. Nor are they due to a duel.

Manic Episode

For at least one week the individual must present a differentiated episode of an abnormal and elevated, expanded or irritable mood. As well as an abnormal and persistent increase in activity or energy directed at a target. If hospitalization is required, the time may be less than one week. During this period three or more of the following symptoms persist (four if the mood is only irritable):

  1. Exaggerated self-esteem or greatness.
  2. Disminution of necesity of sleep.
  3. More talkative than usual.
  4. Leakage of ideas or subjective experience that thoughts go at great speed.
  5. Ease of distraction.
  6. Increased activity aimed at an objective or psychomotor agitation
  7. Excessive involvement in pleasant activities that have a high potential to produce serious consequences.

This type of alteration causes labor and social deterioration. The symptoms are not associated with the effects of any substance or medical illness.

Hypomanic episode

Mood is abnormal, elevated, expansive or irritable for at least four consecutive days. It has the same symptoms as the manic episode, however, it is shorter and not as severe. It does not require hospitalization. In this case it does not prevent work or social functioning. The symptoms are not due to the effects of any substance or disease. If there are psychotic characteristics, it would be a manic episode.

Mixed Episode

For at least a week, almost every day meets the criteria for both a manic episode and a major depressive episode (except in duration). Gravity affects the labor and social sphere. The symptoms are not due to the effects of any substance or disease. The person can experience on the same day moods that alternate quickly accompanied by symptoms of manic and depressive episode: agitation, insomnia, suicidal ideation, sadness ...

Bipolar disorder

Once these concepts have been introduced, we are able to understand more deeply the different types of bipolar disorders and related disorders. What types of bipolar disorder exist? Let's get in full!

Type I Bipolar Disorder

Type I bipolar disorder with the most recent hypomanic episode

  • The current or most recent episode is the hypomanic.
  • Previous existence of at least one manic episode.
  • The symptoms cause a noticeable deterioration in the life of the individual.
  • It is not better explained by another psychotic disorder.

Type I bipolar disorder with more recent manic episode

  • The current or most recent episode is a hypomanic episode.
  • Previous existence of at least one major depressive episode or a manic episode.
  • It is not better explained by another psychotic disorder.

Type I bipolar disorder with the most recent depressive episode

  • The current or most recent episode is a major depressive episode.
  • Previous existence of at least one manic episode.
  • It is not better explained by another psychotic disorder.

Type I bipolar disorder with more recent episode not specified

  • The current or most recent episode meets the criteria - except for the duration - of a major depressive episode, manic or hypomanic episode.
  • Previous existence of at least one manic episode.
  • It is not better explained by another psychotic disorder.

Type II bipolar disorder

  • Presence or history of one or more major depressive episodes or presence or history of a hypomanic episode.
  • There has never been a manic episode.
  • The symptoms can cause a significant deterioration in the life of the individual.
  • It is not better explained by another psychotic disorder.

In this disorder it is possible to specify whether the most recent episode is hypomanic or depressive. In all diagnoses, the most recent episode will be important and depending on the disorder.

You may be interested: Bipolar disorder, symptoms, causes and diagnostic errors

Cyclothymic disorder

Cyclothymic disorder has the following characteristics:

  • For at least two years there have been several episodes with hypomanic symptoms that do not meet the criteria for a complete hypomanic episode and numerous periods with depressive symptoms that do not meet the criteria for a major depression episode.
  • During the two-year period, both depressive and hypomanic periods have been present at least half of the time and the individual has had no symptoms for more than two months in a row.
  • The criteria for an episode of major, manic or hypomanic depression have never been met.
  • Hypomanic symptoms are not explained by any disorder of the spectrum of schizophrenia or other specified or unspecified psychotic disorders.
  • The symptoms are not derived from any substance or medical cause.
  • These symptoms cause clinically significant discomfort or social, occupational or other important areas deterioration.
  • Manic and hypomanic symptoms can be caused by substances such as cocaine, amphetamines, alcohol, L-dopa, phencyclidine, etc.
  • The existence of anxiety must be specified.

Bipolar disorder and related substance-induced disorder

  • There is an important and lasting alteration of the mood in which it appears elevated, expansive or irritable. With or without depressed mood or notable decrease in interest or pleasure in all or almost all activities.
  • There is evidence from the medical history, physical examination or laboratory analysis of two factors. The first of these are that the previously described symptoms have manifested during or shortly after the intoxication or withdrawal of a substance. The second factor is that the substance can produce the symptoms described.
  • The disorder is not best explained by a bipolar disorder or a related disorder not induced by substances.
  • It does not occur only during the syndrome of a confusional disorder.
  • It causes significant discomfort at social, labor and in different areas.
  • It must be specified if the onset took place during intoxication or withdrawal.

Bipolar disorder and related disorder due to another medical condition

  • There is an important and lasting period of abnormally elevated, expansive or irritable mood and an abnormal increase in activity or energy.
  • There is evidence that the disorder is the direct pathophysiological consequence of another medical condition.
  • The disorder is not best explained by another mental disorder.
  • The disorder does not occur only during the course of a confusional syndrome.
  • It causes clinically significant discomfort and deterioration in the social, labor and other areas of operation. Hospitalization may be necessary so that the individual does not injure himself or others.
  • It should be specified if there are manic characteristics, if there is a mixed or hypomanic type episode or mixed characteristics occur.

Bipolar disorder and related related disorder

  • Short-lived hypomanic episodes - two or three days - and major depression episodes.
  • Presence of hypomanic episodes with insufficient symptoms and episodes of major depression.
  • Hypomanic episodes without previous episode of major depression.
  • Short duration cyclothymia (less than 24 months).

Bipolar disorder and related disorder not specified

Manic, hypomanic symptoms (with or without depressive symptoms) appear that do not meet the criteria required for the diagnosis of bipolar and related disorders. However, on this occasion, the professional does not specify the cause of the breach.


The etiology of this disorder is still unknown.. Different investigations shed light, but today there is no general agreement. Some authors claim that it is due to biochemical imbalance at the brain level. In this sense, depressive symptoms are usually associated with a norepinephrine deficit, and maniacs with an excess of dopamine. However, researchers such as Jones and Bentall (2006), point out that these data are based more on the efficacy of medications than on checks at the brain level.

Other types of theories also add importance to environmental, psychological, emotional, family and social factors. Even so, it is a disorder under investigation and it is not yet possible to offer a specific cause.


For this task, the evaluation proposed by Sevillá and Pastor (2009) will be presented, since it fully includes the different aspects to be taken into account.

  1. First, they are obtained clinical and psychopathological data:
  • History and evolution of the disorder. At what time it appeared and what circumstances went down. Presence or not of subsequent episodes.
  • They should describe how the episodes went. How are depressive, hypomanic, manic or mixed episodes in cognitive, behavioral and emotional terms.
  • Collect the possible triggers of the episodes: both environmental, biological or emotional.
  • Ask about the coping strategies that the subject has carried out.
  • Psychological vulnerability.
  • Presence or not of family history.

2. Pharmacotherapy:

  • Pick up if there is current pharmacological treatment, as well as its effectiveness and the side effects they may present.
  • History of drug treatment.
  • Relationship between the doctor and the health system.

3. Lifestyle:

  • Current occupation.
  • Family. Relationship with family, social and couple.
  • Existence or not of social support.
  • Presence or not of reinforcement.
  • Sleep pattern.

4. Consumption or not of substances (specify if there is substance abuse).

5. Level of stress management and daily anxiety.

6. Other type of psychological problems.

7. Type of motivation and expectations regarding psychological treatmentor.


The treatment for bipolar disorder is primarily pharmacological and cognitive behavioral. Specifically, the efficacy of three types of drugs has been proven: antipsychotics, antidepressants and mood stabilizers.

As stated by Caballo, Salazar and Carrobles (2014), within the mood stabilizers we find: lithium, valproic acid, carmabacepin, lamotrigine. They are usually lifelong treatments. Antipsychotics aim to control the manic and hypomanic phases. The duration of treatment is temporary. Antidepressants are used for the purpose of controlling depressive phases. The protagonists are usually selective serotonin reuptake inhibitors.

At the therapeutic level, cognitive behavioral therapy has been shown to be the most efficient for this type of disorder. Thus, a pharmacological combination with psychological therapy will be important support for the patient. In this way, you will increase your quality of life so that you can function as normally as possible.


  • Caballo, V., Salazar, I. and Carrobles, J. (2014). Manual of psychopathology and psychological disorders. Madrid: Pyramid Editions.
  • American Psychiatric Association (2013). DSM-V Diagnostic and statistical manual of mental disorders. Pan American Medical Editorial.
  • Jones, S., Tai, S., Evershed, K., Knowles, R. and Bentall, R. (2006). Early detection of bipolar disorder: a pilot familial high-risk study of parents with bipolar disorder and their adolescent children. Bipolar Disoder, 8 (4), 362-372.
  • WHO. (1992). ICD-10. Tenth revision of the international classification of diseases. Mental and behavioral disorders. Clinical description and diagnostic guidelines. Madrid: Ed. Méditor.
  • Sevillá, J. and Pastor, C. (2009). Cognitive behavioral therapy for bipolar disorder. A practical manual for the therapist. Valencia: Publications of the Center for Behavior Therapy.
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