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Bipolar Disorder: Manic, Depressive, and Mixed Episode Symptoms

Manic Episode (DSM-5 Criteria: ≥1 week or any duration if hospitalized)

  • Elevated, expansive, or irritable mood
  • Inflated self-esteem/grandiosity
  • Decreased need for sleep (feels rested after 3 hrs)
  • Pressured speech, flight of ideas, racing thoughts
  • Distractibility
  • Goal-directed activity increase (social, work, sexual)
  • Risky behavior (spending, sex, investments, reckless driving)
  • Psychotic features possible (mood-congruent)

Hypomanic Episode

Same symptoms but ≥4 days, no marked impairment, no psychosis, not hospitalized. Observable by others.

Major Depressive Episode (≥2 weeks)

  • Depressed mood or anhedonia
  • Weight/appetite change, sleep disturbance, psychomotor agitation/retardation
  • Fatigue, worthlessness/guilt, indecisiveness
  • Suicidal ideation/behavior

Mixed Features Specifier

Manic/hypomanic episode with ≥3 depressive symptoms (or vice versa). High suicide risk. Treatment complex — avoid antidepressants without mood stabilizer.

Diagnostic Types

  • Bipolar I: ≥1 manic episode
  • Bipolar II: ≥1 hypomanic + ≥1 major depressive (no mania)
  • Cyclothymia: 2+ years subthreshold hypomanic/depressive symptoms

Treatment Foundation

  • Mood stabilizers: lithium (gold standard), valproate, lamotrigine, carbamazepine
  • Atypical antipsychotics (quetiapine, lurasidone, cariprazine, olanzapine-fluoxetine)
  • Antidepressants only with mood stabilizer
  • Psychotherapy (CBT, FFT, IPSRT), regular rhythm, substance avoidance

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