Bipolar and Related Disorders
Bipolar I Disorder
ICD-10-CM: F31.9
1. Criteria
DSM Criteria
Criterion A
- A manic episode is a distinct period of abnormally and persistently elevated, expansive, or irritable mood together with abnormally and persistently increased activity or energy.
- The episode lasts at least 1 week and is present most of the day, nearly every day, unless hospitalization is required sooner.
DSM Criteria
Criterion B
- During the period of mood disturbance and increased energy or activity, 3 or more of the following symptoms are present to a significant degree, or 4 if the mood is only irritable:
DSM Criteria
Criterion B symptom list
- Inflated self-esteem or grandiosity.
- Decreased need for sleep, such as feeling rested after only a few hours.
- More talkative than usual or pressure to keep talking.
- Flight of ideas or the subjective experience that thoughts are racing.
- Distractibility, meaning attention is too easily drawn to unimportant or irrelevant external stimuli.
- Increase in goal-directed activity socially, at work or school, sexually, or psychomotor agitation.
- Excessive involvement in activities that have a high potential for painful consequences, such as spending sprees, sexual indiscretions, or reckless business investments.
DSM Criteria
Criterion C
- The episode is severe enough to cause marked impairment in social or occupational functioning, require hospitalization to prevent harm, or include psychotic features.
DSM Criteria
Criterion D
- The episode is not attributable to substances or another medical condition.
- If mania emerges during antidepressant treatment but persists beyond the physiologic effect of treatment, it counts as a manic episode.
2. Context
- Bipolar I disorder is defined by mania. Many patients spend more time depressed than manic, but a single true manic episode changes the diagnostic frame and has major implications for risk, treatment, and long-term planning.
- Defining feature: A full manic episode is enough for the diagnosis, even if the person has never had a major depressive episode.
- High-risk points: The highest-stakes questions are usually about psychosis, impulsivity, suicidality, spending, sexual risk, agitation, and how fast functioning is falling apart.
- Treatment lens: Treatment decisions usually make the most sense when you anchor them to polarity: acute mania, bipolar depression, or maintenance after stabilization.
- Clinical focus: Standard clinician-rated tool for manic symptom severity.
3. Validated scales
YMRS
Standard clinician-rated tool for manic symptom severity.
CGI-BP
Quick global severity and improvement tracking across polarity states.
MADRS
Often paired with bipolar depression monitoring.
Altman Self-Rating Mania Scale
Brief self-report check for manic symptoms between visits.
4. FDA approved treatments
Acute mania or mixed episodes
FDA-indicated options commonly used for manic or mixed states; some are also used in maintenance after stabilization.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
Bipolar depression
FDA-indicated medications specifically tied to bipolar depressive episodes in bipolar I disorder or bipolar depression labeling.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
Maintenance treatment
Maintenance choices are used to reduce recurrence risk after acute stabilization and should be individualized by polarity pattern.
Common treatment side effects
Check drugs.com/sfx for common side effects. Direct side-effect links for the medications in this section are below when available.
Common off-label medications
Interventional psychiatry modalities
- ECT is used in severe mania, psychotic mood episodes, and refractory bipolar depression.
- Ketamine is being studied and used selectively for bipolar depression in specialty settings.
- TMS is under study and used off-label in some bipolar depression programs.
Related Guides
5. Top management articles
- The CANMAT and ISBD guidelines for the management of patients with bipolar disorder Bipolar Disorders, 2018 update lineage
- Treatment of bipolar disorder The Lancet, 2013
- Maintenance treatment in bipolar disorder: what do guidelines recommend? Review literature
When to seek professional help
- Seek urgent help if there are thoughts of suicide, self-harm, or feeling unable to stay safe.3
- Seek urgent help if there are thoughts of harming someone else, escalating violent urges, or loss of behavioral control.3
- Take hopelessness seriously, especially if the person feels trapped, cannot imagine staying safe, or is withdrawing from support.4
- Use emergency services if there is immediate danger, severe agitation, psychosis, intoxication, or inability to care for basic needs. In the United States, call or text 988 for crisis support and call 911 for immediate danger. Use emergency services in your region if you are outside the U.S.3