Diagnosis and Treatment of Bipolar I Disorder

Diagnostic Criteria

• The American Psychiatric Association recommends that a manic episode be diagnosed based on a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 7 days, with symptoms including decreased need for sleep, increased energy, and increased goal-directed activity 1, 2
• A first-degree relative with bipolar disorder increases the risk 4-6 fold, making this diagnosis highly probable given the family history 1

Treatment Recommendations

• The American Academy of Child and Adolescent Psychiatry recommends pharmacotherapy as the primary treatment for acute mania in well-defined Bipolar I Disorder, with first-line agents including lithium, valproate, and atypical antipsychotics 3
• Lithium reduces suicide attempts 8.6-fold and completed suicides 9-fold, and is expected to normalize symptoms within 1-3 weeks 4

Monitoring and Follow-Up

• The American Psychiatric Association recommends scheduling follow-up within 1-2 weeks to assess medication response, side effects, and adherence, and to assess suicidality at every visit 1, 4
• Annual physical health monitoring is recommended to screen for metabolic syndrome, weight gain, lipid abnormalities, diabetes, smoking, and cardiovascular risk factors 4