II. Epidemiology

  1. Bipolar Incidence: 1% of adults (United States)
  2. Gender predisposition: Men and women equally affected
  3. Age of onset: Early adulthood to mid-40s
  4. Affective disorder Family History confers risk
    1. One parent with affective disorder: 27%
    2. Two parents with affective disorder: 50-75%

III. Pathophysiology

  1. Related to noradrenergic system (Norepinephrine)

IV. Types

  1. Bipolar I Disorder
    1. Manic or mixed episode
    2. Psychosis may be present
    3. Major Depression may be present
  2. Bipolar II Disorder
    1. Recurrent Major Depression
    2. Hypomanic episodes that do not meet criteria for Mania Diagnosis
  3. Cyclothymic Disorder (Cyclothymia)
    1. Depressive symptoms that do not meet criteria for Major Depression
    2. Hypomanic episodes that do not meet criteria for Mania Diagnosis

V. History

  1. Impaired social functioning
    1. Multiple divorces
    2. Legal or financial problems
    3. Recurrent job loss
  2. Recurrent Major Depression
    1. Typically onset by age 13 years
    2. May present as Seasonal Affective Disorder
    3. Failed response to at least three Antidepressants
    4. Atypical Depression
    5. Hypersomnia
    6. Pathologic guilt
  3. Attempted Suicide
  4. Drug Abuse or Alcohol Abuse
  5. Manic symptoms
    1. Mania or Hypomania episodes
    2. Psychosis
    3. Agitation or mania caused by Antidepressant, Corticosteroid or other medication
  6. Family History
    1. Bipolar Disorder
    2. Multiple relatives with Major Depression or Anxiety Disorder
    3. Multiple relatives with Suicidality, incarceration, Drug Abuse or Alcohol Abuse

VI. Symptoms

  1. Maintains several days with reduced sleep and without feeling tired
  2. Frequent mood swings (or mood lability) or periods of intense goal orientation
  3. Racing thoughts interfere with sleep onset
  4. Sleep disruptions trigger mania or Hypomania
    1. Seasonal changes in spring and fall
    2. Jet Lag on time zone changes
    3. Shift work or child care
  5. Associated symptoms
    1. Irritability
    2. Impulsivity
    3. Irrationality

VII. Differential Diagnosis

  1. See Mania Secondary Causes
  2. Personality Disorder
  3. Recurrent Major Depression
  4. Schizophrenia
  5. Obsessive-Compulsive Disorder

VIII. Diagnosis

IX. Labs: Consider for evaluation of secondary causes

  1. Highest yield tests
    1. Thyroid Function Tests (Thyroid Stimulating Hormone)
    2. Serum or Urine Drug Screen
    3. Urinalysis
      1. Older patients to evaluate for Urinary Tract Infection
  2. Sexually Transmitted Diseases
    1. Syphilis Serology (e.g. RPR)
    2. HIV Test
    3. Hepatitis C
  3. Rare causes
    1. Heavy metal levels

X. Labs: Consider for baseline labs prior to starting medications

XI. Diagnostics: Consider if suggested by history or examination

XII. Management: General

  1. Continue mood stabilizers indefinately due to high relapse rate
  2. Consult psychiatry for comanagement
  3. Discuss Teratogenicity of medications with women of child bearing age
    1. Reliable Contraception is critical
  4. Do not use Antidepressants as monotherapy for mania, mixed disorder or Bipolar Disorder
    1. High risk of triggering manic episode
  5. Avoid medications that are more likely to trigger or exacerbate mania
    1. Avoid Trazodone
    2. Avoid Tricyclic Antidepressants
    3. Avoid SNRIs (e.g. Venlafaxine or Duloxetine)
  6. Employ behavioral management as a first line therapy
    1. Cognitive behavioral therapy
    2. Caregiver support
  7. Manage comorbidity
    1. Alcohol Abuse
    2. Tobacco abuse
    3. Drug Abuse
  8. Patients and their family should be aware of early warning signs of relapse
    1. Sleep disturbance
    2. Agitation
    3. Increased goal oriented activity
    4. Disrupted routine

XIII. Management: Acute

  1. Acute Mania
    1. Hospitalize due to high risk of self harm or Suicidality
    2. Therapy goals
      1. Adequate sleep
      2. Reduce psychotic symptoms
    3. Medication protocol
      1. Start mood stabilizer (see below)
        1. Lithium (preferred) or
        2. Valproate
      2. Start adjunctive therapy (see below)
        1. Indicated while mood stabilizer (esp. Lithium) reaches steady state over days
        2. Atypical Antipsychotic (e.g. Olanzapine, Quetiaprine) or Haloperidol
        3. Benzodiazepines (e.g. Lorazepam)
  2. Acute Hypomania
    1. Medication management is similar to acute mania
    2. Observe for major depressive episode immediately following acute Hypomania episode
    3. Assess for functional capacity
      1. Decision making
      2. Compliance with treatment
  3. Acute Major Depression
    1. Hospitalize for Suicidality or homicidal thoughts
    2. Psychotherapy
    3. First-line therapies
      1. Primary mood stabilizers are both effective for Major Depression
        1. Lithium (preferred)
        2. Valproate
      2. Other anticonvulsants effective for Major Depression
        1. Lamotrigine or Lamictal (preferred)
          1. Requires 6 weeks to titrate to level (due to Steven's Johnson Syndrome risk)
        2. Carbamazepine or Tegretol
        3. Topiramate
      3. Atypical Antipsychotics effective for Major Depression
        1. Quetiapine or Seroquel (preferred)
          1. Risk of weight gain, Glucose Intolerance, and Extrapyramidal Side Effects
        2. Olanzapine (Zyprexa)
    4. Second-line therapies
      1. Add only to first line agents if effect is incomplete
        1. Do not use standard Antidepressants without mood stabilizers
        2. These agents do not increase efficacy over mood stabilizers alone
        3. Avoid Tricyclic Antidepressants, Trazodone, or Venlafaxine which can trigger manic episodes
      2. Selective Serotonin Reuptake Inhibitors
      3. Bupropion
  4. Refractory Cases
    1. Consider switching mood stabilizer
    2. Consider combining 2-3 mood stabilizers
    3. Consider Electroconvulsive Therapy

XIV. Management: Mood Stabilizer Selection

  1. Mood stabilizer options
    1. First-line agents
      1. Lithium (preferred)
        1. Suicide is 3 fold less likely with Lithium than Valproate
        2. Starting dose may be up to 300 mg twice daily
        3. Titrate dose every 2-3 days as tolerated to effect and serum Lithium level of 0.6 to 1.5 mEq/L
        4. Target dose: 900 to 1800 mg orally daily
      2. Valproate
        1. Loading dose in acute mania: 15-20 mg/kg
        2. Starting dose without load: 500 to 750 mg/day in divided dosing
        3. Titrate every 2-3 days as tolerated to serum Valproic Acid level of 50 to 125 mcg/ml
        4. Target dose: 200 to 1600 mg daily
    2. Alternative mood stabilizers (consider for specific indications)
      1. Carbamazepine (Tegretol)
        1. Starting dose 200 mg twice daily
        2. Therapeutic range for biopolar: 4-12 mcg/ml
        3. Available as long acting agent (Equetro)
      2. Oxcarbazepine
        1. Consider instead of Carbamazepine
        2. Similar efficacy with fewer adverse effects
      3. Lamotrigine (Lamictal)
        1. Starting dose 25 mg daily
        2. Effective as mood stabilizer and Antidepressant
        3. No blood monitoring needed
        4. Rash develops in 10% of patients (Risk of Steven's Johnson)
          1. Requires slow titration over at least 6 weeks to effective dose
  2. Specific agent indications
    1. Classic mania or Hypomania (Euphoric mood)
      1. Lithium (preferred) or
      2. Valproate
    2. Mixed episode or rapid cycling
      1. Valproate (preferred) or
      2. Carbamazepine

XV. Management: Adjunctive Medications

  1. Adjunctive medications: Benzodiazepine
    1. Examples: Lorazepam, Clonazepam
    2. Indications for Benzodiazepine
      1. Mania or Hypomania with Insomnia or agitation
      2. Psychosis refractory to Antipsychotic
    3. Alternatives
      1. Consider Gabapentin for anxiety
  2. Adjunctive medications: Antipsychotics
    1. Precautions
      1. Monitor for Extrapyramidal Side Effects (e.g. Tardive Dyskinesia)
      2. Atypical Antipsychotic agents have specific lab monitoring guidelines
    2. Antipsychotic indications
      1. Psychosis
        1. Consider Electroconvulsive Therapy
      2. Mania with Insomnia or agitation
        1. Despite Benzodiazepine
      3. Acute mania episode
        1. Antipsychotic use may increase Lithium or Valproate efficacy
    3. Agents (low doses are often effective in mania)
      1. Risperidone (Risperdal) 2-4 mg per day
      2. Olanzapine 10-15 mg per day
      3. Quetiapine 400-800 mg per day
        1. Mood stabilizers have improved efficacy when used with Quetiapine
        2. Yatham (2009) Bipolar Disord 11(3):225-55 [PubMed] (or open in [QxMD Read])
  3. Adjunctive medications: Antidepressants
    1. See Acute Depression Management above
    2. First-line agents
      1. Mood Stabilizers (Lithium, Valproate)
    3. Second-line agents (used in combination with mood stabilizers)
      1. Atypical Antipsychotics
      2. Selective Seotonin Reuptake Inhibitors (SSRIs)
        1. Risk of precipitating mania (do not use as montherapy)
        2. Avoid Tricyclic Antidepressants, Trazodone, or Venlafaxine which can trigger manic episodes
    4. Other adjunctive measures
      1. Omega-3 Fatty Acid Supplements

Images: Related links to external sites (from Google)

Ontology: Depression, Bipolar (C0005587)

Definition (CSP) severe disorder characterized by one or more manic episodes; although diagnosis does not require a major depressive episode, virtually all cases eventually develop one.
Definition (NCI) The depressive stage of bipolar disorder.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001714
SnomedCT 191627008
English Bipolar disorder, depressed, MANIC DEPRESSIVE DISEASE, DEPRESSED PHASE, Bipolar affective disorder, depressed, BIPOLAR DISEASE, DEPRESSED, BIPOLAR DISORDER, DEPRESSED, CYCLOTHYMIC DISORDER, DEPRESSED, bipolar depression, Bipolar affective - now depres, Manic-depress.-now depressed, MANIC DEPRESSIVE DISEASE DEPRESSED PHASE, Bipolar depression, BIPOLAR DISORDER DEPRESSION, bipolar depression disorder, bipolar disorder depressed, depression bipolar disorder, depression bipolar, bipolar disorder depression, Bipolar affective disorder, current episode depression, Manic-depressive - now depressed, Bipolar affective disorder, current episode depression (disorder), Bipolar Depression, Depression, Bipolar
Dutch bipolaire depressie, depressieve bipolaire affectieve stoornis, Depressie, bipolaire
French Trouble affectif bipolaire, épisode dépressif, Dépression bipolaire
German bipolare affektive Stoerung, depressiv, bipolare Depression, Depression, bipolare
Italian Sindrome affettiva bipolare, episodio depressivo, Depressione bipolare
Portuguese Perturbação afectiva bipolar, deprimida, Depressão bipolar, Depressão Bipolar
Spanish Trastorno afectivo bipolar en fase depresiva, Depresión bipolar, Depresión Bipolar, Depresion Bipolar, maníaco depresivo - actualmente deprimido, trastorno afectivo bipolar, actualmente episodio depresivo (trastorno), trastorno afectivo bipolar, actualmente episodio depresivo, trastorno bipolar afectivo, actualmente episodio depresivo (trastorno), trastorno bipolar afectivo, actualmente episodio depresivo
Japanese 双極性感情障害、うつ病型, 双極性うつ病, ソウキョクセイカンジョウショウガイウツビョウガタ, ソウキョクセイウツビョウ
Czech deprese bipolární, Bipolární afektivní porucha, depresivní epizoda, Bipolární deprese
Hungarian Bipolaris affectiv zavar, depressziós, Bipolaris depresszió

Ontology: Cyclothymic Disorder (C0010598)

Definition (MSH) An affective disorder characterized by periods of depression and hypomania. These may be separated by periods of normal mood.
Definition (PSY) Affective disorder characterized by alternating and recurring periods of depression and elation, similar to manic depressive disorder but of a less severe nature.
Definition (CSP) chronic mood disturbance of at least 2 years' duration involving numerous hypomanic episodes separated by periods of depression or loss of pleasure or interest.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D003527
ICD9 301.13, 301.10, 301.1
ICD10 F34.0
SnomedCT 14697007, 191751008, 191754000, 286737005, 192383002, 191755004, 191752001, 76105009, 386798001, 268756002
DSM4 301.13
English Cyclothymia, Affective personality, Cyclothymic Disorder, Cyclothymic Disorders, Cyclothymic Personalities, Cyclothymic Personality, Disorder, Cyclothymic, Disorders, Cyclothymic, Personalities, Cyclothymic, Cyclothymic personality trait, Personality, Cyclothymic, Affective personality dis. NOS, Affective personality dis.unsp, Affective personality disorder NOS, Affective personality disorder, unspecified, Unspecified affective personality disorder, CYCLOTHYMIC DIS, cyclothymic disorder (diagnosis), affective personality disorder (diagnosis), affective personality disorder, cyclothymic disorder, cyclothymia, Disorder cyclothymic, Cyclothymic personality disorder, CYCLOTHYMIC DISORDER, Affectiv personality NOS, Affective personality disorder NOS (disorder), Unspecified affective personality disorder (disorder), Cyclothymic Disorder [Disease/Finding], affective personality, cyclothymia disorder, cyclothymic disorders, Affective personality disorder, Affective personality trait, Cyclothymic disorder, Cyclothymic personality, Unstable personality trait, Cycloid personality, Tends to be unstable in affect, Cyclothymia (disorder), Affective personality trait (finding), cycloid personality, cyclothymic personality, cyclothymic; disorder, cyclothymic; personality disorder, disorder; cyclothymic, affective; personality disorder, personality disorder; affective, personality disorder; cyclothymic, Cyclothymia [Ambiguous], Tends to be unstable in affect (finding)
Dutch affectieve persoonlijkheidsstoornis, cyclothymie, stoornis cyclothymisch, niet-gespecificeerde affectieve persoonlijkheidsstoornis, cycloïde persoonlijkheid, cyclothyme persoonlijkheidsstoornis, affectief; persoonlijkheidsstoornis, cyclothym; persoonlijkheidsstoornis, cyclothym; stoornis, persoonlijkheidsstoornis; affectief, persoonlijkheidsstoornis; cyclothym, stoornis; cyclothym, Cyclothymie, cyclothyme stoornis, Cyclothyme persoonlijkheid, Cyclothyme stoornis
French Trouble de personnalité affective, non précisé, Personnalité cycloïde, Troubles affectifs de la personnalité, Cyclothymie, Trouble cyclothymique, Personnalité cyclothymique
German affektive Persoenlichkeitsstoerung, zykloide Persoenlichkeit, zyklothyme Persoenlichkeitsstoerung, affektive Persoenlichkeitsstoerung, unspezifisch, Stoerung, zyklothym, Zyklothymia, zyklothyme Stoerung, Zyklothymie, Zyklothyme Persönlichkeit, Zyklothyme Störung
Italian Disturbo di personalità affettivo, Disturbo di personalità affettivo, non specificato, Personalità cicloide, Ciclotimia, Disturbo ciclotimico della personalità, Personalità ciclotimica, Disturbo ciclotimico
Portuguese Perturbação afectiva da personalidade, Personalidade ciclóide, Perturbação de personalidade ciclotímica, Ciclotimia, Perturbação afectiva da personalidade NE, Perturbação ciclotímica, Personalidade Ciclotímica, Transtorno Ciclotímico
Spanish Ciclotimia, Trastorno ciclotímico de la personalidad, Trastorno afectivo de la personalidad, Personalidad ciclotímica, Trastorno afectivo de la personalidad, no especificado, rasgo de personalidad afectiva, Cyclothymia, Tends to be unstable in affect, Cyclothymia [Ambiguous], Cyclothymic personality, Cyclothymic disorder, trastorno ciclotímico, trastorno cilotímico, característica de personalidad afectiva, característica de personalidad inestable, ciclotimia (trastorno), ciclotimia, rasgo afectivo de personalidad (hallazgo), rasgo afectivo de personalidad, rasgo de personalidad afectiva (hallazgo), rasgo de personalidad ciclotímica (hallazgo), rasgo de personalidad ciclotímica, trastorno afectivo de la personalidad no especificado (trastorno), trastorno afectivo de la personalidad no especificado, trastorno afectivo de la personalidad, SAI (trastorno), trastorno afectivo de la personalidad, SAI, Trastorno ciclotímico, Personalidad Ciclotímica, Trastorno Ciclotímico, Personalidad Ciclotimica, Trastorno Ciclotimico
Japanese 情動性人格異常, 気分循環性障害, 循環性人格, 情動性人格障害、詳細不明, 循環性人格障害, ジュンカンセイジンカク, キブンジュンカンセイショウガイ, ジュンカンキシツ, ジョウドウセイジンカクイジョウ, ジョウドウセイジンカクショウガイショウサイフメイ, ジュンカンセイジンカクショウガイ, 気分循環症, 循環気質障害, 循環性格, 循環気質, 循環病
Swedish Stämningsstörningar
Czech cyklotymní poruchy, Cyklotymie, Afektivní porucha osobnosti, blíže neurčená, Cyklotymní porucha osobnosti, Porucha cyklotymní, Afektivní porucha osobnosti, Cykloidní osobnost, Cyklotymní porucha
Finnish Mielialan aaltoiluhäiriö
Russian TSIKLOTIMICHESKAIA LICHNOST', TSIKLOTIMIIA, ЦИКЛОТИМИЧЕСКАЯ ЛИЧНОСТЬ, ЦИКЛОТИМИЯ
Korean 순환성 기분장애
Polish Zaburzenia cyklotymiczne, Osobowość cyklotymiczna
Hungarian Érzelmi élet eltérése, Cyclothymiás zavar, Cyclothymiás személyiség, Cyclothymiás személyiségzavar, Érzelmi élet eltérése, nem meghatározott, Cyclothymia, Cyclothym zavar

Ontology: Manic Disorder (C0024713)

Definition (CSP) manic episode of the major affective disorder bipolar depression; tendency to remission and recurrence and to swing to the major depressive episode.
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001714
ICD9 296.40
SnomedCT 68569003
DSM4 296.40
English Bipolar disorder, manic, Manic Disorders, MANIC DEPRESSIVE DISEASE, MANIC PHASE, Bipolar affective disorder, manic, bipolar depression manic phase, BIPOLAR DISEASE, MANIC, BIPOLAR DISORDER, MANIC, Bipolar I Disorder, Most Recent Episode Manic, Unspecified, CYCLOTHYMIC DISORDER, MANIC, Disorder, Manic, MANIC DISORDER, MANIC DEPRESSIVE DISEASE MANIC PHASE, Manic bipolar I disorder, NOS, MANIC DIS, bipolar disorder manic phase, Manic bipolar disorder, NOS, manic disorder, monopolar mania, bipolar I disorder, most recent episode, manic, bipolar I disorder, most recent episode, manic (diagnosis), BIPOLAR DISORDER MANIC UNSPECIFIED, Bipol I currnt manic NOS, bipolar disorder manic, manic disorders, Bipolar I disorder, most recent episode manic, Manic bipolar I disorder (disorder), Manic bipolar I disorder, disorder; bipolar, I, most recent episode, manic, disorder; manic, manic; disorder, Manic Bipolar Affective Disorder, Manic Disorder, Bipolar affective disorder, manic, unspecified degree
Dutch manische bipolaire affectieve stoornis, manische bipolaire affectieve stoornis, ernst niet-gespecificeerd, manisch; stoornis, stoornis; bipolair, I, meest recente episode, manisch, stoornis; manisch, Manische stoornis
French Trouble affectif bipolaire, épisode maniaque, degré non précisé, Trouble affectif bipolaire, épisode maniaque, Trouble maniaque
German bipolare affektive Stoerung, manisch, unspezifische Form, bipolare affektive Stoerung, manisch, Manische Störung
Italian Sindrome affettiva bipolare, episodio maniacale, Sindrome affettiva bipolare, episodio maniacale, grado non specificato, Disturbo maniacale
Portuguese Perturbação afectiva bipolar, maníaca, NE, Perturbação afectiva bipolar, maníaca, Transtorno Maníaco
Spanish Trastorno afectivo bipolar maniaco, Trastorno afectivo bipolar maniaco, grado no especificado, Trastorno Maníaco, Trastorno Maniaco, trastorno bipolar I maníaco (trastorno), trastorno bipolar I maníaco, trastorno bipolar I, episodio más reciente maníaco
Japanese 双極性感情障害、躁病型, ソウキョクセイカンジョウショウガイソウビョウガタ
Czech manická porucha, Bipolární afektivní porucha, manická epizoda, Bipolární afektivní porucha, manická epizoda, blíže neurčená závažnost
Hungarian Bipolaris affectiv zavar, mániás, nem meghatározott súlyosságú, Bipolaris affectiv zavar, mániás

Ontology: Bipolar II Disorder (C0236788)

Concepts Mental or Behavioral Dysfunction (T048)
ICD10 F31.81
SnomedCT 231497008, 83225003
DSM4 296.89
English Bipolar II Disorder, Bipolar II disorder, NOS, bipolar II disorder, bipolar II disorder (diagnosis), bipolar disorder ii, bipolar ii disorder, Bipolar II disorder, Bipolar II disorder (disorder), bipolar; disorder, II, disorder; bipolar, II
Italian Disturbo bipolare II
Japanese 双極2型障害, ソウキョク2ガタショウガイ
Spanish [X]Bipolar II disorder, Bipolar II disorder, trastorno bipolar II (trastorno), trastorno bipolar II, Trastorno bipolar II
Czech Bipolární porucha II
Hungarian Bipolaris II zavar
Dutch bipolair; stoornis, II, stoornis; bipolair, II, bipolaire II stoornis
Portuguese Perturbação bipolar II
French Trouble bipolaire II
German Bipolar-II-Stoerung

Ontology: Hypomania (C0241934)

Definition (NCI) A less severe form of mania characterized by elevated mood, hyperactivity, and grandiosity. In contrast to mania, these symptoms do not cause significant impairment of the individual's productivity at work, or social and family relationships.
Definition (PSY) Mild form of mania.
Concepts Mental or Behavioral Dysfunction (T048)
ICD10 F30.0 , F30.8
SnomedCT 192350009, 231496004, 154872008, 268750008
English HYPOMANIA, Hypomania, Hypomania (disorder), hypomania
Italian Ipomania
Japanese 軽躁, ケイソウ
Spanish Hypomania, hipomanía (trastorno), hipomanía, Hipomanía
Czech Hypománie
Korean 경조병
Hungarian Hypomania
Dutch Hypomanie, hypomanie
Portuguese Hipomania
French Hypomanie
German Hypomanie

Ontology: Manic (C0338831)

Definition (NCI) A disorder characterized by excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganization of behavior and elevation of mood.
Definition (NCI) Excitement of psychotic proportions manifested by mental and physical hyperactivity, disorganisation of behaviour and elevation of mood. (On-line Medical Dictionary)
Concepts Mental or Behavioral Dysfunction (T048)
MSH D001714
ICD10 F30.9
SnomedCT 231494001, 154872008, 268750008
English Manias, Manic State, Manic States, State, Manic, States, Manic, MANIA, Manic, Manic state, Mania NOS, manic state, manic, Mania (disorder), mania, Mania
French MANIE, Etat maniaque, Manie, État maniaque
Portuguese MANIA, Estado maníaco, Mania
Spanish MANIA, Estado maníaco, Mania, manía (trastorno), maníaco, manía, Manía
Dutch manische toestand, manie
German manischer Zustand, MANIE, Manie
Japanese ソウビョウ, ソウジョウタイ, 躁障害, 躁状態, 躁病, そう病, 躁狂, そう状態, 定型的躁状態, メーニア
Czech mánie, Manický stav, Mánie
Italian Mania, Stato maniacale
Hungarian Mania, Maniás állapot

Ontology: Bipolar I disorder (C0853193)

Concepts Mental or Behavioral Dysfunction (T048)
SnomedCT 371596008
Italian Disturbo bipolare I
Japanese 双極1型障害, ソウキョク1ガタショウガイ
Czech Bipolární porucha I
English bipolar i disorder, Bipolar I disorder, Bipolar I disorder (disorder), bipolar; disorder, I, disorder; bipolar, I
Hungarian Bipolaris I zavar
Dutch bipolair; stoornis, I, stoornis; bipolair, I, bipolaire I stoornis
Spanish trastorno bipolar I (trastorno), trastorno bipolar I, Trastorno bipolar I
Portuguese Perturbação bipolar I
French Trouble bipolaire I
German Bipolar-I-Stoerung

Ontology: Other and unspecified bipolar disorders (C1456309)

Concepts Mental or Behavioral Dysfunction (T048)
ICD9 296.8
English Other and unspecified bipolar disorders