Bipolar I Disorder
Bipolar I disorder is diagnosed after at least one manic episode: a distinct period of abnormally elevated, expansive or irritable mood and increased energy that causes a major change from usual functioning.
Understanding mania
A manic episode lasts at least one week for most of the day nearly every day, or for any duration when hospital care is required. It may involve much less need for sleep, pressured speech, racing thoughts, inflated self-confidence, distractibility, increased activity or high-risk decisions.
Mania is not always experienced as happiness; it may be predominantly irritable, anxious or disorganised. Severe impairment, psychosis or the need for hospital care distinguishes mania from hypomania. A major depressive episode is common but is not required for the diagnosis of bipolar I disorder.
Assessment and differential diagnosis
- A clinician establishes the timing, severity and functional impact of mood and energy changes, including information from someone who knows the person when possible.
- Substances, prescribed medicines, thyroid or neurological conditions and other psychotic or mood disorders must be considered.
- Suicide risk is assessed during depressive, manic and mixed presentations, not only when a person appears visibly low.
Treatment and long-term stability
Acute mania requires prompt psychiatric treatment and may require hospital care. Long-term treatment commonly combines mood-stabilising or antipsychotic medication with psychoeducation, a regular sleep pattern, recognition of early warning signs and a relapse plan.
Structured psychological and family interventions can support relationships, functioning and treatment continuity. Medication should not be stopped abruptly, and antidepressants should not be used without specialist consideration of bipolar risk. Physical health monitoring is part of safe care.
When urgent help is needed
Seek immediate assessment when the need for sleep falls sharply, activity or spending escalates, behaviour becomes dangerous, psychosis appears or the person cannot care safely for themselves. Current suicidal intent, violence or several nights with almost no sleep and loss of control is an emergency.