bipolar

Bipolar disorder is classified into Bipolar I (at least one manic episode lasting ≥7 days or requiring hospitalization, often with psychotic features, may or may not include depressive episodes) and Bipolar II (at least one hypomanic episode ≥4 days plus at least one major depressive episode, without full mania). Mania is characterized by DIG FAST criteria: Distractibility, Impulsivity/Irresponsibility, Grandiosity, Flight of ideas, Activity increase, Sleep decreased need, Talkativeness/pressured speech—symptoms must cause marked impairment in functioning or require hospitalization, and last ≥1 week (or any duration if hospitalization needed). Hypomania has similar symptoms but is less severe (no marked impairment, no psychosis, no hospitalization, lasting ≥4 days). Cyclothymic disorder involves numerous periods of hypomanic and depressive symptoms not meeting full criteria, lasting ≥2 years. Etiology involves genetic predisposition (high concordance in monozygotic twins), neurotransmitter dysregulation (dopamine, norepinephrine, serotonin), and circadian rhythm disturbances. Treatment: mood stabilizers are first-line—lithium (also reduces suicide risk; monitor renal/thyroid function, teratogenic—Ebstein anomaly), valproate (hepatotoxicity, teratogenic—neural tube defects), lamotrigine (Stevens-Johnson syndrome risk), and atypical antipsychotics (quetiapine, olanzapine, risperidone) for acute mania or as adjuncts. Antidepressants alone are avoided due to risk of triggering mania. Differential diagnosis includes substance-induced mood disorder, borderline personality disorder, ADHD, and schizoaffective disorder. Increased risk of suicide, especially during depressive or mixed episodes.