Bipolar disorder

Bipolar disorder is characterised by alternating manic and depressive episodes1 , generally separated by “normal” periods lasting several months or years.

Episodes of mania are characterised by elation, euphoria and hyperactivity accompanied by insomnia, grandiose ideas, and loss of social inhibitions (sexual, in particular).
Depressive episodes are often severe, with significant risk of suicide.
Search family history of similar symptoms (particularly suicide), very frequent in bipolar patients.

– Episodes of mania are treated with risperidone PO starting at a low dose (2 mg once daily), increase if necessary in steps of 1 mg daily (max. 6 mg daily) or haloperidol PO (5 to 15 mg daily) for 3 to 6 weeks.
– Diazepam PO (5 mg daily) can be added during the first weeks.
– At the end of antipsychotic treatment, medication should be stopped gradually, monitoring for possible relapse. Continue treatment if necessary. 
– Depressive episodes are treated as depression (see Depression).

– If the patient has an episode of mania while on antidepressants, immediately stop antidepressants and treat the episode of mania as above. An episode of mania while on antidepressants is indicative of bipolar disorder.

The primary treatment for bipolar disorder is a long-term mood stabiliser. It is recommended to contact a specialist to set up this type of long-term treatment.

Ref Notes
1 “Unipolar forms” are characterized by recurring episodes of depression.