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Essentials of Diagnosis
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Episodic mood shifts into mania, major depression, hypomania, and mixed states
Bipolar I is diagnosed in individuals who have manic episodes
Bipolar II is diagnosed in individuals who experience hypomanic episodes without frank mania
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General Considerations
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Manic episodes
Mood ranging from euphoria to irritability
Over-involvement in life activities
Flight of ideas with distractibility
Sleep disruption, little need for sleep
Racing thoughts
Behaviors may initially attract others
Irritability, mood lability, aggression, and grandiosity usually lead to problems in relationships
Excessive spending, resignation from a job, hasty marriage or divorce, sexual acting out, or exhibitionism may occur
Atypical episodes involve gross delusions, paranoid ideations, and auditory hallucinations
Patients with four or more discrete episodes of a mood disturbance in 1 year have "rapid cycling"
Most depressions
Lowered mood, varying from mild sadness to intense feelings of guilt, worthlessness, and hopelessness
Difficulty in thinking, including inability to concentrate, ruminations, and lack of decisiveness
Loss of interest, with diminished involvement in work and recreation
Somatic complaints such as
Anxiety
Some severe depressions
Psychomotor retardation or agitation
Delusions of a hypochondriacal or persecutory nature
Withdrawal from activities
Physical symptoms of major severity, eg,
Suicidal ideation
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Differential Diagnosis
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Schizophrenia and other psychotic disorders
Intoxication with stimulants
Major depressive episode
Hypothyroidism
Persistent depressive disorder (dysthymia)
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Mania
Olanzapine (2.5–10 mg intramuscularly) or haloperidol (5–10 mg orally or intramuscularly) if behavioral control is immediately necessary; may be repeated as needed until symptoms subside
Olanzapine (5–20 mg orally), risperidone (2–3 mg orally), or aripiprazole (15–30 mg), in conjunction with a benzodiazepine if indicated, to treat acute manic symptoms
Clonazepam (1–2 mg orally every 4–6 hours; up to 16 mg/day) may be used instead of or in conjunction with a neuroleptic to control acute manic symptoms
Lithium (started at 300 mg orally two or three times daily; 1200–1800 mg orally ...