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Bipolar I disorder is a sub-type of bipolar disorder – a severe mental illness, previously called manic-depressive psychosis. It is characterised by periods of altered mood, which may be manic, depressive or mixed (i.e., alternating rapidly between mania and depression). These intense moods often lead to problems with daily functioning, ruined personal relationships and suicide attempts. The first manic episode, necessary for making a diagnosis of bipolar I disorder, is frequently preceded by one or more depressive episodes.
No single cause has been identified for bipolar disorder, but biological, psychological and social factors are all thought to contribute, leading to chemical changes in the brain.
People with bipolar I disorder may experience unusually intense emotional states that occur in distinct periods known as ‘episodes’.
An excessively joyful or overexcited state is called a manic episode and is associated with increased energy and activity. It is a defining feature of bipolar I disorder.1 Symptoms include inflated self-esteem and flights of ideas, decreased need for sleep, excessive talking, and a tendency for impulsive and reckless behaviour.
The manic episodes may alternate with prolonged episodes of depression, during which there is a lowering of mood and decreased energy and activity. There may also be ‘mixed’ episodes, when both mania and depression occur on the same day, with the person cycling rapidly between the two states.
Bipolar disorder affects more than 30 million people worldwide, and is among the top 20 leading causes of disability.2 Up to 2% of Europeans will have a bipolar disorder at some point in their life, of which approximately half will develop bipolar I disorder.3,4
Bipolar I disorder is equally common in men and women, and affects people from all social and ethnic backgrounds.3 The risk of developing a bipolar disorder is highest in young adults, with at least half of all cases starting before the age of 25.5
People with bipolar I disorder are at particular risk of developing other illnesses at the same time (so-called ‘co-morbidity’). The recent World Health Organisation ‘World Mental Health Survey Initiative’3 found that two thirds of people with a bipolar disorder also suffered from anxiety disorders, and over a third had a substance use disorder. Despite these serious effects, less than half of people with bipolar disorders receive treatment for their condition.3
Diagnosis and care
There is no cure for bipolar I disorder, but with effective treatment most people can gain better control of their mood swings and related symptoms.
A doctor diagnoses bipolar disorder by asking the patient to describe their symptom patterns. Treatment for bipolar I disorder must effectively treat both manic and depressive episodes, as well as mixed mood and rapidly cycling states. It is also important to prevent the episodes from recurring. Treatment for bipolar I disorder usually includes the use of medications together with psychosocial interventions such as cognitive therapy.
Bipolar I disorder is a serious mental illness, and professional help to address the condition is essential.
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, DSM-IV-TR.Washington,DC: 2000.
2. World Health Organisation. The global burden of disease. 2004 update. www.who.int/healthinfo/global_burden_disease/2004_report_update/en/index.html. Accessed 06/09/11.
3. Merikangas KR, Jin R, He JP, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011; 68 (3): 241–251.
4. Pini S, de Queiroz V, Pagnin D, et al. Prevalence and burden of bipolar disorders in European countries. Eur Neuropsychopharmacol 2005; 15 (4): 425–434.
5. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Co-morbidity Survey Replication. Arch Gen Psychiatry 2005; 62 (6): 593–602.
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