Bipolar disorder

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<h1 id="firstHeading" lang="en">Bipolar disorder</h1>

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<div>"Manic depression" redirects here. For other uses, see <a href="http://en.wikipedia.org/wiki/Manic_depression_(disambiguation)" title="Manic depression (disambiguation)">Manic depression (disambiguation)</a>.</div>

<div>"Bipolar disorders" redirects here. For the medical journal, see <a href="http://en.wikipedia.org/wiki/Bipolar_Disorders_(journal)" title="Bipolar Disorders (journal)">Bipolar Disorders (journal)</a>.</div>

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Bipolar disorder, also known as bipolar affective disorder (and originally called manic-depressive illness), is a <a href="http://en.wikipedia.org/wiki/Mental_disorder" title="Mental disorder">mental disorder</a> characterized by periods of elevated mood and <a href="http://en.wikipedia.org/wiki/Major_depressive_episode" title="Major depressive episode">periods of depression</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-DSM5-2">[2]</a> The elevated mood is significant and is known as <a href="http://en.wikipedia.org/wiki/Mania" title="Mania">mania</a> or <a href="http://en.wikipedia.org/wiki/Hypomania" title="Hypomania">hypomania</a> depending on the severity or whether there is psychosis. During mania an individual feels or acts abnormally happy, energetic, or irritable.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a> They often make poorly thought out decisions with little regard to the consequences. The need for sleep is usually reduced.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-DSM5-2">[2]</a> During periods of depression there may be crying, poor eye contact with others, and a negative outlook on life.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a> The risk of <a href="http://en.wikipedia.org/wiki/Suicide" title="Suicide">suicide</a> among those with the disorder is high at greater than 6% over 20 years, while <a href="http://en.wikipedia.org/wiki/Self_harm" title="Self harm">self harm</a> occurs in 30–40%.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a> Other mental health issues such as <a href="http://en.wikipedia.org/wiki/Anxiety_disorder" title="Anxiety disorder">anxiety disorder</a> and <a href="http://en.wikipedia.org/wiki/Drug_misuse" title="Drug misuse">drug misuse</a> are commonly associated.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a>

The cause is not clearly understood, but both genetic and environmental factors play a role.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a> Many genes of small effect contribute to risk.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-3">[3]</a> Environmental factors include long term <a href="http://en.wikipedia.org/wiki/Stress_(psychological)" title="Stress (psychological)">stress</a> and a history of <a href="http://en.wikipedia.org/wiki/Childhood_abuse" title="Childhood abuse">childhood abuse</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a> It is divided into <a href="http://en.wikipedia.org/wiki/Bipolar_I_disorder" title="Bipolar I disorder">bipolar I disorder</a> if there is at least one manic episode and <a href="http://en.wikipedia.org/wiki/Bipolar_II_disorder" title="Bipolar II disorder">bipolar II disorder</a> if there are at least one hypomanic episode and one major depressive episode. In those with less severe symptoms of a prolonged duration the condition <a href="http://en.wikipedia.org/wiki/Cyclothymic_disorder" title="Cyclothymic disorder">cyclothymic disorder</a> may be present. If due to drugs or medical problems it is classified separately.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-DSM5-2">[2]</a> Other conditions that may present in a similar manner include drug misuse, <a href="http://en.wikipedia.org/wiki/Personality_disorder" title="Personality disorder">personality disorders</a>, <a href="http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">attention deficit hyperactivity disorder</a>, and <a href="http://en.wikipedia.org/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a> as well as a number of medical conditions.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a>

Treatment commonly includes <a href="http://en.wikipedia.org/wiki/Psychotherapy" title="Psychotherapy">psychotherapy</a> and medications such as <a href="http://en.wikipedia.org/wiki/Mood_stabilizer" title="Mood stabilizer">mood stabilizers</a> or <a href="http://en.wikipedia.org/wiki/Antipsychotic" title="Antipsychotic">antipsychotics</a>. Examples of mood stabilizers that are commonly used include <a href="http://en.wikipedia.org/wiki/Lithium_(medication)" title="Lithium (medication)">lithium</a> and <a href="http://en.wikipedia.org/wiki/Anticonvulsant" title="Anticonvulsant">anticonvulsants</a>. Treatment in hospital against a person's wishes may be required at times as people may be at risk to themselves or others yet refuse treatment. Severe behavioural problems may be managed with short term <a href="http://en.wikipedia.org/wiki/Benzodiazepine" title="Benzodiazepine">benzodiazepines</a> or antipsychotics. In periods of mania it is recommended that<a href="http://en.wikipedia.org/wiki/Antidepressant" title="Antidepressant">antidepressants</a> be stopped. If antidepressants are used for periods of depression they should be used with a mood stabilizer. <a href="http://en.wikipedia.org/wiki/Electroconvulsive_therapy" title="Electroconvulsive therapy">Electroconvulsive therapy</a> may be helpful in those who do not respond to other treatments. If treatments are stopped it is recommended that this be done slowly. Most people have social, financial or work related problem due to the disorder. These difficulties occur a quarter to a third of the time on average. The risk of death from <a href="http://en.wikipedia.org/wiki/Natural_causes" title="Natural causes">natural causes</a> such as heart disease is twice that of the general population. This is due to poor lifestyle choices and the side effects from medications.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a>

About 3% of people in the United States have bipolar disorder at some point in their life.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Schmitt2014-4">[4]</a> Lower rates of around 1% are found in other countries. The most common age at which symptoms begin is 25.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a> Rates appear to be similar in males as females.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-5">[5]</a> The economic costs of the disorder has been estimated at $45 billion for the United States in 1991.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Hirs205-6">[6]</a> A large proportion of this was related to a higher number of missed work days estimated at 50 per year.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Hirs205-6">[6]</a> People with bipolar disorder often face problems with <a href="http://en.wikipedia.org/wiki/Social_stigma" title="Social stigma">social stigma</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BMJ2012-1">[1]</a>

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<h2>Contents</h2>

[<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#" id="togglelink">hide</a>] </div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Signs_and_symptoms">1 Signs and symptoms</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Manic_episodes">1.1 Manic episodes</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Hypomanic_episodes">1.2 Hypomanic episodes</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Depressive_episodes">1.3 Depressive episodes</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Mixed_affective_episodes">1.4 Mixed affective episodes</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Associated_features">1.5 Associated features</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Comorbid_conditions">1.6 Comorbid conditions</a></li>

</ul>

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<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Causes">2 Causes</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Genetic">2.1 Genetic</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Physiological">2.2 Physiological</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Environmental">2.3 Environmental</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Neurological">2.4 Neurological</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Neuroendocrinological">2.5 Neuroendocrinological</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Evolutionary">2.6 Evolutionary</a></li>

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<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Prevention">3 Prevention</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Diagnosis">4 Diagnosis</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Bipolar_spectrum">4.1 Bipolar spectrum</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Criteria_and_subtypes">4.2 Criteria and subtypes</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Differential_diagnosis">4.3 Differential diagnosis</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Management">5 Management</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Psychosocial">5.1 Psychosocial</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Medication">5.2 Medication</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Alternative_medicine">5.3 Alternative medicine</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Prognosis">6 Prognosis</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Functioning">6.1 Functioning</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Recovery_and_recurrence">6.2 Recovery and recurrence</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Suicide">6.3 Suicide</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Epidemiology">7 Epidemiology</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#History">8 History</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Society_and_culture">9 Society and culture</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Specific_populations">10 Specific populations</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Children">10.1 Children</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Elderly">10.2 Elderly</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Notes">12 Notes</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#References">13 References</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#Further_reading">14 Further reading</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#External_links">15 External links</a></li>

</ul>

</div>

<h2>Signs and symptoms</h2>

<a href="http://en.wikipedia.org/wiki/Mania" title="Mania">Mania</a> is the defining feature of bipolar disorder,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a> and can occur with different levels of severity. With milder levels of mania, known as <a href="http://en.wikipedia.org/wiki/Hypomania" title="Hypomania">hypomania</a>, individuals appear energetic, excitable, and may be highly productive.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> As mania worsens, individuals begin to exhibit erratic and impulsive behavior, often making poor decisions due to unrealistic ideas about the future, and sleep very little.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> At the most severe level, manic individuals can experience very distorted beliefs about the world known as <a href="http://en.wikipedia.org/wiki/Psychosis" title="Psychosis">psychosis</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> A depressive episode commonly follows an episode of mania.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> The biological mechanisms responsible for switching from a manic or hypomanic episode to a depressive episode or vice versa remain poorly understood.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Salvadore2010-9">[9]</a>

<h3>Manic episodes</h3>

Mania is a distinct period of at least one week of elevated or irritable <a href="http://en.wikipedia.org/wiki/Mood_(psychology)" title="Mood (psychology)">mood</a>, which can take the form of euphoria, and exhibit three or more of the following behaviors (four if irritable): <a href="http://en.wikipedia.org/wiki/Pressured_speech" title="Pressured speech">speak in a rapid, uninterruptible manner</a>, are easily distracted, have <a href="http://en.wikipedia.org/wiki/Racing_thoughts" title="Racing thoughts">racing thoughts</a>, display an increase in goal-oriented activities or feel agitated, or exhibit behaviors characterized as impulsive or high-risk such as<a href="http://en.wikipedia.org/wiki/Hypersexuality" title="Hypersexuality">hypersexuality</a> or excessive money spending.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a> To meet the definition for a manic episode, these behaviors must impair the individual's ability to socialize or work.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> If untreated, a manic episode usually lasts three to six months.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-10">[10]</a>

People with mania may also experience a decreased need for sleep, speak excessively in addition to speaking rapidly, and may have impaired judgment.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Tarr2011-11">[11]</a> Manic individuals often have issues with substance abuse due to a combination of thrill-seeking and poor judgment.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Post2013-12">[12]</a> At more extreme levels, a person in a manic state can experience <a href="http://en.wikipedia.org/wiki/Psychosis" title="Psychosis">psychosis</a>, or a break with reality, a state in which thinking is affected along with mood.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> They may feel out of control or unstoppable, or as if they have been "chosen" and are on a special mission, or have other grandiose or delusional ideas.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Knowles2011-13">[13]</a> Approximately 50% of those with bipolar disorder experience delusions or hallucinations.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Kerner2014-14">[14]</a> This may lead to violent behaviors and hospitalization in an inpatient <a href="http://en.wikipedia.org/wiki/Psychiatric_hospital" title="Psychiatric hospital">psychiatric hospital</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Tarr2011-11">[11]</a> The severity of manic symptoms can be measured by rating scales such as the <a href="http://en.wikipedia.org/wiki/Young_Mania_Rating_Scale" title="Young Mania Rating Scale">Young Mania Rating Scale</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Tarr2011-11">[11]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-15">[15]</a>

The onset of a manic (or depressive) episode is often foreshadowed by <a href="http://en.wikipedia.org/wiki/Sleep_disorder" title="Sleep disorder">sleep disturbances</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-McKenna2012-16">[16]</a> Mood changes, <a href="http://en.wikipedia.org/wiki/Psychomotor_agitation" title="Psychomotor agitation">psychomotor</a> and appetite changes, and an increase in anxiety can also occur up to three weeks before a manic episode develops.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Mansell2008-17">[17]</a>

<h3>Hypomanic episodes</h3>

<a href="http://en.wikipedia.org/wiki/Hypomania" title="Hypomania">Hypomania</a> is a milder form of mania defined as at least four days of the same criteria as mania,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> but does not cause a significant decrease in the individual's ability to socialize or work, lacks psychotic features (i.e., <a href="http://en.wikipedia.org/wiki/Delusions" title="Delusions">delusions</a> or hallucinations), and does not require psychiatric hospitalization.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a> Overall functioning may actually increase during episodes of hypomania and is thought to serve as a defense mechanism against depression.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bowins2013-18">[18]</a> Hypomanic episodes rarely progress to true manic episodes.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bowins2013-18">[18]</a> Some hypomanic people show increased creativity<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> while others are irritable or demonstrate poor judgment. Hypomanic people generally have increased energy and increased activity levels.

Hypomania may feel good to the person who experiences it.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Beentjes2012-8">[8]</a> Thus, even when family and friends recognize mood swings, the individual will often deny that anything is wrong.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-19">[19]</a> What might be called a "hypomanic event", if not accompanied by depressive episodes, is often not deemed as problematic, unless the mood changes are uncontrollable, volatile or mercurial.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bowins2013-18">[18]</a> Most commonly, symptoms continue for a few weeks to a few months.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-20">[20]</a>

<h3>Depressive episodes</h3>

Signs and symptoms of the <a href="http://en.wikipedia.org/wiki/Major_depressive_episode" title="Major depressive episode">depressive phase</a> of bipolar disorder include persistent feelings of <a href="http://en.wikipedia.org/wiki/Sadness" title="Sadness">sadness</a>, anxiety, <a href="http://en.wikipedia.org/wiki/Guilt_(emotion)" title="Guilt (emotion)">guilt</a>, <a href="http://en.wikipedia.org/wiki/Anger" title="Anger">anger</a>, <a href="http://en.wikipedia.org/wiki/Solitude" title="Solitude">isolation</a>, or <a href="http://en.wikipedia.org/wiki/Hopelessness" title="Hopelessness">hopelessness</a>;<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Muneer2013-21">[21]</a> disturbances in sleep and appetite; fatigue and loss of interest in usually enjoyable activities; problems concentrating; loneliness, self-loathing, apathy or indifference; <a href="http://en.wikipedia.org/wiki/Depersonalization" title="Depersonalization">depersonalization</a>; loss of interest in sexual activity; shyness or <a href="http://en.wikipedia.org/wiki/Social_anxiety" title="Social anxiety">social anxiety</a>; irritability, chronic pain (with or without a known cause); lack of motivation; and morbid suicidal thoughts.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Muneer2013-21">[21]</a> In severe cases, the individual may become <a href="http://en.wikipedia.org/wiki/Psychotic" title="Psychotic">psychotic</a>, a condition also known as severe bipolar depression with psychotic features. These symptoms include <a href="http://en.wikipedia.org/wiki/Delusion" title="Delusion">delusions</a> or, less commonly, <a href="http://en.wikipedia.org/wiki/Hallucination" title="Hallucination">hallucinations</a>, which are usually unpleasant. A major depressive episode persists for at least two weeks, and may continue for over six months if left untreated.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-22">[22]</a>

The earlier the age of onset, the more likely the first few episodes are to be depressive.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bowden-23">[23]</a> Because a bipolar diagnosis requires a manic or hypomanic episode, many patients are initially diagnosed and treated as having <a href="http://en.wikipedia.org/wiki/Major_depressive_disorder" title="Major depressive disorder">major depression</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Muzina2007-24">[24]</a>

<h3>Mixed affective episodes</h3>

In the context of bipolar disorder, a <a href="http://en.wikipedia.org/wiki/Mixed_state_(psychiatry)" title="Mixed state (psychiatry)">mixed state</a> is a condition during which symptoms of both mania and depression occur at the same time.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Swann2013-25">[25]</a> Individuals experiencing a mixed state may have manic symptoms such as grandiose thoughts while at the same time experiencing depressive symptoms such as excessive guilt or feeling suicidal.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Swann2013-25">[25]</a> Mixed states are considered to be high-risk for suicidal behavior since depressive emotions such as hopelessness are often paired with <a href="http://en.wikipedia.org/wiki/Emotional_lability" title="Emotional lability">mood swings</a> or <a href="http://en.wikipedia.org/wiki/Impulsivity" title="Impulsivity">difficulties with impulse control</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Swann2013-25">[25]</a> <a href="http://en.wikipedia.org/wiki/Anxiety_disorder" title="Anxiety disorder">Anxiety disorder</a> occurs more frequently as a comorbidity in mixed bipolar episodes than in non mixed bipolar depression or mania.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Swann2013-25">[25]</a> Substance abuse (including alcohol) also follows this trend.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Swann2013-25">[25]</a>

<h3>Associated features</h3>

<div>Main article: <a href="http://en.wikipedia.org/wiki/Associated_features_of_bipolar_disorder" title="Associated features of bipolar disorder">Associated features of bipolar disorder</a></div>

Associated features are clinical phenomena that often accompany the disorder but are not part of the diagnostic criteria. In adults with the condition, bipolar disorder is often accompanied by changes in<a href="http://en.wikipedia.org/wiki/Cognition" title="Cognition">cognitive</a> processes and abilities. These include reduced <a href="http://en.wikipedia.org/wiki/Attention" title="Attention">attentional</a> and <a href="http://en.wikipedia.org/wiki/Executive_functions" title="Executive functions">executive</a> capabilities and impaired <a href="http://en.wikipedia.org/wiki/Memory" title="Memory">memory</a>. How the individual processes the world also depends on the phase of the disorder, with differential characteristics between the manic, hypomanic and depressive states.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Mansell2008-17">[17]</a> Some studies have found a significant association between bipolar disorder and <a href="http://en.wikipedia.org/wiki/Creativity" title="Creativity">creativity</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid20936438-26">[26]</a> Those with bipolar disorder may have difficulty in maintaining relationships.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEGoodwinJamison2007338-27">[27]</a> There are several common childhood precursors seen in children who later receive a diagnosis of bipolar disorder; these disorders include mood abnormalities, full major depressive episodes, and <a href="http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">attention deficit hyperactivity disorder</a> (ADHD).<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Reinhardt2013-28">[28]</a>

<h3>Comorbid conditions</h3>

The diagnosis of bipolar disorder can be complicated by coexisting (comorbid) psychiatric conditions including the following: <a href="http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder" title="Obsessive-compulsive disorder">obsessive-compulsive disorder</a>, <a href="http://en.wikipedia.org/wiki/Substance_abuse" title="Substance abuse">substance abuse</a>, <a href="http://en.wikipedia.org/wiki/Eating_disorder" title="Eating disorder">eating disorders</a>, attention deficit hyperactivity disorder, <a href="http://en.wikipedia.org/wiki/Social_anxiety_disorder" title="Social anxiety disorder">social phobia</a>, <a href="http://en.wikipedia.org/wiki/Premenstrual_syndrome" title="Premenstrual syndrome">premenstrual syndrome</a> (including <a href="http://en.wikipedia.org/wiki/Premenstrual_dysphoric_disorder" title="Premenstrual dysphoric disorder">premenstrual dysphoric disorder</a>), or <a href="http://en.wikipedia.org/wiki/Panic_disorder" title="Panic disorder">panic disorder</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Post2013-12">[12]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Kerner2014-14">[14]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Muneer2013-21">[21]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Cirillo2012-29">[29]</a> A careful longitudinal analysis of symptoms and episodes, enriched if possible by discussions with friends and family members, is crucial to establishing a treatment plan where these comorbidities exist.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-30">[30]</a>

<h2>Causes</h2>

The causes of bipolar disorder likely vary between individuals and the exact mechanism underlying the disorder remains unclear.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Nierenberg2013-31">[31]</a> Genetic influences are believed to account for 60–80% of the risk of developing the disorder indicating a strong hereditary component.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Kerner2014-14">[14]</a> The overall <a href="http://en.wikipedia.org/wiki/Heritability" title="Heritability">heritability</a> of the bipolar spectrum has been estimated at 0.71.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Edvardsen2008-32">[32]</a> <a href="http://en.wikipedia.org/wiki/Twin_studies" title="Twin studies">Twin studies</a> have been limited by relatively small sample sizes but have indicated a substantial genetic contribution, as well as environmental influence. For bipolar disorder type I, the (probandwise) <a href="http://en.wikipedia.org/wiki/Concordance_(genetics)" title="Concordance (genetics)">concordance</a> rates in modern studies have been consistently estimated at around 40% in <a href="http://en.wikipedia.org/wiki/Monozygotic" title="Monozygotic">identical</a> twins (same genes), compared to about 5% in <a href="http://en.wikipedia.org/wiki/Dizygotic" title="Dizygotic">fraternal</a> twins.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Kieseppa_2004-33">[33]</a> A combination of bipolar I, II and <a href="http://en.wikipedia.org/wiki/Cyclothymia" title="Cyclothymia">cyclothymia</a> produced concordance rates of 42% vs 11%, with a relatively lower ratio for bipolar II that likely reflects <a href="http://en.wikipedia.org/wiki/Homogeneity_and_heterogeneity" title="Homogeneity and heterogeneity">heterogeneity</a>. There is overlap with <a href="http://en.wikipedia.org/wiki/Unipolar_depression" title="Unipolar depression">unipolar depression</a> and if this is also counted in the co-twin the concordance with bipolar disorder rises to 67% in monozygotic twins and 19% in dizygotic.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-34">[34]</a> The relatively low concordance between dizygotic twins brought up together suggests that shared family environmental effects are limited, although the ability to detect them has been limited by small sample sizes.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Edvardsen2008-32">[32]</a>

<h3>Genetic</h3>

Genetic studies have suggested that many <a href="http://en.wikipedia.org/wiki/Chromosomal" title="Chromosomal">chromosomal</a> regions and <a href="http://en.wikipedia.org/wiki/Candidate_gene" title="Candidate gene">candidate genes</a> are related to bipolar disorder susceptibility with <a href="http://en.wikipedia.org/wiki/Polygenic_disorder" title="Polygenic disorder">each gene exerting a mild to moderate effect</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Kerner2014-14">[14]</a> The risk of bipolar disorder is nearly ten-fold higher in first degree-relatives of those affected with bipolar disorder when compared to the general population; similarly, the risk of <a href="http://en.wikipedia.org/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a> is three times higher in relatives of those with bipolar disorder when compared to the general population.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a>

Although the first <a href="http://en.wikipedia.org/wiki/Genetic_linkage" title="Genetic linkage">genetic linkage</a> finding for mania was in 1969,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-35">[35]</a> the linkage studies have been inconsistent.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a> The largest and most recent <a href="http://en.wikipedia.org/wiki/Genome-wide_association_study" title="Genome-wide association study">genome-wide association study</a> failed to find any particular locus that exerts a large effect reinforcing the idea that no single gene is responsible for bipolar disorder in most cases.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Craddock2013-36">[36]</a>

Findings point strongly to heterogeneity, with different genes being implicated in different families.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-37">[37]</a> Robust and replicable genome-wide significant associations showed several common <a href="http://en.wikipedia.org/wiki/Single_nucleotide_polymorphism" title="Single nucleotide polymorphism">single nucleotide polymorphisms</a>, including variants within the genes <a href="http://en.wikipedia.org/wiki/CACNA1C" title="CACNA1C">CACNA1C</a>, <a href="http://en.wikipedia.org/wiki/ODZ4" title="ODZ4">ODZ4</a>, and <a href="http://en.wikipedia.org/wiki/NCAN" title="NCAN">NCAN</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Kerner2014-14">[14]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Craddock2013-36">[36]</a>

<a href="http://en.wikipedia.org/wiki/Paternal_age_effect" title="Paternal age effect">Advanced paternal age</a> has been linked to a somewhat increased chance of bipolar disorder in offspring, consistent with a hypothesis of increased new <a href="http://en.wikipedia.org/wiki/Genetic_mutations" title="Genetic mutations">genetic mutations</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-38">[38]</a>

<h3>Physiological</h3>

<div>

<div>

Brain imaging studies have revealed differences in the volume of various brain regions between BD patients and healthy control subjects</div>

</div>

Abnormalities in the structure and/or function of certain brain circuits could underlie bipolar. <a href="http://en.wikipedia.org/wiki/Meta_analysis" title="Meta analysis">Meta-analyses</a> of structural MRI studies in bipolar disorder report an increase in the volume of the <a href="http://en.wikipedia.org/wiki/Lateral_ventricles" title="Lateral ventricles">lateral ventricles</a>, <a href="http://en.wikipedia.org/wiki/Globus_pallidus" title="Globus pallidus">globus pallidus</a> and increase in the rates of deep <a href="http://en.wikipedia.org/wiki/White_matter" title="White matter">white matter</a> <a href="http://en.wikipedia.org/wiki/Hyperintensities" title="Hyperintensities">hyperintensities</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-39">[39]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid19721106-40">[40]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-41">[41]</a> <a href="http://en.wikipedia.org/wiki/Functional_magnetic_resonance_imaging" title="Functional magnetic resonance imaging">Functional MRI</a> findings suggest that abnormal modulation between ventral <a href="http://en.wikipedia.org/wiki/Prefrontal_cortex" title="Prefrontal cortex">prefrontal</a> and <a href="http://en.wikipedia.org/wiki/Limbic_system" title="Limbic system">limbic</a> regions, especially the <a href="http://en.wikipedia.org/wiki/Amygdala" title="Amygdala">amygdala</a>, are likely contribute to poor emotional regulation and mood symptoms.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-42">[42]</a>

According to the "kindling" hypothesis, when people who are genetically predisposed toward bipolar disorder experience stressful events, the stress threshold at which mood changes occur becomes progressively lower, until the episodes eventually start (and recur) spontaneously. There is evidence supporting an association between early-life stress and dysfunction of the <a href="http://en.wikipedia.org/wiki/Hypothalamic-pituitary-adrenal_axis" title="Hypothalamic-pituitary-adrenal axis">hypothalamic-pituitary-adrenal axis</a> (HPA axis) leading to its over activation, which may play a role in the pathogenesis of bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bender2011-43">[43]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Lee2013-44">[44]</a>

Other brain components which have been proposed to play a role are the <a href="http://en.wikipedia.org/wiki/Mitochondria" title="Mitochondria">mitochondria</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Nierenberg2013-31">[31]</a> and a sodium <a href="http://en.wikipedia.org/wiki/ATPase" title="ATPase">ATPase</a> pump.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEBrownBasso200416-45">[45]</a> Alterations to these components are believed to cause cyclical periods of poor neuron firing (depression) and hypersensitive neuron firing (mania).[<a href="http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] <a href="http://en.wikipedia.org/wiki/Circadian_rhythm" title="Circadian rhythm">Circadian rhythms</a> and melatonin activity also seem to be altered.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note--46">[46]</a>

<h3>Environmental</h3>

Evidence suggests that environmental factors play a significant role in the development and course of bipolar disorder, and that individual psychosocial variables may interact with genetic dispositions.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Serretti-47">[47]</a> There is fairly consistent evidence from prospective studies that recent life events and interpersonal relationships contribute to the likelihood of onsets and recurrences of bipolar mood episodes, as they do for onsets and recurrences of unipolar depression.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Geddestreatment-48">[48]</a> There have been repeated findings that 30–50% of adults diagnosed with bipolar disorder report traumatic/abusive experiences in childhood, which is associated on average with earlier onset, a higher rate of suicide attempts, and more co-occurring disorders such as <a href="http://en.wikipedia.org/wiki/PTSD" title="PTSD">PTSD</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Brietzke2012-49">[49]</a> The total number of reported stressful events in childhood is higher in those with an adult diagnosis of bipolar spectrum disorder compared to those without, particularly events stemming from a harsh environment rather than from the child's own behavior.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-50">[50]</a>

<h3>Neurological</h3>

Less commonly bipolar disorder or a bipolar-like disorder may occur as a result of or in association with a neurological condition or injury. Such conditions and injuries include (but are not limited to) <a href="http://en.wikipedia.org/wiki/Stroke" title="Stroke">stroke</a>,<a href="http://en.wikipedia.org/wiki/Traumatic_brain_injury" title="Traumatic brain injury">traumatic brain injury</a>, <a href="http://en.wikipedia.org/wiki/HIV" title="HIV">HIV</a> infection, <a href="http://en.wikipedia.org/wiki/Multiple_sclerosis" title="Multiple sclerosis">multiple sclerosis</a>, <a href="http://en.wikipedia.org/wiki/Porphyria" title="Porphyria">porphyria</a>, and rarely <a href="http://en.wikipedia.org/wiki/Temporal_lobe_epilepsy" title="Temporal lobe epilepsy">temporal lobe epilepsy</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-51">[51]</a>

<h3>Neuroendocrinological</h3>

<a href="http://en.wikipedia.org/wiki/Dopamine" title="Dopamine">Dopamine</a>, a known neurotransmitter responsible for mood cycling, has been shown to have increased transmission during the manic phase.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Salvadore2010-9">[9]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-52">[52]</a> The dopamine hypothesis states that the increase in dopamine results in secondary homeostatic down regulation of key systems and receptors such as an increase in dopamine mediated <a href="http://en.wikipedia.org/wiki/G_protein-coupled_receptors" title="G protein-coupled receptors">G protein-coupled receptors</a>. This results in decreased dopamine transmission characteristic of the depressive phase.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Salvadore2010-9">[9]</a> The depressive phase ends with homeostatic up regulation potentially restarting the cycle over again.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-53">[53]</a>

Two additional neurotransmitters, <a href="http://en.wikipedia.org/wiki/Gamma-Aminobutyric_acid" title="Gamma-Aminobutyric acid">gamma-Aminobutyric acid</a> (GABA) and <a href="http://en.wikipedia.org/wiki/Glutamate" title="Glutamate">glutamate</a>, have been found to cause elevated mood states.[<a href="http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Glutamate is significantly increased within the left dorsolateral prefrontal cortex during the manic phase of bipolar disorder, and returns to normal levels once the phase is over.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-54">[54]</a> GABA is found in higher concentrations in people with bipolar disorder, overall leading to a decrease in <a href="http://en.wikipedia.org/wiki/GABA_B_receptor" title="GABA B receptor">GABA B receptors</a>.[<a href="http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] The increase in GABA is possibly caused by a disturbance in early development causing a disturbance of cell migration and the formation of normal lamination, the layering of brain structures commonly associated with the <a href="http://en.wikipedia.org/wiki/Cerebral_cortex" title="Cerebral cortex">cerebral cortex</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-55">[55]</a>

<h3>Evolutionary</h3>

Because bipolar disorder affects an individual’s ability to function in society and has a high morbidity rate, <a href="http://en.wikipedia.org/wiki/Evolutionary_theory" title="Evolutionary theory">evolutionary theory</a> would suggest that the genes responsible would have been naturally selected against, effectively culling the disorder. Yet there continue to be high rates of bipolar disorder in many populations, suggesting the genes responsible may have an evolutionary benefit.

Proponents of <a href="http://en.wikipedia.org/wiki/Evolutionary_medicine" title="Evolutionary medicine">evolutionary medicine</a> hypothesize that the genes that cause severe bipolar disorder when inherited in large doses may increase fitness when inherited in small doses.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-56">[56]</a> High rates of bipolar disorder throughout history suggest that the ability to switch between depressive and manic moods conveyed some evolutionary advantage on ancestral humans. Theories put forward to explain the<a href="http://en.wikipedia.org/wiki/Evolutionary_approaches_to_depression" title="Evolutionary approaches to depression">evolutionary advantages of major depressive disorder</a> may also explain the adaptiveness of the depressive episodes of bipolar disorder. For example, in individuals under increased stress, depressive mood may serve as a defensive strategy that causes the individual to retreat from the external stressor, increase sleep, and preserve resources and energy for better times.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-57">[57]</a> Additionally, manic moods may convey advantage in some situations. Creativity, confidence, and high energy have all been linked to mania and hypomania.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-58">[58]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-url_Hypomanias_up_side-59">[59]</a> The ability to utilize mild manic symptoms to be more productive and think more creatively during stress-free times may have increased the fitness of ancestral humans. Being able to employ both hypomania and mild depression convey advantages that benefit individuals in a variable environment. However, if the genes enabling the manipulation of both of these moods are over activated, the manic and/or severe depressive moods of full bipolar disorder may be triggered instead.

Evolutionary biologists have hypothesized that bipolar disorder could have come from an adaptation to extreme climates in the northern <a href="http://en.wikipedia.org/wiki/Temperate_zone" title="Temperate zone">temperate zone</a> during the <a href="http://en.wikipedia.org/wiki/Pleistocene" title="Pleistocene">Pleistocene</a>. The Evolutionary Origin of Bipolar Disorder (EOBD) hypothesis states that during the short summers of extreme climates, hypomania would be adaptive, allowing the completion of many tasks necessary for survival within a short period of time. During long winters the lethargy, <a href="http://en.wikipedia.org/wiki/Hypersomnia" title="Hypersomnia">hypersomnia</a>, lack of interest in social activities, and overeating of depression would be adaptive to group cohesion and survival.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-60">[60]</a> Evidence for the EOBD hypothesis include an association between bipolar disorder and a cold-adapted build, correlation between seasonality and mood changes in those with bipolar disorder, and low rates of bipolar disorder in African Americans.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-61">[61]</a> The EOBD hypothesis suggests that in the absence of the extreme climatic conditions that fostered the success of bipolar disorder genes, many bipolar disorder behaviors are maladaptive and can often severely impair normal functioning.

<h2>Prevention</h2>

<a href="http://en.wikipedia.org/wiki/Mental_disorder#Prevention" title="Mental disorder">Prevention</a> of bipolar has focused on stress (such as childhood adversity or highly conflictual families) which, although not a diagnostically specific causal agent for bipolar, does place genetically and biologically vulnerable individuals at risk for a more pernicious course of illness.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-62">[62]</a> There has been debate regarding the causal relationship between usage of <a href="http://en.wikipedia.org/wiki/Cannabis_(drug)" title="Cannabis (drug)">cannabis</a> and bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-63">[63]</a>

<h2>Diagnosis</h2>

Bipolar disorder often goes unrecognized and is commonly diagnosed during adolescence or early adulthood.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Price2012-64">[64]</a> The disorder can be difficult to distinguish from <a href="http://en.wikipedia.org/wiki/Unipolar_depression" title="Unipolar depression">unipolar depression</a> and the mean delay in diagnosis is 5–10 years after symptoms begin.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Phillips2013-65">[65]</a> Diagnosis of bipolar disorder takes several factors into account and considers the self-reported experiences of the symptomatic individual, <a href="http://en.wikipedia.org/wiki/Abnormality_(behavior)" title="Abnormality (behavior)">behavior abnormalities</a> reported by family members, friends or co-workers, and observable signs of illness as assessed by a <a href="http://en.wikipedia.org/wiki/Psychiatrist" title="Psychiatrist">psychiatrist</a>, <a href="http://en.wikipedia.org/wiki/Nurse" title="Nurse">nurse</a>, <a href="http://en.wikipedia.org/wiki/Social_worker" title="Social worker">social worker</a>, <a href="http://en.wikipedia.org/wiki/Clinical_psychologist" title="Clinical psychologist">clinical psychologist</a> or other health professional. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's <a href="http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders" title="Diagnostic and Statistical Manual of Mental Disorders">Diagnostic and Statistical Manual of Mental Disorders</a>, the current version being DSM-IV-TR, and the <a href="http://en.wikipedia.org/wiki/World_Health_Organization" title="World Health Organization">World Health Organization's</a> <a href="http://en.wikipedia.org/wiki/ICD" title="ICD">International Statistical Classification of Diseases and Related Health Problems</a>, currently the ICD-10. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions, as well as prevailing in research studies. The <a href="http://en.wikipedia.org/wiki/DSM-V" title="DSM-V">DSM-V</a>, published in 2013, included further and more accurate sub-typing.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-66">[66]</a>

An initial assessment may include a physical exam by a physician. Although there are no biological tests that are diagnostic of bipolar disorder,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Craddock2013-36">[36]</a> tests may be carried out to exclude medical illnesses with clinical presentations similar to that of bipolar disorder such as <a href="http://en.wikipedia.org/wiki/Hypothyroidism" title="Hypothyroidism">hypothyroidism</a> or <a href="http://en.wikipedia.org/wiki/Hyperthyroidism" title="Hyperthyroidism">hyperthyroidism</a>, metabolic disturbance, a chronic disease, or an infection such as <a href="http://en.wikipedia.org/wiki/HIV" title="HIV">HIV</a> or <a href="http://en.wikipedia.org/wiki/Syphilis" title="Syphilis">syphilis</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Price2012-64">[64]</a> An <a href="http://en.wikipedia.org/wiki/Electroencephalography" title="Electroencephalography">EEG</a> may be used to exclude a seizure disorder such as <a href="http://en.wikipedia.org/wiki/Epilepsy" title="Epilepsy">epilepsy</a>, and a <a href="http://en.wikipedia.org/wiki/Computed_tomography" title="Computed tomography">CT scan</a> of the head may be used to exclude brain lesions.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Price2012-64">[64]</a> Investigations are not generally repeated for a relapse unless there is a specific medical indication.

Several <a href="http://en.wikipedia.org/wiki/Rating_scale" title="Rating scale">rating scales</a> for the <a href="http://en.wikipedia.org/wiki/Screening(medicine)" title="Screening (medicine)">screening</a> and evaluation of bipolar disorder exist, such as the <a href="http://en.wikipedia.org/wiki/Bipolar_spectrum_diagnostic_scale" title="Bipolar spectrum diagnostic scale">Bipolar spectrum diagnostic scale</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid19122534-67">[67]</a> The use of evaluation scales can not substitute a full clinical interview but they serve to systematize the recollection of symptoms.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid19122534-67">[67]</a> On the other hand, instruments for the screening of bipolar disorder have low sensitivity[<a href="http://en.wikipedia.org/wiki/Wikipedia:Please_clarify" title="Wikipedia:Please clarify">clarification needed</a>] and limited diagnostic <a href="http://en.wikipedia.org/wiki/Validity(statistics)" title="Validity (statistics)">validity</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid19122534-67">[67]</a>

<h3>Bipolar spectrum</h3>

Bipolar spectrum disorders (BSD) include the following four disorders: <a href="http://en.wikipedia.org/wiki/Bipolar_I_disorder" title="Bipolar I disorder">bipolar I disorder</a>, <a href="http://en.wikipedia.org/wiki/Bipolar_II_disorder" title="Bipolar II disorder">bipolar II disorder</a>, <a href="http://en.wikipedia.org/wiki/Cyclothymic_disorder" title="Cyclothymic disorder">cyclothymic disorder</a>, and <a href="http://en.wikipedia.org/wiki/Bipolar_disorder_not_otherwise_specified" title="Bipolar disorder not otherwise specified">bipolar disorder not otherwise specified</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Price2012-64">[64]</a> These disorders typically involve<a href="http://en.wikipedia.org/wiki/Major_depressive_disorder" title="Major depressive disorder">depressive</a> symptoms or episodes that alternate with elevated mood states or with <a href="http://en.wikipedia.org/wiki/Mixed_episodes" title="Mixed episodes">mixed episodes</a> that feature symptoms of both depressive and elevated mood states.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-68">[68]</a> The concept of the bipolar <a href="http://en.wikipedia.org/wiki/Spectrum_disorder" title="Spectrum disorder">spectrum</a>is similar to that of <a href="http://en.wikipedia.org/wiki/Emil_Kraepelin" title="Emil Kraepelin">Emil Kraepelin</a>'s original concept of manic depressive illness.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-69">[69]</a>

Unipolar hypomania without accompanying depression has been noted in the medical literature.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid19689506-70">[70]</a> There is speculation as to whether this condition may occur with greater frequency in the general, untreated population; successful social function of these potentially high-achieving individuals may lead to being labeled as normal, rather than as individuals with substantial dysregulation.

<h3>Criteria and subtypes</h3>

There is no clear consensus as to how many types of bipolar disorder exist.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-71">[71]</a> In <a href="http://en.wikipedia.org/wiki/DSM-IV-TR" title="DSM-IV-TR">DSM-IV-TR</a> and <a href="http://en.wikipedia.org/wiki/ICD-10" title="ICD-10">ICD-10</a>, bipolar disorder is conceptualized as a spectrum of disorders occurring on a continuum. The DSM-IV-TR lists three specific subtypes and one for non-specified:<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTE.27.27DSM-IV.27.272000-72">[72]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-73">[73]</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_I_disorder" title="Bipolar I disorder">Bipolar I disorder</a>: At least one <a href="http://en.wikipedia.org/wiki/Manic_episode" title="Manic episode">manic episode</a> is necessary to make the diagnosis;<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Renk2014-74">[74]</a> depressive episodes are common in bipolar disorder I, but are unnecessary for the diagnosis.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_II_disorder" title="Bipolar II disorder">Bipolar II disorder</a>: No manic episodes, but one or more <a href="http://en.wikipedia.org/wiki/Hypomanic" title="Hypomanic">hypomanic</a> episodes and one or more <a href="http://en.wikipedia.org/wiki/Major_depressive_episode" title="Major depressive episode">major depressive episode</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Renk2014-74">[74]</a> Hypomanic episodes do not go to the full extremes of mania (i.e., do not usually cause severe social or occupational impairment, and are without <a href="http://en.wikipedia.org/wiki/Psychosis" title="Psychosis">psychosis</a>), and this can make bipolar II more difficult to diagnose, since the hypomanic episodes may simply appear as a period of successful high productivity and is reported less frequently than a distressing, crippling depression.</li>

<li><a href="http://en.wikipedia.org/wiki/Cyclothymia" title="Cyclothymia">Cyclothymia</a>: A history of hypomanic episodes with periods of <a href="http://en.wikipedia.org/wiki/Clinical_depression" title="Clinical depression">depression</a> that do not meet criteria for major depressive episodes.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Van_Meter_2012-75">[75]</a> There is a low-grade cycling of mood which appears to the observer as a personality trait and interferes with functioning.</li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_NOS" title="Bipolar NOS">Bipolar disorder NOS</a> (not otherwise specified): This is a catchall category, diagnosed when the disorder does not fall within a specific subtype.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Towbin2013-76">[76]</a> Bipolar NOS can still significantly impair and adversely affect the quality of life of the patient.</li>

</ul>

The bipolar I and II categories have specifiers that indicate the presentation and course of the disorder. For example, the "with full interepisode recovery" specifier applies if there was full remission between the two most recent episodes.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-77">[77]</a>

<h4>Rapid cycling</h4>

Most people who meet criteria for bipolar disorder experience a number of episodes, on average 0.4 to 0.7 per year, lasting three to six months.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-78">[78]</a> Rapid cycling, however, is a course specifier that may be applied to any of the above subtypes. It is defined as having four or more mood disturbance episodes within a one year span and is found in a significant proportion of individuals with bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Muneer2013-21">[21]</a> These episodes are separated from each other by a remission (partial or full) for at least two months or a switch in mood polarity (i.e., from a depressive episode to a manic episode or vice versa).<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a> The definition of rapid cycling most frequently cited in the literature (including the DSM) is that of Dunner and Fieve: at least four major depressive, manic, hypomanic or mixed episodes are required to have occurred during a 12-month period.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bauer2008-79">[79]</a> Ultra-rapid (days) and ultra-ultra rapid or <a href="http://en.wikipedia.org/wiki/Ultradian" title="Ultradian">ultradian</a> (within a day) cycling have also been described.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid14642014-80">[80]</a> The literature examining the pharmacological treatment of rapid cycling is sparse and there is no clear consensus with respect to its optimal pharmacological management.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Fountoulakis2013-81">[81]</a>

<h3>Differential diagnosis</h3>

There are several other mental disorders with symptoms similar to those seen in bipolar disorder. These disorders include <a href="http://en.wikipedia.org/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a>, <a href="http://en.wikipedia.org/wiki/Major_depressive_disorder" title="Major depressive disorder">major depressive disorder</a>,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Baldessarini2013-82">[82]</a> <a href="http://en.wikipedia.org/wiki/Attention_deficit_hyperactivity_disorder" title="Attention deficit hyperactivity disorder">attention deficit hyperactivity disorder</a>(ADHD), and certain personality disorders, such as <a href="http://en.wikipedia.org/wiki/Borderline_personality_disorder" title="Borderline personality disorder">borderline personality disorder</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Sood2005-83">[83]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Magill2004-84">[84]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bassett2012-85">[85]</a>

It has been noted that the bipolar disorder diagnosis is officially characterized in historical terms such that, technically, anyone with a history of (hypo)mania and depression has bipolar disorder whatever their current or future functioning and vulnerability. This has been described as "an ethical and methodological issue", as it means no one can be considered as being recovered (only "in <a href="http://en.wikipedia.org/wiki/Remission_(medicine)" title="Remission (medicine)">remission</a>") from bipolar disorder according to the official criteria. This is considered especially problematic given that brief hypomanic episodes are widespread among people generally and not necessarily associated with dysfunction.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Mansell2008-17">[17]</a>

<h2>Management</h2>

<div>Main article: <a href="http://en.wikipedia.org/wiki/Treatment_of_bipolar_disorder" title="Treatment of bipolar disorder">Treatment of bipolar disorder</a></div>

There are a number of <a href="http://en.wikipedia.org/wiki/Pharmacological" title="Pharmacological">pharmacological</a> and <a href="http://en.wikipedia.org/wiki/Psychotherapeutic" title="Psychotherapeutic">psychotherapeutic</a> techniques used to treat bipolar disorder. Individuals may use <a href="http://en.wikipedia.org/wiki/Self-help_groups_for_mental_health" title="Self-help groups for mental health">self-help</a> and pursue <a href="http://en.wikipedia.org/wiki/Recovery_model" title="Recovery model">recovery</a>.

Hospitalization may be required especially with the manic episodes present in bipolar I. This can be voluntary or (if mental health legislation allows and varying state-to-state regulations in the USA) involuntary (called civil or <a href="http://en.wikipedia.org/wiki/Involuntary_commitment" title="Involuntary commitment">involuntary commitment</a>). Long-term inpatient stays are now less common due to <a href="http://en.wikipedia.org/wiki/Deinstitutionalization" title="Deinstitutionalization">deinstitutionalization</a>, although these can still occur.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-BeckerKilian2006-86">[86]</a> Following (or in lieu of) a hospital admission, support services available can include drop-in centers, visits from members of a community mental health team or an <a href="http://en.wikipedia.org/wiki/Assertive_Community_Treatment" title="Assertive Community Treatment">Assertive Community Treatment</a> team, supported employment and patient-led support groups, intensive outpatient programs. These are sometimes referred to as partial-inpatient programs.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-87">[87]</a>

<h3>Psychosocial</h3>

<a href="http://en.wikipedia.org/wiki/Psychotherapy" title="Psychotherapy">Psychotherapy</a> is aimed at alleviating core symptoms, recognizing episode triggers, reducing negative expressed emotion in relationships, recognizing <a href="http://en.wikipedia.org/wiki/Prodromal" title="Prodromal">prodromal</a> symptoms before full-blown recurrence, and, practicing the factors that lead to maintenance of <a href="http://en.wikipedia.org/wiki/Remission_(medicine)" title="Remission (medicine)">remission</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-88">[88]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTELeahyJohnson2003-89">[89]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEBascoRush2005-90">[90]</a> <a href="http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a>, <a href="http://en.wikipedia.org/wiki/Family_therapy" title="Family therapy">family-focused therapy</a>, and <a href="http://en.wikipedia.org/wiki/Psychoeducation" title="Psychoeducation">psychoeducation</a> have the most evidence for efficacy in regard to relapse prevention, while <a href="http://en.wikipedia.org/wiki/Interpersonal_and_social_rhythm_therapy" title="Interpersonal and social rhythm therapy">interpersonal and social rhythm therapy</a> and cognitive-behavioral therapy appear the most effective in regard to residual depressive symptoms. Most studies have been based only on bipolar I, however, and treatment during the acute phase can be a particular challenge.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-91">[91]</a> Some clinicians emphasize the need to talk with individuals experiencing mania, to develop a <a href="http://en.wikipedia.org/wiki/Therapeutic_alliance" title="Therapeutic alliance">therapeutic alliance</a> in support of<a href="http://en.wikipedia.org/wiki/Recovery_model" title="Recovery model">recovery</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-92">[92]</a>

<h3>Medication</h3>

<div>

<div>

<a href="http://en.wikipedia.org/wiki/Lithium_(medication)" title="Lithium (medication)">Lithium carbonate</a> is one of many treatments for bipolar disorder.</div>

</div>

A number of medications are used to treat bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Geddestreatment-48">[48]</a> The medication with the best evidence is <a href="http://en.wikipedia.org/wiki/Lithium_(medication)" title="Lithium (medication)">lithium</a>, which is effective in treating acute manic episodes and preventing relapses; lithium is also an effective treatment for bipolar depression.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Brown2013-93">[93]</a> Lithium reduces the risk of suicide, self-harm, and death in people with bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid23814104-94">[94]</a>

Four <a href="http://en.wikipedia.org/wiki/Anticonvulsant" title="Anticonvulsant">anticonvulsants</a> are used in the treatment of bipolar disorder. <a href="http://en.wikipedia.org/wiki/Carbamazepine" title="Carbamazepine">Carbamazepine</a> effectively treats manic episodes, with some evidence it has greater benefit in rapid-cycling bipolar disorder, or those with more psychotic symptoms or a more schizoaffective clinical picture. It is less effective in preventing relapse than lithium or valproate.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-95">[95]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Rapoport2009-96">[96]</a>Carbamazepine became a popular treatment option for bipolar in the late 1980s and early 1990s, but was displaced by <a href="http://en.wikipedia.org/wiki/Sodium_valproate" title="Sodium valproate">sodium valproate</a> in the 1990s.[<a href="http://en.wikipedia.org/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed">citation needed</a>] Since then, valproate has become a commonly prescribed treatment, and is effective in treating manic episodes.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Macr02-97">[97]</a> <a href="http://en.wikipedia.org/wiki/Lamotrigine" title="Lamotrigine">Lamotrigine</a> has some efficacy in treating bipolar depression, and this benefit is greatest in more severe depression.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-98">[98]</a> It has also been shown to have some benefit in preventing further episodes, though there are concerns about the studies done, and is of no benefit in rapid cycling disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-99">[99]</a> The effectiveness of <a href="http://en.wikipedia.org/wiki/Topiramate" title="Topiramate">topiramate</a> is unknown.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid16437453-100">[100]</a> Depending on the severity of the case, anticonvulsants may be used in combination with lithium or on their own.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEBarker2003284.E2.80.9385-101">[101]</a>

<a href="http://en.wikipedia.org/wiki/Antipsychotic" title="Antipsychotic">Antipsychotic medications</a> are effective for short-term treatment of bipolar manic episodes and appear to be superior to lithium and anticonvulsants for this purpose.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Geddestreatment-48">[48]</a> However, other medications such as lithium are preferred for long-term use.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Geddestreatment-48">[48]</a> <a href="http://en.wikipedia.org/wiki/Olanzapine" title="Olanzapine">Olanzapine</a> is effective in preventing relapses, although the evidence is not as solid as for lithium.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-102">[102]</a> <a href="http://en.wikipedia.org/wiki/Antidepressants" title="Antidepressants">Antidepressants</a> have not been found to be of any benefit over that found with mood stabilizers.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-PostGrad10-103">[103]</a>

Short courses of <a href="http://en.wikipedia.org/wiki/Benzodiazepines" title="Benzodiazepines">benzodiazepines</a> may be used in addition to other medications until mood stabilizing become effective.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-104">[104]</a>

<h3>Alternative medicine</h3>

There is some evidence that the addition of <a href="http://en.wikipedia.org/wiki/Omega_3_fatty_acids" title="Omega 3 fatty acids">omega 3 fatty acids</a> may have beneficial effects on depressive symptoms, although studies have been scarce and of variable quality.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid18425912-105">[105]</a>

<h2>Prognosis</h2>

For many individuals with bipolar disorder a good <a href="http://en.wikipedia.org/wiki/Prognosis" title="Prognosis">prognosis</a> results from good treatment, which, in turn, results from an accurate <a href="http://en.wikipedia.org/wiki/Medical_diagnosis" title="Medical diagnosis">diagnosis</a>. Of the various forms of bipolar disorder, rapid cycling bipolar disorder is associated with the worst prognosis.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Muneer2013-21">[21]</a> Because bipolar disorder can have a high rate of both under-diagnosis and <a href="http://en.wikipedia.org/wiki/Misdiagnosis" title="Misdiagnosis">misdiagnosis</a>,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Bowden-23">[23]</a> it is often difficult for individuals with the condition to receive timely and competent treatment.

Bipolar disorder can be a severely disabling medical condition. However, many individuals with bipolar disorder can live full and satisfying lives. Quite often, medication is needed to enable this. Persons with bipolar disorder may have periods of normal or near normal functioning between episodes.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEBergen1999-106">[106]</a>

<h3>Functioning</h3>

Functioning in bipolar I and II varies over time along a spectrum from good to fair to poor. During periods of <a href="http://en.wikipedia.org/wiki/Major_depression" title="Major depression">major depression</a> or mania (in BPI), functioning was on average poor, with depression being more persistently associated with disability than mania. Functioning between episodes was on average good — more or less normal. Subthreshold symptoms were generally still substantially impairing, however, except for hypomania (below or above threshold) which was associated with improved functioning.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-107">[107]</a>

<h3>Recovery and recurrence</h3>

A naturalistic study from first admission for mania or mixed episode (representing the hospitalized and therefore most severe cases) found that 50% achieved syndromal recovery (no longer meeting criteria for the diagnosis) within six weeks and 98% within two years. Within two years, 72% achieved symptomatic recovery (no symptoms at all) and 43% achieved functional recovery (regaining of prior occupational and residential status). However, 40% went on to experience a new episode of mania or depression within 2 years of syndromal recovery, and 19% switched phases without recovery.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-108">[108]</a>

Symptoms preceding a relapse (<a href="http://en.wikipedia.org/wiki/Prodromal" title="Prodromal">prodromal</a>), specially those related to mania, can be reliably identified by people with bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid12738039-109">[109]</a> There have been intents to teach patients <a href="http://en.wikipedia.org/wiki/Coping_strategies" title="Coping strategies">coping strategies</a> when noticing such symptoms with encouraging results.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid16125292-110">[110]</a>

<h3>Suicide</h3>

Bipolar disorder can cause suicidal ideation that leads to <a href="http://en.wikipedia.org/wiki/Suicidal" title="Suicidal">suicidal</a> attempts. Individuals whose bipolar disorder begins with a depressive or mixed affective episode seem to have a poorer prognosis and an increased risk of suicide.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Baldessarini2013-82">[82]</a> One out of two people with bipolar disorder attempt suicide at least once during their lifetime and many attempts are successfully completed.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Kerner2014-14">[14]</a> The annual average suicide rate is 0.4%, which is 10–20 times that of the general population.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTESadockKaplanSadock2007388-111">[111]</a> The <a href="http://en.wikipedia.org/wiki/Standardized_mortality_ratio" title="Standardized mortality ratio">standardized mortality ratio</a> from <a href="http://en.wikipedia.org/wiki/Suicide" title="Suicide">suicide</a> in bipolar disorder is between 18 and 25.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-MortBio_2006-112">[112]</a> The lifetime risk of suicide has been estimated to be as high as 20% in those with bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Barnett2009-7">[7]</a>

<h2>Epidemiology</h2>

<div>

<div>

Burden of bipolar disorder around the world: <a href="http://en.wikipedia.org/wiki/Disability-adjusted_life_year" title="Disability-adjusted life year">disability-adjusted life years</a> per 100,000 inhabitants in 2004.

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Bipolar disorder is the sixth leading cause of disability worldwide and has a lifetime prevalence of about 3% in the general population.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Schmitt2014-4">[4]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Boland2013-113">[113]</a> However, a reanalysis of data from the National Epidemiological Catchment Area survey in the United States suggested that 0.8% of the population experience a <a href="http://en.wikipedia.org/wiki/Manic_episode" title="Manic episode">manic episode</a> at least once (the diagnostic threshold for <a href="http://en.wikipedia.org/wiki/Bipolar_I" title="Bipolar I">bipolar I</a>) and a further 0.5% have a <a href="http://en.wikipedia.org/wiki/Hypomanic" title="Hypomanic">hypomanic</a> episode (the diagnostic threshold for bipolar II or cyclothymia). Including sub-threshold diagnostic criteria, such as one or two symptoms over a short time-period, an additional 5.1% of the population, adding up to a total of 6.4%, were classified as having a bipolar spectrum disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Judd_and_Akiskal_2003-114">[114]</a> A more recent analysis of data from a second US <a href="http://en.wikipedia.org/wiki/National_Comorbidity_Survey" title="National Comorbidity Survey">National Comorbidity Survey</a> found that 1% met lifetime prevalence criteria for bipolar I, 1.1% for bipolar II, and 2.4% for subthreshold symptoms.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-115">[115]</a>

There are conceptual and methodological limitations and variations in the findings. Prevalence studies of bipolar disorder are typically carried out by lay interviewers who follow fully structured/fixed interview schemes; responses to single items from such interviews may suffer limited validity. In addition, diagnoses (and therefore estimates of prevalence) vary depending on whether a categorical or <a href="http://en.wikipedia.org/wiki/Spectrum_approach" title="Spectrum approach">spectrum approach</a> is used. This consideration has led to concerns about the potential for both underdiagnosis and overdiagnosis.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-116">[116]</a>

The incidence of bipolar disorder is similar in men and women<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Farren2012-117">[117]</a> as well as across different cultures and ethnic groups. A 2000 study by the <a href="http://en.wikipedia.org/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> found that prevalence and incidence of bipolar disorder are very similar across the world. Age-standardized prevalence per 100,000 ranged from 421.0 in South Asia to 481.7 in Africa and Europe for men and from 450.3 in Africa and Europe to 491.6 in Oceania for women. However, severity may differ widely across the globe. Disability-adjusted life year rates, for example, appear to be higher in developing countries, where medical coverage may be poorer and medication less available.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-118">[118]</a> Within the United States, <a href="http://en.wikipedia.org/wiki/Asian_American" title="Asian American">Asian Americans</a> have significantly lower rates than their <a href="http://en.wikipedia.org/wiki/African_American" title="African American">African</a> and <a href="http://en.wikipedia.org/wiki/European_American" title="European American">European American</a> counterparts.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-kurasaki-119">[119]</a>

Late adolescence and early adulthood are peak years for the onset of bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Christie88-120">[120]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEGoodwinJamison20071945-121">[121]</a> One study also found that in 10% of bipolar cases, the onset of mania had happened after the patient had turned 50.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-122">[122]</a>

<h2>History</h2>

<div>Main article: <a href="http://en.wikipedia.org/wiki/History_of_bipolar_disorder" title="History of bipolar disorder">History of bipolar disorder</a></div>

<div>

<div>

German psychiatrist<a href="http://en.wikipedia.org/wiki/Emil_Kraepelin" title="Emil Kraepelin">Emil Kraepelin</a> first distinguished between manic–depressive illness and "dementia praecox" (now known as <a href="http://en.wikipedia.org/wiki/Schizophrenia" title="Schizophrenia">schizophrenia</a>) in the late 19th century</div>

</div>

Variations in moods and energy levels have been observed as part of the human experience since throughout history. The words "<a href="http://en.wikipedia.org/wiki/Melancholia" title="Melancholia">melancholia</a>" (an old word for <a href="http://en.wikipedia.org/wiki/Depression_(mood)" title="Depression (mood)">depression</a>) and "mania" originated in <a href="http://en.wikipedia.org/wiki/Ancient_Greek" title="Ancient Greek">Ancient Greek</a>. The word melancholia is derived from melas/μελας, meaning "black", and chole/χολη, meaning "bile" or "gall",<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTELiddellScott1980-123">[123]</a> indicative of the term's origins in pre-<a href="http://en.wikipedia.org/wiki/Hippocrates" title="Hippocrates">Hippocratic</a> <a href="http://en.wikipedia.org/wiki/Humoral" title="Humoral">humoral</a> theories. Within the humoral theories, mania was viewed as arising from an excess of <a href="http://en.wikipedia.org/wiki/Yellow_bile" title="Yellow bile">yellow bile</a>, or a mixture of black and yellow bile. The <a href="http://en.wikipedia.org/wiki/Linguistics" title="Linguistics">linguistic</a> origins of mania, however, are not so clear-cut. Several etymologies are proposed by the <a href="http://en.wikipedia.org/wiki/Ancient_Rome" title="Ancient Rome">Roman</a> physician <a href="http://en.wikipedia.org/wiki/Caelius_Aurelianus" title="Caelius Aurelianus">Caelius Aurelianus</a>, including the Greek word ania, meaning "to produce great mental anguish", and manos, meaning "relaxed" or "loose", which would contextually approximate to an excessive relaxing of the mind or soul.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Angst-2001-124">[124]</a> There are at least five other candidates, and part of the confusion surrounding the exact etymology of the word mania is its varied usage in the pre-Hippocratic <a href="http://en.wikipedia.org/wiki/Poetry" title="Poetry">poetry</a> and <a href="http://en.wikipedia.org/wiki/Mythology" title="Mythology">mythologies</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Angst-2001-124">[124]</a>

In the early 1800s, French psychiatrist <a href="http://en.wikipedia.org/wiki/Jean-%C3%89tienne_Dominique_Esquirol" title="Jean-Étienne Dominique Esquirol">Jean-Étienne Dominique Esquirol</a>'s lypemania, one of his affective <a href="http://en.wikipedia.org/wiki/Monomania" title="Monomania">monomanias</a>, was the first elaboration on what was to become modern depression.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-125">[125]</a> The basis of the current conceptualisation of manic–depressive illness can be traced back to the 1850s; on January 31, 1854, <a href="http://en.wikipedia.org/wiki/Jules_Baillarger" title="Jules Baillarger">Jules Baillarger</a> described to the French Imperial <a href="http://en.wikipedia.org/wiki/Acad%C3%A9mie_Nationale_de_M%C3%A9decine" title="Académie Nationale de Médecine">Academy of Medicine</a> a <a href="http://en.wikipedia.org/wiki/Stereotypy" title="Stereotypy">biphasic</a> <a href="http://en.wikipedia.org/wiki/Mental_illness" title="Mental illness">mental illness</a> causing recurrent oscillations between mania and depression, which he termed folie à double forme ("dual-form insanity").<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-126">[126]</a>Two weeks later, on February 14, 1854, <a href="http://en.wikipedia.org/wiki/Jean-Pierre_Falret" title="Jean-Pierre Falret">Jean-Pierre Falret</a> presented a description to the Academy on what was essentially the same disorder, and designated folie circulaire ("circular<a href="http://en.wikipedia.org/wiki/Insanity" title="Insanity">insanity</a>") by him.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Sedler-127">[127]</a>

These concepts were developed by the German <a href="http://en.wikipedia.org/wiki/Psychiatrist" title="Psychiatrist">psychiatrist</a> <a href="http://en.wikipedia.org/wiki/Emil_Kraepelin" title="Emil Kraepelin">Emil Kraepelin</a> (1856–1926), who, using <a href="http://en.wikipedia.org/wiki/Karl_Ludwig_Kahlbaum" title="Karl Ludwig Kahlbaum">Kahlbaum</a>'s concept of <a href="http://en.wikipedia.org/wiki/Cyclothymia" title="Cyclothymia">cyclothymia</a>,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEMillon1996290-128">[128]</a> categorized and studied the natural course of untreated bipolar patients. He coined the term manic depressive <a href="http://en.wikipedia.org/wiki/Psychosis" title="Psychosis">psychosis</a>, after noting that periods of acute illness, manic or depressive, were generally punctuated by relatively symptom-free intervals where the patient was able to function normally.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-129">[129]</a>

The term "manic–depressive reaction" appeared in the first <a href="http://en.wikipedia.org/wiki/American_Psychiatric_Association" title="American Psychiatric Association">American Psychiatric Association</a> Diagnostic Manual in 1952, influenced by the legacy of <a href="http://en.wikipedia.org/wiki/Adolf_Meyer(psychiatrist)" title="Adolf Meyer (psychiatrist)">Adolf Meyer</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEGoodwinJamison2007Chapter_1-130">[130]</a> Subclassifying this into 'unipolar' and 'bipolar' disorder was first proposed by German psychiatrists <a href="http://en.wikipedia.org/wiki/Karl_Kleist" title="Karl Kleist">Karl Kleist</a> and <a href="http://en.wikipedia.org/wiki/Karl_Leonhard" title="Karl Leonhard">Karl Leonhard</a> in the 1950s and, since the DSM-III, Major Depressive Disorder has been regarded as a separate condition to Bipolar Disorder. Subtypes of 'Bipolar II' and 'rapid cycling' have been included since the DSM-IV, based on work from the 1970s by <a href="http://en.wikipedia.org/wiki/David_L.Dunner" title="David L. Dunner">David L. Dunner</a>, <a href="http://en.wikipedia.org/wiki/Elliot_S.Gershon" title="Elliot S. Gershon">Elliot S. Gershon</a>,<a href="http://en.wikipedia.org/wiki/Frederick_K.Goodwin" title="Frederick K. Goodwin">Frederick K. Goodwin</a>, <a href="http://en.wikipedia.org/wiki/Ronald_R.Fieve" title="Ronald R. Fieve">Ronald R. Fieve</a> and <a href="http://en.wikipedia.org/wiki/Joseph_L.Fleiss" title="Joseph L. Fleiss">Joseph L. Fleiss</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-131">[131]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-132">[132]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Ban-133">[133]</a>

<h2>Society and culture</h2>

<div>See also: <a href="http://en.wikipedia.org/wiki/List_of_people_with_bipolar_disorder" title="List of people with bipolar disorder">List of people with bipolar disorder</a>, <a href="http://en.wikipedia.org/wiki/Category:Books_about_bipolar_disorder" title="Category:Books about bipolar disorder">Category:Books about bipolar disorder</a> and <a href="http://en.wikipedia.org/wiki/Category:Films_about_bipolar_disorder" title="Category:Films about bipolar disorder">Category:Films about bipolar disorder</a></div>

<div>

<div>

Singer <a href="http://en.wikipedia.org/wiki/Rosemary_Clooney" title="Rosemary Clooney">Rosemary Clooney</a>'s public revelation of bipolar disorder in 1977 made her an early celebrity spokeswoman for mental illness</div>

</div>

There are widespread problems with <a href="http://en.wikipedia.org/wiki/Social_stigma" title="Social stigma">social stigma</a>, <a href="http://en.wikipedia.org/wiki/Stereotypes" title="Stereotypes">stereotypes</a>, and <a href="http://en.wikipedia.org/wiki/Prejudice" title="Prejudice">prejudice</a> against individuals with a diagnosis of bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Elgie2007-134">[134]</a>

<a href="http://en.wikipedia.org/wiki/Kay_Redfield_Jamison" title="Kay Redfield Jamison">Kay Redfield Jamison</a>, a clinical psychologist and Professor of Psychiatry at the <a href="http://en.wikipedia.org/wiki/Johns_Hopkins_University_School_of_Medicine" title="Johns Hopkins University School of Medicine">Johns Hopkins University School of Medicine</a>, profiled her own bipolar disorder in her memoir <a href="http://en.wikipedia.org/wiki/An_Unquiet_Mind" title="An Unquiet Mind">An Unquiet Mind</a> (1995).<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEJamison1995-135">[135]</a> In his autobiography <a href="http://en.wikipedia.org/wiki/Manicdotes:There%27s_Madness_in_His_Method" title="Manicdotes: There's Madness in His Method">Manicdotes: There's Madness in His Method</a> (2008) <a href="http://en.wikipedia.org/wiki/Chris_Joseph(autobiographer)" title="Chris Joseph (autobiographer)">Chris Joseph</a> describes his struggle between the creative dynamism which allowed the creation of his multi-million pound advertising agency <a href="http://en.wikipedia.org/wiki/Hook_Advertising" title="Hook Advertising">Hook Advertising</a>, and the money-squandering dark despair of his bipolar illness.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTEJoseph2008-136">[136]</a>

Several dramatic works have portrayed characters with traits suggestive of the diagnosis that has been the subject of discussion by psychiatrists and film experts alike. A notable example is <a href="http://en.wikipedia.org/wiki/Mr.Jones(1993_film)" title="Mr. Jones (1993 film)">Mr. Jones</a> (1993), in which Mr. Jones (<a href="http://en.wikipedia.org/wiki/Richard_Gere" title="Richard Gere">Richard Gere</a>) swings from a manic episode into a depressive phase and back again, spending time in a psychiatric hospital and displaying many of the features of the syndrome.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTERobinson200378.E2.80.9381-137">[137]</a> In <a href="http://en.wikipedia.org/wiki/The_Mosquito_Coast" title="The Mosquito Coast">The Mosquito Coast</a> (1986), Allie Fox (<a href="http://en.wikipedia.org/wiki/Harrison_Ford" title="Harrison Ford">Harrison Ford</a>) displays some features including recklessness, grandiosity, increased goal-directed activity and mood lability, as well as some paranoia.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-FOOTNOTERobinson200384.E2.80.9385-138">[138]</a> Psychiatrists have suggested that <a href="http://en.wikipedia.org/wiki/Willy_Loman" title="Willy Loman">Willy Loman</a>, the main character in <a href="http://en.wikipedia.org/wiki/Arthur_Miller" title="Arthur Miller">Arthur Miller</a>'s classic play <a href="http://en.wikipedia.org/wiki/Death_of_a_Salesman" title="Death of a Salesman">Death of a Salesman</a>, suffers from bipolar disorder,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-139">[139]</a> though that specific term for the condition did not exist when the play was written.

<a href="http://en.wikipedia.org/wiki/TV_special" title="TV special">TV specials</a>, for example the <a href="http://en.wikipedia.org/wiki/BBC" title="BBC">BBC</a>'s <a href="http://en.wikipedia.org/wiki/Stephen_Fry:_The_Secret_Life_of_the_Manic_Depressive" title="Stephen Fry: The Secret Life of the Manic Depressive">Stephen Fry: The Secret Life of the Manic Depressive</a>,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-140">[140]</a> <a href="http://en.wikipedia.org/wiki/MTV" title="MTV">MTV</a>'s <a href="http://en.wikipedia.org/wiki/True_Life" title="True Life">True Life</a>: I'm Bipolar, talk shows, and public radio shows, and the greater willingness of public figures to discuss their own bipolar disorder, have focused on psychiatric conditions, thereby, raising public awareness.

On April 7, 2009, the nighttime drama <a href="http://en.wikipedia.org/wiki/90210(TV_series)" title="90210 (TV series)">90210</a> on the <a href="http://en.wikipedia.org/wiki/The_CW" title="The CW">CW</a> network, aired a <a href="http://en.wikipedia.org/wiki/Very_special_episode" title="Very special episode">special episode</a> where the character Silver was diagnosed with bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-141">[141]</a> <a href="http://en.wikipedia.org/wiki/Stacey_Slater" title="Stacey Slater">Stacey Slater</a>, a character from the BBC soap <a href="http://en.wikipedia.org/wiki/EastEnders" title="EastEnders">EastEnders</a>, has been diagnosed with the disorder. The storyline was developed as part of the BBC's Headroom campaign.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-142">[142]</a> The <a href="http://en.wikipedia.org/wiki/Channel_4" title="Channel 4">Channel 4</a> soap<a href="http://en.wikipedia.org/wiki/Brookside" title="Brookside">Brookside</a> had earlier featured a story about bipolar disorder when the character <a href="http://en.wikipedia.org/wiki/Jimmy_Corkhill" title="Jimmy Corkhill">Jimmy Corkhill</a> was diagnosed with the condition.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Echo14May2003-143">[143]</a> In April 2014, <a href="http://en.wikipedia.org/wiki/American_Broadcasting_Company" title="American Broadcasting Company">ABC</a> premiered a medical drama,<a href="http://en.wikipedia.org/wiki/Black_Box(TV_series)" title="Black Box (TV series)">Black Box</a>, in which the main character, a world-renowned neuroscientist, is bipolar.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-144">[144]</a>

Currently, British secret intelligence agency, <a href="http://en.wikipedia.org/wiki/SIS" title="SIS">SIS</a>, doesn't accept job applications from those who "have ever suffered from bipolar disorder".<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-145">[145]</a>

<h2>Specific populations</h2>

<h3>Children</h3>

<div>Main article: <a href="http://en.wikipedia.org/wiki/Bipolar_disorder_in_children" title="Bipolar disorder in children">Bipolar disorder in children</a></div>

<div>

<div>

<a href="http://en.wikipedia.org/wiki/Lithium_(medication)" title="Lithium (medication)">Lithium</a> is the only medication approved for treating mania in children by the FDA</div>

</div>

In the 1920s, <a href="http://en.wikipedia.org/wiki/Emil_Kraepelin" title="Emil Kraepelin">Emil Kraepelin</a> noted that manic episodes are rare before puberty.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a> In general, bipolar disorder in children was not recognized in the first half of the twentieth century. This issue diminished with an increased following of the DSM criteria in the last part of the twentieth century.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-147">[147]</a>

While in adults the course of bipolar disorder is characterized by discrete episodes of depression and mania with no clear symptomatology between them, in children and adolescents very fast mood changes or even chronic symptoms are the norm.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Pediatric bipolar disorder is commonly characterized by outbursts of anger, irritability and<a href="http://en.wikipedia.org/wiki/Psychosis" title="Psychosis">psychosis</a>, rather than <a href="http://en.wikipedia.org/wiki/Euphoria" title="Euphoria">euphoric</a> <a href="http://en.wikipedia.org/wiki/Mania" title="Mania">mania</a>, which is more likely to be seen in adults.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Early onset bipolar disorder is more likely to manifest as depression rather than mania or hypomania.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Cosgrove2013-149">[149]</a>

The diagnosis of childhood bipolar disorder is controversial,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> although it is not under discussion that the typical symptoms of bipolar disorder have negative consequences for minors suffering them.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a> The debate is mainly centered on whether what is called bipolar disorder in children refers to the same disorder as when diagnosing adults,<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a> and the related question of whether the criteria for diagnosis for adults are useful and accurate when applied to children.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Regarding diagnosis of children, some experts recommend following the DSM criteria.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Others believe that these criteria do not correctly separate children with bipolar disorder from other problems such as ADHD, and emphasize fast mood cycles.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Still others argue that what accurately differentiates children with bipolar disorder is irritability.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> The practice parameters of the <a href="http://en.wikipedia.org/wiki/American_Academy_of_Child_and_Adolescent_Psychiatry" title="American Academy of Child and Adolescent Psychiatry">AACAP</a>encourage the first strategy.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> American children and adolescents diagnosed with bipolar disorder in community hospitals increased 4-fold reaching rates of up to 40% in 10 years around the beginning of the 21st century, while in <a href="http://en.wikipedia.org/wiki/Outpatient" title="Outpatient">outpatient</a> clinics it doubled reaching 6%.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Studies using DSM criteria show that up to 1% of youth may have bipolar disorder.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a>

Treatment involves medication and psychotherapy.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Drug prescription usually consists in <a href="http://en.wikipedia.org/wiki/Mood_stabilizer" title="Mood stabilizer">mood stabilizers</a> and <a href="http://en.wikipedia.org/wiki/Atypical_antipsychotic" title="Atypical antipsychotic">atypical antipsychotics</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> Among the former, <a href="http://en.wikipedia.org/wiki/Lithium(medication)" title="Lithium (medication)">lithium</a> is the only compound approved by the<a href="http://en.wikipedia.org/wiki/Food_and_Drug_Administration" title="Food and Drug Administration">FDA</a> for children.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17195735-146">[146]</a> Psychological treatment combines normally <a href="http://en.wikipedia.org/wiki/Psychoeducation" title="Psychoeducation">education on the disease</a>, <a href="http://en.wikipedia.org/wiki/Group_psychotherapy" title="Group psychotherapy">group therapy</a> and <a href="http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">cognitive behavioral therapy</a>.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> <a href="http://en.wikipedia.org/wiki/Chronic(medicine)" title="Chronic (medicine)">Chronic</a> medication is often needed.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a>

Current research directions for bipolar disorder in children include optimizing treatments, increasing the knowledge of the genetic and neurobiological basis of the pediatric disorder and improving diagnostic criteria.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid17716034-148">[148]</a> The <a href="http://en.wikipedia.org/wiki/DSM-V" title="DSM-V">DSM-V</a> has proposed a new diagnosis which is considered to cover some presentations currently thought of as childhood-onset bipolar.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-150">[150]</a>

<h3>Elderly</h3>

There is a relative lack of knowledge about bipolar disorder in late life. There is evidence that it becomes less prevalent with age but nevertheless accounts for a similar percentage of psychiatric admissions; that older bipolar patients had first experienced symptoms at a later age; that later onset of mania is associated with more neurologic impairment; that substance abuse is considerably less common in older groups; and that there is probably a greater degree of variation in presentation and course, for instance individuals may develop new-onset mania associated with vascular changes, or become manic only after recurrent depressive episodes, or may have been diagnosed with bipolar disorder at an early age and still meet criteria. There is also some weak and not conclusive evidence that mania is less intense and there is a higher prevalence of mixed episodes, although there may be a reduced response to treatment. Overall, there are likely more similarities than differences from younger adults.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-Vasudev2010-151">[151]</a><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-pmid15383127-152">[152]</a> In the elderly, recognition and treatment of bipolar disorder may be complicated by the presence of <a href="http://en.wikipedia.org/wiki/Dementia" title="Dementia">dementia</a> or the side effects of medications being taken for other conditions.<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_note-153">[153]</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorders_research" title="Bipolar disorders research">Bipolar disorders research</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_Disorders_(journal)" title="Bipolar Disorders (journal)">Bipolar Disorders (journal)</a></li>

</ul>

<h2>Notes</h2>

<div>

<ol>

<li id="cite_note-BMJ2012-1">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-4">e</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-5">f</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-6">g</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-7">h</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-8">i</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-9">j</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-10">k</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BMJ2012_1-11">l</a> Anderson, IM; Haddad, PM; Scott, J (Dec 27, 2012). "Bipolar disorder.". BMJ (Clinical research ed.) 345: e8508. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1136%2Fbmj.e8508">10.1136/bmj.e8508</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23271744">23271744</a>.</li>

<li id="cite_note-DSM5-2">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-DSM5_2-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-DSM5_2-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-DSM5_2-2">c</a> American Psychiatry Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed. ed.). Arlington: American Psychiatric Publishing. pp. 123–154. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/0890425558" title="Special:BookSources/0890425558">0890425558</a>.</li>

<li id="cite_note-3"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-3">Jump up^{</a> Goodwin}, Guy M. "Bipolar disorder". Medicine 40 (11): 596–598. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.mpmed.2012.08.011">10.1016/j.mpmed.2012.08.011</a>.</li>

<li id="cite_note-Schmitt2014-4">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Schmitt2014_4-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Schmitt2014_4-1">b</a> Schmitt A, Malchow B, Hasan A, Falkai P (February 2014). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920481">"The impact of environmental factors in severe psychiatric disorders"</a>. Front Neurosci 8 (19). <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.3389%2Ffnins.2014.00019">10.3389/fnins.2014.00019</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920481">3920481</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/24574956">24574956</a>.</li>

<li id="cite_note-5"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-5">Jump up^{</a> Diflorio}, A; Jones, I (2010). "Is sex important? Gender differences in bipolar disorder.". International review of psychiatry (Abingdon, England) 22 (5): 437–52. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.3109%2F09540261.2010.514601">10.3109/09540261.2010.514601</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/21047158">21047158</a>.</li>

<li id="cite_note-Hirs205-6">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Hirs205_6-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Hirs205_6-1">b</a> Hirschfeld, RM; Vornik, LA (Jun 2005). "Bipolar disorder—costs and comorbidity.". The American journal of managed care 11 (3 Suppl): S85–90. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/16097719">16097719</a>.</li>

<li id="cite_note-Barnett2009-7">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-4">e</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-5">f</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-6">g</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-7">h</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-8">i</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Barnett2009_7-9">j</a> Barnett JH, Smoller JW (2009). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637882">"The genetics of bipolar disorder"</a>. Neuroscience 164 (1): 331–43. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.neuroscience.2009.03.080">10.1016/j.neuroscience.2009.03.080</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3637882">3637882</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19358880">19358880</a>.</li>

<li id="cite_note-Beentjes2012-8">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-4">e</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-5">f</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-6">g</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-7">h</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-8">i</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-9">j</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Beentjes2012_8-10">k</a> Beentjes TA, Goossens PJ, Poslawsky IE (October 2012). "Caregiver burden in bipolar hypomania and mania: a systematic review". Perspect Psychiatr Care 48 (4): 187–97. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1744-6163.2012.00328.x">10.1111/j.1744-6163.2012.00328.x</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23005586">23005586</a>.</li>

<li id="cite_note-Salvadore2010-9">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Salvadore2010_9-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Salvadore2010_9-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Salvadore2010_9-2">c</a> Salvadore G, Quiroz JA, Machado-Vieira R, Henter ID, Manji HK, Zarate CA (November 2010). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000635">"The neurobiology of the switch process in bipolar disorder: a review"</a>. J Clin Psychiatry 71 (11): 1488–1501.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.4088%2FJCP.09r05259gre">10.4088/JCP.09r05259gre</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3000635">3000635</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/20492846">20492846</a>.</li>

<li id="cite_note-10"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-10">Jump up^{</a>&nbsp};Titmarsh S (May–June 2013). <a rel="nofollow" href="http://onlinelibrary.wiley.com/doi/10.1002/pnp.283/pdf">"Characteristics and duration of mania: implications for continuation treatment"</a>. Progress in Neurology and Psychiatry 17 (3): 26–7. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1002%2Fpnp.283">10.1002/pnp.283</a>.</li>

<li id="cite_note-Tarr2011-11">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Tarr2011_11-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Tarr2011_11-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Tarr2011_11-2">c</a> Tarr GP, Glue P, Herbison P (November 2011). "Comparative efficacy and acceptability of mood stabilizer and second generation antipsychotic monotherapy for acute mania—a systematic review and meta-analysis". J Affect Disord 134 (1–3): 14–9. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.jad.2010.11.009">10.1016/j.jad.2010.11.009</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/21145595">21145595</a>.</li>

<li id="cite_note-Post2013-12">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Post2013_12-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Post2013_12-1">b</a> Post RM, Kalivas P (March 2013). <a rel="nofollow" href="http://bjp.rcpsych.org/content/202/3/172.long">"Bipolar disorder and substance misuse: pathological and therapeutic implications of their comorbidity and cross-sensitisation"</a>. Br J Psychiatry 202 (3): 172–6.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1192%2Fbjp.bp.112.116855">10.1192/bjp.bp.112.116855</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23457180">23457180</a>.</li>

<li id="cite_note-Knowles2011-13"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Knowles2011_13-0">Jump up^{</a>&nbsp};Knowles R, McCarthy-Jones S, Rowse G (June 2011). "Grandiose delusions: a review and theoretical integration of cognitive and affective perspectives". Clin Psychol Rev 31 (4): 684–96.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.cpr.2011.02.009">10.1016/j.cpr.2011.02.009</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/21482326">21482326</a>.</li>

<li id="cite_note-Kerner2014-14">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Kerner2014_14-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Kerner2014_14-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Kerner2014_14-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Kerner2014_14-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Kerner2014_14-4">e</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Kerner2014_14-5">f</a> Kerner B (February 2014). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966627">"Genetics of bipolar disorder"</a>. Appl Clin Genet 7: 33–42.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.2147%2Ftacg.s39297">10.2147/tacg.s39297</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3966627">3966627</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/24683306">24683306</a>.</li>

<li id="cite_note-15"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-15">Jump up^{</a>&nbsp};Furukawa TA (2010). "Assessment of mood: Guides for clinicians". Journal of Psychosomatic Research68 (6): 581–589. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.jpsychores.2009.05.003">10.1016/j.jpsychores.2009.05.003</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/20488276">20488276</a>.</li>

<li id="cite_note-McKenna2012-16"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-McKenna2012_16-0">Jump up^{</a>&nbsp};McKenna BS, Eyler LT (November 2012). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922056">"Overlapping prefrontal systems involved in cognitive and emotional processing in euthymic bipolar disorder and following sleep deprivation: a review of functional neuroimaging studies"</a>. Clin Psychol Rev 32 (7): 650–63. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.cpr.2012.07.003">10.1016/j.cpr.2012.07.003</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3922056">3922056</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22926687">22926687</a>.</li>

<li id="cite_note-Mansell2008-17">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Mansell2008_17-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Mansell2008_17-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Mansell2008_17-2">c</a> Mansell W, Pedley R (Mar 2008). "The ascent into mania: a review of psychological processes associated with the development of manic symptoms.". Clinical Psychology Review 28 (3): 494–520.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.cpr.2007.07.010">10.1016/j.cpr.2007.07.010</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17825463">17825463</a>.</li>

<li id="cite_note-Bowins2013-18">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bowins2013_18-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bowins2013_18-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bowins2013_18-2">c</a> Bowins B (2007). "Cognitive regulatory control therapies". Am J Psychother 67 (3): 215–36.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/24236353">24236353</a>.</li>

<li id="cite_note-19"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-19">Jump up^{</a> }<a rel="nofollow" href="http://web.archive.org/web/20080429204140/http://www.pueblo.gsa.gov/cic_text/health/bipolar/bipolar.htm">"Bipolar Disorder: NIH Publication No. 95-3679"</a>. U.S. National Institutes of Health. September 1995. Archived from <a rel="nofollow" href="http://www.pueblo.gsa.gov/cic_text/health/bipolar/bipolar.htm">the original</a> on 2008-04-29.</li>

<li id="cite_note-20"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-20">Jump up^{</a> }<a rel="nofollow" href="http://www.webmd.com/bipolar-disorder/guide/bipolar-2-disorder">"Bipolar II Disorder Symptoms and Signs"</a>. Web M.D. Retrieved 2010-12-06.</li>

<li id="cite_note-Muneer2013-21">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Muneer2013_21-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Muneer2013_21-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Muneer2013_21-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Muneer2013_21-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Muneer2013_21-4">e</a> Muneer A (June 2013). "Treatment of the depressive phase of bipolar affective disorder: a review".J Pak Med Assoc 63 (6): 763–9. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23901682">23901682</a>.</li>

<li id="cite_note-22"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-22">Jump up^{</a> }"APA Practice Guidelines for the Treatment of Psychiatric Disorders: Comprehensive Guidelines and Guideline Watches" 1. 2006. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fappi.books.9780890423363.50051">10.1176/appi.books.9780890423363.50051</a>. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-89042-336-3" title="Special:BookSources/978-0-89042-336-3">978-0-89042-336-3</a>.<code>|chapter=</code> ignored (<a href="http://en.wikipedia.org/wiki/Help:CS1_errors#chapter_ignored" title="Help:CS1 errors">help</a>)</li>

<li id="cite_note-Bowden-23">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bowden_23-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bowden_23-1">b</a> Bowden CL (January 2001). "Strategies to reduce misdiagnosis of bipolar depression". Psychiatr Serv52 (1): 51–5. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fappi.ps.52.1.51">10.1176/appi.ps.52.1.51</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/11141528">11141528</a>.</li>

<li id="cite_note-Muzina2007-24"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Muzina2007_24-0">Jump up^{</a>&nbsp};Muzina DJ, Kemp DE, McIntyre RS (October–December 2007). "Differentiating bipolar disorders from major depressive disorders: treatment implications". Ann Clin Psychiatry 19 (4): 305–12.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1080%2F10401230701653591">10.1080/10401230701653591</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18058287">18058287</a>.</li>

<li id="cite_note-Swann2013-25">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Swann2013_25-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Swann2013_25-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Swann2013_25-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Swann2013_25-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Swann2013_25-4">e</a> Swann AC, Lafer B, Perugi G, Frye MA, Bauer M, Bahk WM, Scott J, Ha K, Suppes T (January 2013). "Bipolar mixed states: an international society for bipolar disorders task force report of symptom structure, course of illness, and diagnosis". Am J Psychiatry 170 (1): 31–42.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fappi.ajp.2012.12030301">10.1176/appi.ajp.2012.12030301</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23223893">23223893</a>.</li>

<li id="cite_note-pmid20936438-26"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid20936438_26-0">Jump up^{</a>&nbsp};Srivastava S, Ketter TA (December 2010). "The link between bipolar disorders and creativity: evidence from personality and temperament studies.". Current psychiatry reports 12 (6): 522–30. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1007%2Fs11920-010-0159-x">10.1007/s11920-010-0159-x</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/20936438">20936438</a>.</li>

<li id="cite_note-FOOTNOTEGoodwinJamison2007338-27"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEGoodwinJamison2007338_27-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFGoodwinJamison2007">Goodwin & Jamison 2007</a>, p. 338.</li>

<li id="cite_note-Reinhardt2013-28"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Reinhardt2013_28-0">Jump up^{</a>&nbsp};Reinhardt MC, Reinhardt CA (March–April 2013). "Attention deficit-hyperactivity disorder, comorbidities, and risk situations". J Pediatr (Rio J) 89 (2): 124–30. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.jped.2013.03.015">10.1016/j.jped.2013.03.015</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23642421">23642421</a>.</li>

<li id="cite_note-Cirillo2012-29"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Cirillo2012_29-0">Jump up^{</a>&nbsp};Cirillo PC, Passos RB, Bevilaqua MC, López JR, Nardi AE (December 2012). <a rel="nofollow" href="http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1516-44462012000400015&lng=en&nrm=iso&tlng=en">"Bipolar disorder and Premenstrual Syndrome or Premenstrual Dysphoric Disorder comorbidity: a systematic review"</a>. Rev Bras Psiquiatr 34 (4): 467–79. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.rbp.2012.04.010">10.1016/j.rbp.2012.04.010</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23429819">23429819</a>.</li>

<li id="cite_note-30"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-30">Jump up^{</a>&nbsp};Sagman D and Tohen M (2009). <a rel="nofollow" href="http://www.psychiatrictimes.com/display/article/10168/1391541">"Comorbidity in Bipolar Disorder: The Complexity of Diagnosis and Treatment"</a>. Psychiatric Times.</li>

<li id="cite_note-Nierenberg2013-31">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Nierenberg2013_31-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Nierenberg2013_31-1">b</a> Nierenberg AA, Kansky C, Brennan BP, Shelton RC, Perlis R, Iosifescu DV (January 2013). "Mitochondrial modulators for bipolar disorder: a pathophysiologically informed paradigm for new drug development". Aust N Z J Psychiatry 47 (1): 26–42. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1177%2F0004867412449303">10.1177/0004867412449303</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22711881">22711881</a>.</li>

<li id="cite_note-Edvardsen2008-32">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Edvardsen2008_32-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Edvardsen2008_32-1">b</a> Edvardsen J, Torgersen S, Røysamb E, Lygren S, Skre I, Onstad S, Oien PA (2008). "Heritability of bipolar spectrum disorders. Unity or heterogeneity?". Journal of Affective Disorders 106 (3): 229–240.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.jad.2007.07.001">10.1016/j.jad.2007.07.001</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17692389">17692389</a>.</li>

<li id="cite_note-Kieseppa_2004-33"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Kieseppa_2004_33-0">Jump up^{</a>&nbsp};Kieseppä T, Partonen T, Haukka J, Kaprio J, Lönnqvist J (2004). "High Concordance of Bipolar I Disorder in a Nationwide Sample of Twins". American Journal of Psychiatry 161 (10): 1814–1821.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fappi.ajp.161.10.1814">10.1176/appi.ajp.161.10.1814</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/15465978">15465978</a>.</li>

<li id="cite_note-34"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-34">Jump up^{</a>&nbsp};McGuffin P, Rijsdijk F, Andrew M, Sham P, Katz R, Cardno A (2003). "The Heritability of Bipolar Affective Disorder and the Genetic Relationship to Unipolar Depression". Archives of General Psychiatry 60 (5): 497–502. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1001%2Farchpsyc.60.5.497">10.1001/archpsyc.60.5.497</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/12742871">12742871</a>.</li>

<li id="cite_note-35"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-35">Jump up^{</a>&nbsp};Reich T, Clayton PJ, Winokur G (1969). "Family history studies: V. The genetics of mania". The American Journal of Psychiatry 125 (10): 1358–1369. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fajp.125.10.1358">10.1176/ajp.125.10.1358</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/5304735">5304735</a>.</li>

<li id="cite_note-Craddock2013-36">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Craddock2013_36-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Craddock2013_36-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Craddock2013_36-2">c</a> Craddock N, Sklar P (May 2013). "Genetics of bipolar disorder". Lancet 381 (9878): 1654–62.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2FS0140-6736%2813%2960855-7">10.1016/S0140-6736(13)60855-7</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23663951">23663951</a>.</li>

<li id="cite_note-37"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-37">Jump up^{</a>&nbsp};Segurado R, Detera-Wadleigh SD, Levinson DF, Lewis CM, Gill M, Nurnberger JI, Craddock N, DePaulo JR, Baron M, Gershon ES, Ekholm J, Cichon S, Turecki G, Claes S, Kelsoe JR, Schofield PR, Badenhop RF, Morissette J, Coon H, Blackwood D, McInnes LA, Foroud T, Edenberg HJ, Reich T, Rice JP, Goate A, McInnis MG, McMahon FJ, Badner JA, Goldin LR, Bennett P, Willour VL, Zandi PP, Liu J, Gilliam C, Juo SH, Berrettini WH, Yoshikawa T, Peltonen L, Lönnqvist J, Nöthen MM, Schumacher J, Windemuth C, Rietschel M, Propping P, Maier W, Alda M, Grof P, Rouleau GA, Del-Favero J, Van Broeckhoven C, Mendlewicz J, Adolfsson R, Spence MA, Luebbert H, Adams LJ, Donald JA, Mitchell PB, Barden N, Shink E, Byerley W, Muir W, Visscher PM, Macgregor S, Gurling H, Kalsi G, McQuillin A, Escamilla MA, Reus VI, Leon P, Freimer NB, Ewald H, Kruse TA, Mors O, Radhakrishna U, Blouin JL, Antonarakis SE, Akarsu N (2003). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1180589">"Genome Scan Meta-Analysis of Schizophrenia and Bipolar Disorder, Part III: Bipolar Disorder"</a>. The American Journal of Human Genetics 73 (1): 49–62. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1086%2F376547">10.1086/376547</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1180589">1180589</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/12802785">12802785</a>.</li>

<li id="cite_note-38"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-38">Jump up^{</a>&nbsp};Frans EM, Sandin S, Reichenberg A, Lichtenstein P, Långström N, Hultman CM (2008). "Advancing Paternal Age and Bipolar Disorder". Archives of General Psychiatry 65 (9): 1034–1040.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1001%2Farchpsyc.65.9.1034">10.1001/archpsyc.65.9.1034</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18762589">18762589</a>.</li>

<li id="cite_note-39"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-39">Jump up^{</a>&nbsp};Kempton MJ, Geddes JR, Ettinger U, Williams SC, Grasby PM (2008). "Meta-analysis, Database, and Meta-regression of 98 Structural Imaging Studies in Bipolar Disorder". Archives of General Psychiatry 65 (9): 1017–1032. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1001%2Farchpsyc.65.9.1017">10.1001/archpsyc.65.9.1017</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18762588">18762588</a>.</li>

<li id="cite_note-pmid19721106-40"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid19721106_40-0">Jump up^{</a>&nbsp};Arnone D, Cavanagh J, Gerber D, Lawrie SM, Ebmeier KP, McIntosh AM (2009). "Magnetic resonance imaging studies in bipolar disorder and schizophrenia: Meta-analysis". The British Journal of Psychiatry 195(3): 194–201. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1192%2Fbjp.bp.108.059717">10.1192/bjp.bp.108.059717</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19721106">19721106</a>.</li>

<li id="cite_note-41"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-41">Jump up^{</a> }<a rel="nofollow" href="https://sites.google.com/site/bipolardatabase/">"Bipolar MRI Database"</a>. Bipolar Disorder Neuroimaging Database (BiND).</li>

<li id="cite_note-42"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-42">Jump up^{</a>&nbsp};Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD (2012). "The functional neuroanatomy of bipolar disorder: A consensus model". Bipolar Disorders 14 (4): 313–325. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1399-5618.2012.01022.x">10.1111/j.1399-5618.2012.01022.x</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22631617">22631617</a>.</li>

<li id="cite_note-Bender2011-43"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bender2011_43-0">Jump up^{</a>&nbsp};Bender RE, Alloy LB (April 2011). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072804">"Life stress and kindling in bipolar disorder: review of the evidence and integration with emerging biopsychosocial theories"</a>. Clin Psychol Rev 31 (3): 383–98.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.cpr.2011.01.004">10.1016/j.cpr.2011.01.004</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3072804">3072804</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/21334286">21334286</a>.</li>

<li id="cite_note-Lee2013-44"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Lee2013_44-0">Jump up^{</a>&nbsp};Lee HJ, Son GH, Geum D (September 2013). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843013">"Circadian Rhythm Hypotheses of Mixed Features, Antidepressant Treatment Resistance, and Manic Switching in Bipolar Disorder"</a>. Psychiatry Investig 10(3): 225–32. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.4306%2Fpi.2013.10.3.225">10.4306/pi.2013.10.3.225</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3843013">3843013</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/24302944">24302944</a>.</li>

<li id="cite_note-FOOTNOTEBrownBasso200416-45"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEBrownBasso200416_45-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFBrownBasso2004">Brown & Basso 2004</a>, p. 16.</li>

<li id="cite_note--46"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-_46-0">Jump up^{</a>&nbsp};Dallaspezia S, Benedetti F (December 2009). "Melatonin, circadian rhythms, and the clock genes in bipolar disorder". Curr Psychiatry Rep 11 (6): 488–93. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1007%2Fs11920-009-0074-1">10.1007/s11920-009-0074-1</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19909672">19909672</a>.</li>

<li id="cite_note-Serretti-47"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Serretti_47-0">Jump up^{</a>&nbsp};Serretti A, Mandelli L (2008). "The genetics of bipolar disorder: Genome 'hot regions,' genes, new potential candidates and future directions". Molecular Psychiatry 13 (8): 742–771. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1038%2Fmp.2008.29">10.1038/mp.2008.29</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18332878">18332878</a>.</li>

<li id="cite_note-Geddestreatment-48">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Geddestreatment_48-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Geddestreatment_48-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Geddestreatment_48-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Geddestreatment_48-3">d</a> Geddes JR, Miklowitz DJ (May 11, 2013). "Treatment of bipolar disorder". Lancet 381 (9878): 1672–82. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2FS0140-6736%2813%2960857-0">10.1016/S0140-6736(13)60857-0</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23663953">23663953</a>.</li>

<li id="cite_note-Brietzke2012-49"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Brietzke2012_49-0">Jump up^{</a>&nbsp};Brietzke E, Kauer Sant'anna M, Jackowski A, Grassi-Oliveira R, Bucker J, Zugman A, Mansur RB, Bressan RA (December 2012). <a rel="nofollow" href="http://www.scielo.br/pdf/rbp/v34n4/v34n4a16.pdf">"Impact of childhood stress on psychopathology"</a>. Rev Bras Psiquiatr 34(4): 480–8. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.rbp.2012.04.009">10.1016/j.rbp.2012.04.009</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23429820">23429820</a>.</li>

<li id="cite_note-50"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-50">Jump up^{</a>&nbsp};Miklowitz DJ, Chang KD (2008). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504732">"Prevention of bipolar disorder in at-risk children: Theoretical assumptions and empirical foundations"</a>. Development and Psychopathology 20 (3): 881–897.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1017%2FS0954579408000424">10.1017/S0954579408000424</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504732">2504732</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18606036">18606036</a>.</li>

<li id="cite_note-51"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-51">Jump up^{</a>&nbsp};Murray ED, Buttner N, Price BH. (2012) Depression and Psychosis in Neurological Practice. In: Neurology in Clinical Practice, 6th Edition. Bradley WG, Daroff RB, Fenichel GM, Jankovic J (eds.) Butterworth Heinemann. April 12, 2012. <a href="http://en.wikipedia.org/wiki/Special:BookSources/1437704344">ISBN 1437704344</a> | <a href="http://en.wikipedia.org/wiki/Special:BookSources/9781437704341">ISBN 978-1437704341</a></li>

<li id="cite_note-52"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-52">Jump up^{</a>&nbsp};Lahera G, Freund N, Sáiz-Ruiz J (January–March 2013). <a rel="nofollow" href="http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90186843&pident_usuario=0&pcontactid=&pident_revista=486&ty=75&accion=L&origen=zonadelectura&web=zl.elsevier.es&lan=en&fichero=486v06n01a90186843pdf001.pdf">"Salience and dysregulation of the dopaminergic system"</a>. Rev Psquiatr Salud Ment 6 (1): 45–51. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.rpsm.2012.05.003">10.1016/j.rpsm.2012.05.003</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23084802">23084802</a>.</li>

<li id="cite_note-53"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-53">Jump up^{</a>&nbsp};Berk M, Dodd S, Kauer-Sant'anna M, Malhi GS, Bourin M, Kapczinski F, Norman T (2007). "Dopamine dysregulation syndrome: implications for a dopamine hypothesis of bipolar disorder". Acta Psychiatr Scanda Suppl 116 (Supplement s434): 41–49. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1600-0447.2007.01058.x">10.1111/j.1600-0447.2007.01058.x</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17688462">17688462</a>.</li>

<li id="cite_note-54"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-54">Jump up^{</a>&nbsp};Michael N, Erfurth A, Ohrmann P, Gössling M, Arolt V, Heindel W, Pfleiderer B (2003). "Acute mania is accompanied by elevated glutamate/glutamine levels within the left dorsolateral prefrontal cortex".Psychopharmacology 168 (3): 344–346. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1007%2Fs00213-003-1440-z">10.1007/s00213-003-1440-z</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/12684737">12684737</a>.</li>

<li id="cite_note-55"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-55">Jump up^{</a>&nbsp};Benes FM, Berretta S (2001). "GABAergic interneurons: implications for understanding schizophrenia and bipolar disorder". Neuropsychopharmacology 25 (1): 1–27. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2FS0893-133X%2801%2900225-1">10.1016/S0893-133X(01)00225-1</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/11377916">11377916</a>.</li>

<li id="cite_note-56"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-56">Jump up^{</a>&nbsp};Phelps JR (2008). <a rel="nofollow" href="http://www.psycheducation.org/BipolarMechanism/5BigPicture.htm">"Chapter 5: The Big Picture — There Must Be Some Evolutionary Advantage?"</a>. The Biologic Basis of Bipolar Disorder. PsychEducation.org.</li>

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<li id="cite_note-58"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-58">Jump up^{</a>&nbsp};Jamison KR (1993). Touched With Fire: Manic-depressive illness and the artistic temperament. New York: The Free Press. <a href="http://en.wikipedia.org/wiki/Amazon_Standard_Identification_Number" title="Amazon Standard Identification Number">ASIN</a> <a rel="nofollow" href="http://www.amazon.com/dp/B002C47A0K">B002C47A0K</a>.</li>

<li id="cite_note-url_Hypomanias_up_side-59"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-url_Hypomanias_up_side_59-0">Jump up^{</a>&nbsp};Carey B (April 2005). <a rel="nofollow" href="http://www.utsandiego.com/uniontrib/20050406/news_1c06hypo.html">"Hypomania's up side distinct but linked to bipolar disorder"</a>. Psychology. New York Times News Service/The San Diego Union-Tribune.</li>

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<li id="cite_note-61"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-61">Jump up^{</a>&nbsp};Sherman JA (2012). "Evolutionary origin of bipolar disorder-revised: EOBD-R". Medical Hypotheses 78(1): 113–122. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.mehy.2011.10.005">10.1016/j.mehy.2011.10.005</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22036090">22036090</a>.</li>

<li id="cite_note-62"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-62">Jump up^{</a>&nbsp};Miklowitz DJ, Chang KD (Summer 2008). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504732">"Prevention of bipolar disorder in at-risk children: theoretical assumptions and empirical foundations."</a>. Development and Psychopathology 20 (3): 881–97.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1017%2Fs0954579408000424">10.1017/s0954579408000424</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504732">2504732</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18606036">18606036</a>.</li>

<li id="cite_note-63"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-63">Jump up^{</a>&nbsp};Khan MA, Akella S (December 2009). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144">"Cannabis-Induced Bipolar Disorder with Psychotic Features: A Case Report"</a>. Psychiatry (Edgmont) 6 (12): 44–8. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811144">2811144</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/20104292">20104292</a>.</li>

<li id="cite_note-Price2012-64">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Price2012_64-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Price2012_64-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Price2012_64-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Price2012_64-3">d</a> Price AL, Marzani-Nissen GR (March 2012). <a rel="nofollow" href="http://www.aafp.org/afp/2012/0301/p483.html">"Bipolar disorders: a review"</a>. Am Fam Physician 85(5): 483–93. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22534227">22534227</a>.</li>

<li id="cite_note-Phillips2013-65"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Phillips2013_65-0">Jump up^{</a>&nbsp};Phillips ML, Kupfer DJ (May 2013). "Bipolar disorder diagnosis: challenges and future directions". Lancet381 (9878): 1663–71. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2FS0140-6736%2813%2960989-7">10.1016/S0140-6736(13)60989-7</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23663952">23663952</a>.</li>

<li id="cite_note-66"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-66">Jump up^{</a> Perugi}, G.; Ghaemi, S. N.; Akiskal, H. (2006). "Bipolar Psychopharmacotherapy". p. 193.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1002%2F0470017953.ch11">10.1002/0470017953.ch11</a>. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/9780470017951" title="Special:BookSources/9780470017951">9780470017951</a>. <code>|chapter=</code> ignored (<a href="http://en.wikipedia.org/wiki/Help:CS1_errors#chapter_ignored" title="Help:CS1 errors">help</a>)</li>

<li id="cite_note-pmid19122534-67">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid19122534_67-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid19122534_67-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid19122534_67-2">c</a> Picardi A (2009). "Rating scales in bipolar disorder". Current Opinion in Psychiatry 22 (1): 42–49.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1097%2FYCO.0b013e328315a4d2">10.1097/YCO.0b013e328315a4d2</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19122534">19122534</a>.</li>

<li id="cite_note-68"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-68">Jump up^{</a> <i}>Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (Text Revision). American Psychiatric Association. p. 2000.</li>

<li id="cite_note-69"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-69">Jump up^{</a>&nbsp};Korn ML. <a rel="nofollow" href="http://www.medscape.com/viewarticle/441617">"Across the Bipolar Spectrum: From Practice to Research"</a>. Medscape.</li>

<li id="cite_note-pmid19689506-70"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid19689506_70-0">Jump up^{</a>&nbsp};Beesdo K, Höfler M, Leibenluft E, Lieb R, Bauer M, Pfennig A (September 2009). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796427">"Mood episodes and mood disorders: patterns of incidence and conversion in the first three decades of life"</a>. Bipolar Disord 11(6): 637–49. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1399-5618.2009.00738.x">10.1111/j.1399-5618.2009.00738.x</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796427">2796427</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19689506">19689506</a>.</li>

<li id="cite_note-71"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-71">Jump up^{</a>&nbsp};Akiskal HS, Benazzi F (2006). "The DSM-IV and ICD-10 categories of recurrent [major] depressive and bipolar II disorders: Evidence that they lie on a dimensional spectrum". Journal of Affective Disorders 92 (1): 45–54. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.jad.2005.12.035">10.1016/j.jad.2005.12.035</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/16488021">16488021</a>.</li>

<li id="cite_note-73"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-73">Jump up^{</a> }<a rel="nofollow" href="http://behavenet.com/bipolar-disorder#301">"Bipolar Disorder"</a>. BehaveNet.</li>

<li id="cite_note-Renk2014-74">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Renk2014_74-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Renk2014_74-1">b</a> Renk K, White R, Lauer BA, McSwiggan M, Puff J, Lowell A (February 2014). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994906">"Bipolar Disorder in Children"</a>. Psychiatry J 2014 (928685): 1–19. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1155%2F2014%2F928685">10.1155/2014/928685</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3994906">3994906</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/24800202">24800202</a>.</li>

<li id="cite_note-Van_Meter_2012-75"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Van_Meter_2012_75-0">Jump up^{</a>&nbsp};Van Meter AR, Youngstrom EA, Findling RL (June 2012). "Cyclothymic disorder: a critical review". Clin Psychol Rev 32 (4): 229–43. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.cpr.2012.02.001">10.1016/j.cpr.2012.02.001</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22459786">22459786</a>.</li>

<li id="cite_note-Towbin2013-76"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Towbin2013_76-0">Jump up^{</a>&nbsp};Towbin K, Axelson D, Leibenluft E, Birmaher B (May 2013). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697010">"Differentiating bipolar disorder-not otherwise specified and severe mood dysregulation"</a>. J Am Acad Child Adolesc Psychiatry 52 (5): 466–81.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.jaac.2013.02.006">10.1016/j.jaac.2013.02.006</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3697010">3697010</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23622848">23622848</a>.</li>

<li id="cite_note-77"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-77">Jump up^{</a> }<a rel="nofollow" href="http://behavenet.com/longitudinal-course-specifiers-mood-disorders-0#301">"Longitudinal Course Specifiers for Mood Disorders"</a>. BehaveNet.</li>

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<li id="cite_note-Bauer2008-79"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bauer2008_79-0">Jump up^{</a>&nbsp};Bauer M, Beaulieu S, Dunner DL, Lafer B, Kupka R (February 2008). "Rapid cycling bipolar disorder – diagnostic concepts". Bipolar Disorders 10 (1 Pt 2): 153–62. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1399-5618.2007.00560.x">10.1111/j.1399-5618.2007.00560.x</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18199234">18199234</a>.</li>

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<li id="cite_note-Fountoulakis2013-81"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Fountoulakis2013_81-0">Jump up^{</a>&nbsp};Fountoulakis KN, Kontis D, Gonda X, Yatham LN (March 2013). "A systematic review of the evidence on the treatment of rapid cycling bipolar disorder". Bipolar Disord 15 (2): 115–37. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fbdi.12045">10.1111/bdi.12045</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23437958">23437958</a>.</li>

<li id="cite_note-Baldessarini2013-82">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Baldessarini2013_82-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Baldessarini2013_82-1">b</a> Baldessarini RJ, Faedda GL, Offidani E, Vázquez GH, Marangoni C, Serra G, Tondo L (May 2013). "Antidepressant-associated mood-switching and transition from unipolar major depression to bipolar disorder: a review". J Affect Disord 148 (1): 129–35. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.jad.2012.10.033">10.1016/j.jad.2012.10.033</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23219059">23219059</a>.</li>

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<li id="cite_note-Magill2004-84"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Magill2004_84-0">Jump up^{</a>&nbsp};Magill CA (2004). "The boundary between borderline personality disorder and bipolar disorder: Current concepts and challenges". Canadian journal of psychiatry. Revue canadienne de psychiatrie 49 (8): 551–556. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/15453104">15453104</a>.</li>

<li id="cite_note-Bassett2012-85"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Bassett2012_85-0">Jump up^{</a>&nbsp};Bassett D (2012). "Borderline personality disorder and bipolar affective disorder. Spectra or spectre? A review". Australian and New Zealand Journal of Psychiatry 46 (4): 327–339.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1177%2F0004867411435289">10.1177/0004867411435289</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22508593">22508593</a>.</li>

<li id="cite_note-BeckerKilian2006-86"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-BeckerKilian2006_86-0">Jump up^{</a>&nbsp};Becker T, Kilian R (2006). "Psychiatric services for people with severe mental illness across western Europe: What can be generalized from current knowledge about differences in provision, costs and outcomes of mental health care?". Acta Psychiatrica Scandinavica 113 (429): 9–16. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1600-0447.2005.00711.x">10.1111/j.1600-0447.2005.00711.x</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/16445476">16445476</a>.</li>

<li id="cite_note-87"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-87">Jump up^{</a>&nbsp};McGurk SR, Mueser KT, Feldman K, Wolfe R, Pascaris A (2007). "Cognitive Training for Supported Employment: 2–3 Year Outcomes of a Randomized Controlled Trial". American Journal of Psychiatry 164(3): 437–441. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fappi.ajp.164.3.437">10.1176/appi.ajp.164.3.437</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17329468">17329468</a>.</li>

<li id="cite_note-88"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-88">Jump up^{</a>&nbsp};Lam et al., 1999; Miklowitz & Goldstein, 1997; Frank, 2005.[<a href="http://en.wikipedia.org/wiki/Wikipedia:Citing_sources#What_information_to_include" title="Wikipedia:Citing sources">full citation needed</a>]</li>

<li id="cite_note-FOOTNOTELeahyJohnson2003-89"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTELeahyJohnson2003_89-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFLeahyJohnson2003">Leahy & Johnson 2003</a>.</li>

<li id="cite_note-FOOTNOTEBascoRush2005-90"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEBascoRush2005_90-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFBascoRush2005">Basco & Rush 2005</a>.</li>

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<li id="cite_note-92"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-92">Jump up^{</a>&nbsp};Havens LL, Ghaemi SN (2005). "Existential despair and bipolar disorder: The therapeutic alliance as a mood stabilizer". American journal of psychotherapy 59 (2): 137–147. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/16170918">16170918</a>.</li>

<li id="cite_note-Brown2013-93"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Brown2013_93-0">Jump up^{</a>&nbsp};Brown KM, Tracy DK (June 2013). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805456">"Lithium: the pharmacodynamic actions of the amazing ion"</a>. Ther Adv Psychopharmacol 3 (3): 163–76. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1177%2F2045125312471963">10.1177/2045125312471963</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3805456">3805456</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/24167688">24167688</a>.</li>

<li id="cite_note-pmid23814104-94"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid23814104_94-0">Jump up^{</a>&nbsp};Cipriani A, Hawton K, Stockton S, Geddes JR (2013). "Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis". BMJ 346: f3646. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1136%2Fbmj.f3646">10.1136/bmj.f3646</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23814104">23814104</a>.</li>

<li id="cite_note-95"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-95">Jump up^{</a>&nbsp};Post RM, Ketter TA, Uhde T, Ballenger JC (2007). "Thirty years of clinical experience with carbamazepine in the treatment of bipolar illness: Principles and practice". CNS Drugs 21 (1): 47–71. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.2165%2F00023210-200721010-00005">10.2165/00023210-200721010-00005</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17190529">17190529</a>.</li>

<li id="cite_note-Rapoport2009-96"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Rapoport2009_96-0">Jump up^{</a>&nbsp};Rapoport SI, Basselin M, Kim HW, Rao JS (October 2009). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757443">"Bipolar disorder and mechanisms of action of mood stabilizers"</a>. Brain Res Rev 61 (2): 185–209. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.brainresrev.2009.06.003">10.1016/j.brainresrev.2009.06.003</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2757443">2757443</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19555719">19555719</a>.</li>

<li id="cite_note-Macr02-97"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Macr02_97-0">Jump up^{</a>&nbsp};Macritchie K, Geddes JR, Scott J, Haslam D, de Lima M, Goodwin G (2003). Reid, Keith, ed. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) (1): CD004052.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1002%2F14651858.CD004052">10.1002/14651858.CD004052</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/12535506">12535506</a>. <code>|chapter=</code> ignored (<a href="http://en.wikipedia.org/wiki/Help:CS1_errors#chapter_ignored" title="Help:CS1 errors">help</a>)</li>

<li id="cite_note-98"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-98">Jump up^{</a>&nbsp};Geddes JR, Calabrese JR, Goodwin GM (2008). "Lamotrigine for treatment of bipolar depression: Independent meta-analysis and meta-regression of individual patient data from five randomised trials". The British Journal of Psychiatry 194 (1): 4–9. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1192%2Fbjp.bp.107.048504">10.1192/bjp.bp.107.048504</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19118318">19118318</a>.</li>

<li id="cite_note-99"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-99">Jump up^{</a>&nbsp};van der Loos ML, Kölling P, Knoppert-van der Klein EA, Nolen WA (2007). "Lamotrigine in the treatment of bipolar disorder, a review". Tijdschrift voor psychiatrie 49 (2): 95–103. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17290338">17290338</a>.</li>

<li id="cite_note-pmid16437453-100"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid16437453_100-0">Jump up^{</a>&nbsp};Vasudev K, Macritchie K, Geddes J, Watson S, Young A (2006). Young, Allan H, ed. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) (1): CD003384.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1002%2F14651858.CD003384.pub2">10.1002/14651858.CD003384.pub2</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/16437453">16437453</a>. <code>|chapter=</code> ignored (<a href="http://en.wikipedia.org/wiki/Help:CS1_errors#chapter_ignored" title="Help:CS1 errors">help</a>)</li>

<li id="cite_note-FOOTNOTEBarker2003284.E2.80.9385-101"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEBarker2003284.E2.80.9385_101-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFBarker2003">Barker 2003</a>, pp. 284–85.</li>

<li id="cite_note-102"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-102">Jump up^{</a>&nbsp};Cipriani A, Rendell JM, Geddes J (2009). Cipriani, Andrea, ed. "Cochrane Database of Systematic Reviews". Cochrane database of systematic reviews (Online) (1): CD004367.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1002%2F14651858.CD004367.pub2">10.1002/14651858.CD004367.pub2</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/19160237">19160237</a>. <code>|chapter=</code> ignored (<a href="http://en.wikipedia.org/wiki/Help:CS1_errors#chapter_ignored" title="Help:CS1 errors">help</a>)</li>

<li id="cite_note-PostGrad10-103"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-PostGrad10_103-0">Jump up^{</a> El}-Mallakh RS, Elmaadawi AZ, Loganathan M, Lohano K, Gao Y (July 2010). "Bipolar disorder: an update". Postgraduate Medicine 122 (4): 24–31. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.3810%2Fpgm.2010.07.2172">10.3810/pgm.2010.07.2172</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/20675968">20675968</a>.</li>

<li id="cite_note-104"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-104">Jump up^{</a> }<a rel="nofollow" href="http://www.webmd.com/bipolar-disorder/bipolar-benzodiazepines">"Benzodiazepines for Bipolar Disorder"</a>. WebMD.com. Retrieved 13 February 2013.</li>

<li id="cite_note-pmid18425912-105"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid18425912_105-0">Jump up^{</a>&nbsp};Montgomery P, Richardson AJ (Apr 16, 2008). Montgomery, Paul, ed. "Omega-3 fatty acids for bipolar disorder". The Cochrane database of systematic reviews (2): CD005169.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1002%2F14651858.CD005169.pub2">10.1002/14651858.CD005169.pub2</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/18425912">18425912</a>.</li>

<li id="cite_note-FOOTNOTEBergen1999-106"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEBergen1999_106-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFBergen1999">Bergen 1999</a>.</li>

<li id="cite_note-107"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-107">Jump up^{</a>&nbsp};Judd LL, Akiskal HS, Schettler PJ, Endicott J, Leon AC, Solomon DA, Coryell W, Maser JD, Keller MB (Dec 2005). "Psychosocial disability in the course of bipolar I and II disorders: a prospective, comparative, longitudinal study.". Archives of General Psychiatry 62 (12): 1322–30. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1001%2Farchpsyc.62.12.1322">10.1001/archpsyc.62.12.1322</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/16330720">16330720</a>.</li>

<li id="cite_note-108"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-108">Jump up^{</a>&nbsp};Tohen M, Zarate CA, Hennen J, Khalsa HM, Strakowski SM, Gebre-Medhin P, Salvatore P, Baldessarini RJ (2003). "The McLean-Harvard First-Episode Mania Study: Prediction of recovery and first recurrence".The American Journal of Psychiatry 160 (12): 2099–2107. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fappi.ajp.160.12.2099">10.1176/appi.ajp.160.12.2099</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/14638578">14638578</a>.</li>

<li id="cite_note-pmid12738039-109"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid12738039_109-0">Jump up^{</a>&nbsp};Jackson A, Cavanagh J, Scott J (2003). "A systematic review of manic and depressive prodromes".Journal of Affective Disorders 74 (3): 209–217. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fs0165-0327%2802%2900266-5">10.1016/s0165-0327(02)00266-5</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/12738039">12738039</a>.</li>

<li id="cite_note-pmid16125292-110"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid16125292_110-0">Jump up^{</a>&nbsp};Lam D, Wong G (2005). "Prodromes, coping strategies and psychological interventions in bipolar disorders". Clinical Psychology Review 25 (8): 1028–1042. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.cpr.2005.06.005">10.1016/j.cpr.2005.06.005</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/16125292">16125292</a>.</li>

<li id="cite_note-FOOTNOTESadockKaplanSadock2007388-111"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTESadockKaplanSadock2007388_111-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFSadockKaplanSadock2007">Sadock, Kaplan & Sadock 2007</a>, p. 388.</li>

<li id="cite_note-MortBio_2006-112"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-MortBio_2006_112-0">Jump up^{</a>&nbsp};Roger S. McIntyre, MD, Joanna K. Soczynska, and Jakub Konarski. <a rel="nofollow" href="http://www.psychiatrictimes.com/article/showArticle.jhtml?articleId=193400986">"Bipolar Disorder: Defining Remission and Selecting Treatment"</a>. Psychiatric Times, October 2006, Vol. XXIII, No. 11.</li>

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<li id="cite_note-Judd_and_Akiskal_2003-114"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Judd_and_Akiskal_2003_114-0">Jump up^{</a>&nbsp};Judd LL, Akiskal HS (2003). "The prevalence and disability of bipolar spectrum disorders in the US population: Re-analysis of the ECA database taking into account subthreshold cases". Journal of Affective Disorders 73 (1–2): 123–131. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fs0165-0327%2802%2900332-4">10.1016/s0165-0327(02)00332-4</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/12507745">12507745</a>.</li>

<li id="cite_note-115"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-115">Jump up^{</a>&nbsp};Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC (2007).<a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931566">"Lifetime and 12-Month Prevalence of Bipolar Spectrum Disorder in the National Comorbidity Survey Replication"</a>. Archives of General Psychiatry 64 (5): 543–552. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1001%2Farchpsyc.64.5.543">10.1001/archpsyc.64.5.543</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931566">1931566</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17485606">17485606</a>.</li>

<li id="cite_note-116"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-116">Jump up^{</a>&nbsp};Phelps J (2006). <a rel="nofollow" href="http://www.psychiatrictimes.com/print.jhtml?articleID=191504355&url_prefix=">"Bipolar Disorder: Particle or Wave? DSM Categories or Spectrum Dimensions?"</a>.Psychiatric Times.</li>

<li id="cite_note-Farren2012-117"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Farren2012_117-0">Jump up^{</a>&nbsp};Farren CK, Hill KP, Weiss RD (December 2012). <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730445">"Bipolar disorder and alcohol use disorder: a review"</a>.Curr Psychiatry Rep 14 (6): 659–66. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1007%2Fs11920-012-0320-9">10.1007/s11920-012-0320-9</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3730445">3730445</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/22983943">22983943</a>.</li>

<li id="cite_note-118"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-118">Jump up^{</a> Ayuso-Mateos}, Jose Luis. <a rel="nofollow" href="http://www.who.int/healthinfo/statistics/bod_bipolar.pdf">"Global burden of bipolar disorder in the year 2000"</a>. <a href="http://en.wikipedia.org/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a>. Retrieved December 9, 2012.</li>

<li id="cite_note-kurasaki-119"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-kurasaki_119-0">Jump up^{</a> Kurasaki}, Karen S. (2002). Asian American Mental Health: Assessment Theories and Methods. pp. 14–15.</li>

<li id="cite_note-Christie88-120"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Christie88_120-0">Jump up^{</a>&nbsp};Christie KA, Burke JD, Regier DA, Rae DS, Boyd JH, Locke BZ (1988). "Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults". The American Journal of Psychiatry 145 (8): 971–975. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fajp.145.8.971">10.1176/ajp.145.8.971</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/3394882">3394882</a>.</li>

<li id="cite_note-FOOTNOTEGoodwinJamison20071945-121"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEGoodwinJamison20071945_121-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFGoodwinJamison2007">Goodwin & Jamison 2007</a>, p. 1945.</li>

<li id="cite_note-122"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-122">Jump up^{</a>&nbsp};Monczor M (2010). "Bipolar disorder in the elderly". Vertex (Buenos Aires, Argentina) 21 (92): 275–283.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/21188315">21188315</a>.</li>

<li id="cite_note-FOOTNOTELiddellScott1980-123"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTELiddellScott1980_123-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFLiddellScott1980">Liddell & Scott 1980</a>.</li>

<li id="cite_note-Angst-2001-124">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Angst-2001_124-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Angst-2001_124-1">b</a> Angst J, Marneros A (December 2001). "Bipolarity from ancient to modern times: conception, birth and rebirth". J Affect Disord 67 (1–3): 3–19. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2FS0165-0327%2801%2900429-3">10.1016/S0165-0327(01)00429-3</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/11869749">11869749</a>.</li>

<li id="cite_note-125"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-125">Jump up^{</a> Borch}-Jacobsen M (October 2010). <a rel="nofollow" href="http://www.lrb.co.uk/v32/n19/mikkel-borch-jacobsen/which-came-first-the-condition-or-the-drug">"Which came first, the condition or the drug?"</a>. London Review of Books 32 (19): 31–33. <q ', '"', '\'', '\'';">at the beginning of the 19th century with Esquirol’s ‘affective monomanias’ (notably ‘lypemania’, the first elaboration of what was to become our modern depression)</q></li>

<li id="cite_note-126"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-126">Jump up^{</a>&nbsp};Pichot P (2004). "Circular insanity, 150 years on". Bulletin de l'Academie nationale de medecine (in French) 188 (2): 275–284. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/15506718">15506718</a>..</li>

<li id="cite_note-Sedler-127"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Sedler_127-0">Jump up^{</a>&nbsp};Sedler MJ (1983). "Falret's discovery: The origin of the concept of bipolar affective illness. Translated by M. J. Sedler and Eric C. Dessain". The American Journal of Psychiatry 140 (9): 1127–1133.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1176%2Fajp.140.9.1127">10.1176/ajp.140.9.1127</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/6351641">6351641</a>.</li>

<li id="cite_note-FOOTNOTEMillon1996290-128"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEMillon1996290_128-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFMillon1996">Millon 1996</a>, p. 290.</li>

<li id="cite_note-129"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-129">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Emil_Kraepelin" title="Emil Kraepelin">Kraepelin, Emil</a> (1921) Manic–depressive Insanity and Paranoia <a href="http://en.wikipedia.org/wiki/Special:BookSources/0405074417">ISBN 0-405-07441-7</a></li>

<li id="cite_note-FOOTNOTEGoodwinJamison2007Chapter_1-130"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEGoodwinJamison2007Chapter_1_130-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFGoodwinJamison2007">Goodwin & Jamison 2007</a>, Chapter 1.</li>

<li id="cite_note-131"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-131">Jump up^{</a> }<a rel="nofollow" href="http://books.google.com/books?id=6-IfJ6dYy2cC&source=gbs_navlinks_s">Bipolar Depression: Molecular Neurobiology, Clinical Diagnosis and Pharmacotherapy</a> Carlos A. Zarate Jr., Husseini K. Manji, Springer Science & Business Media, 16 Apr 2009</li>

<li id="cite_note-132"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-132">Jump up^{</a> }<a rel="nofollow" href="http://apt.rcpsych.org/content/16/5/318.full">The course of bipolar disorder</a> Kate E. A. Saunders and Guy M. Goodwin, Advances in Psychiatric Treatment (2010) 16: 318-328 <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1192%2Fapt.bp.107.004903">10.1192/apt.bp.107.004903</a></li>

<li id="cite_note-Ban-133"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Ban_133-0">Jump up^{</a> }<a rel="nofollow" href="http://d.plnk.co/ACNP/50th/Transcripts/David%20Dunner%20by%20Thomas%20A.%20Ban.doc">DAVID L.DUNNER Interviewed by Thomas A. Ban</a> for the ANCP, Waikoloa, Hawaii, December 13, 2001</li>

<li id="cite_note-Elgie2007-134"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Elgie2007_134-0">Jump up^{</a>&nbsp};Elgie R. Morselli PL (Feb–Mar 2007). "Social functioning in bipolar patients: the perception and perspective of patients, relatives and advocacy organizations – a review". Bipolar disorders 9 (1–2): 144–57.<a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1399-5618.2007.00339.x">10.1111/j.1399-5618.2007.00339.x</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17391357">17391357</a>.</li>

<li id="cite_note-FOOTNOTEJamison1995-135"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEJamison1995_135-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFJamison1995">Jamison 1995</a>.</li>

<li id="cite_note-FOOTNOTEJoseph2008-136"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTEJoseph2008_136-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFJoseph2008">Joseph 2008</a>.</li>

<li id="cite_note-FOOTNOTERobinson200378.E2.80.9381-137"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTERobinson200378.E2.80.9381_137-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFRobinson2003">Robinson 2003</a>, pp. 78–81.</li>

<li id="cite_note-FOOTNOTERobinson200384.E2.80.9385-138"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-FOOTNOTERobinson200384.E2.80.9385_138-0">Jump up^{</a> }<a href="http://en.wikipedia.org/wiki/Bipolar_disorder#CITEREFRobinson2003">Robinson 2003</a>, pp. 84–85.</li>

<li id="cite_note-139"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-139">Jump up^{</a> McKinley}, Jesse (February 28, 1999). <a rel="nofollow" href="http://www.nytimes.com/1999/02/28/weekinreview/ideas-trends-get-that-man-some-prozac-if-the-dramatic-tension-is-all-in-his-head.html">"Get That Man Some Prozac; If the Dramatic Tension Is All in His Head"</a>. The New York Times. Retrieved 3 March 2012.</li>

<li id="cite_note-140"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-140">Jump up^{</a> }<a rel="nofollow" href="http://www.bbc.co.uk/health/tv_and_radio/secretlife_index.shtml">"The Secret Life of the Manic Depressive"</a>. BBC. 2006. Retrieved February 20, 2007.</li>

<li id="cite_note-141"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-141">Jump up^{</a> }<a rel="nofollow" href="http://www.bpkids.org/90210">"Child and Adolescent Bipolar Foundation special 90210 website"</a>. CABF. 2009. Retrieved April 7,2009.[<a href="http://en.wikipedia.org/wiki/Wikipedia:Link_rot" title="Wikipedia:Link rot">dead link</a>]</li>

<li id="cite_note-142"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-142">Jump up^{</a> }<a rel="nofollow" href="http://www.bbc.co.uk/pressoffice/pressreleases/stories/2009/05_may/14/stacey.shtml">"EastEnders' Stacey faces bipolar disorder"</a>. BBC Press Office. May 14, 2009. Retrieved May 28, 2009.</li>

<li id="cite_note-Echo14May2003-143"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Echo14May2003_143-0">Jump up^{</a> Tinniswood}, Rachael (May 14, 2003). <a rel="nofollow" href="http://www.thefreelibrary.com/The+Brookie+boys+who+shone+at+soap+awards+show%3B+TONIGHT+the+nation...-a0101743730">"The Brookie boys who shone at soap awards show"</a>. <a href="http://en.wikipedia.org/wiki/Liverpool_Echo" title="Liverpool Echo">Liverpool Echo</a> (Mirror Group Newspapers). Retrieved April 26, 2014.</li>

<li id="cite_note-144"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-144">Jump up^{</a> }<a rel="nofollow" href="http://abc.go.com/shows/black-box/cast/catherine-black">"Catherine Black by Kelly Reilly - Black Box - abc.com"</a>. ABC. Retrieved May 22, 2014.</li>

<li id="cite_note-145"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-145">Jump up^{</a> }<a rel="nofollow" href="https://gs18.globalsuccessor.com/fe/tpl_lfdssl.asp?newms=hm">"Career Oportunities in the Secret Intelligence Service – Working for SIS"</a>. Secret Intelligence Service MI6. The Crown. Retrieved 31 May 2014.</li>

<li id="cite_note-pmid17195735-146">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-4">e</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-5">f</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-6">g</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17195735_146-7">h</a> McClellan J, Kowatch R, Findling RL (2007). "Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder". Journal of the American Academy of Child & Adolescent Psychiatry 46 (1): 107–125. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1097%2F01.chi.0000242240.69678.c4">10.1097/01.chi.0000242240.69678.c4</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17195735">17195735</a>.</li>

<li id="cite_note-147"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-147">Jump up^{</a> Anthony}, J.; Scott, P. (1960). "Manic–depressive Psychosis in Childhood". Journal of Child Psychology and Psychiatry 1: 53. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1469-7610.1960.tb01979.x">10.1111/j.1469-7610.1960.tb01979.x</a>.</li>

<li id="cite_note-pmid17716034-148">^ <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-0">Jump up to:a</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-1">b</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-2">c</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-3">d</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-4">e</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-5">f</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-6">g</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-7">h</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-8">i</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-9">j</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-10">k</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-11">l</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-12">m</a> <a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid17716034_148-13">n</a> Leibenluft E, Rich BA (2008). "Pediatric Bipolar Disorder". Annual Review of Clinical Psychology 4: 163–187. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1146%2Fannurev.clinpsy.4.022007.141216">10.1146/annurev.clinpsy.4.022007.141216</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/17716034">17716034</a>.</li>

<li id="cite_note-Cosgrove2013-149"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Cosgrove2013_149-0">Jump up^{</a>&nbsp};Cosgrove VE, Roybal D, Chang KD (April 2013). "Bipolar depression in pediatric populations: epidemiology and management". Paediatr Drugs 15 (2): 83–91. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1007%2Fs40272-013-0022-8">10.1007/s40272-013-0022-8</a>.<a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/23529869">23529869</a>.</li>

<li id="cite_note-150"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-150">Jump up^{</a> DSM}-5 Childhood and Adolescent Disorders Work Group (2010-01-28). <a rel="nofollow" href="http://www.dsm5.org/Proposed%20Revision%20Attachments/Justification%20for%20Temper%20Dysregulation%20Disorder%20with%20Dysphoria.pdf">"Proposed change: ...to the Mood Disorders Section of DSM-V"</a>. American Psychiatric Association. Retrieved 2012-02-18.

• <a rel="nofollow" href="http://www.dsm5.org/Newsroom/Documents/Diag%20%20Criteria%20General%20FINAL%202.05.pdf">"APA Announces Draft Diagnostic Criteria for DSM-5"</a> (Press release). American Psychiatric Association. 10 February 2010. Retrieved 2012-02-18.</li>

<li id="cite_note-Vasudev2010-151"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-Vasudev2010_151-0">Jump up^{</a>&nbsp};Vasudev A, Thomas A (July 2010). "'Bipolar disorder' in the elderly: what's in a name?". Maturitas 66 (3): 231–5. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1016%2Fj.maturitas.2010.02.013">10.1016/j.maturitas.2010.02.013</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/20307944">20307944</a>.</li>

<li id="cite_note-pmid15383127-152"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-pmid15383127_152-0">Jump up^{</a>&nbsp};Depp CA, Jeste DV (2004). "Bipolar disorder in older adults: A critical review". Bipolar Disorders 6 (5): 343–367. <a href="http://en.wikipedia.org/wiki/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" href="http://dx.doi.org/10.1111%2Fj.1399-5618.2004.00139.x">10.1111/j.1399-5618.2004.00139.x</a>. <a href="http://en.wikipedia.org/wiki/PubMed_Identifier" title="PubMed Identifier">PMID</a> <a rel="nofollow" href="http://www.ncbi.nlm.nih.gov/pubmed/15383127">15383127</a>.</li>

<li id="cite_note-153"><a href="http://en.wikipedia.org/wiki/Bipolar_disorder#cite_ref-153">Jump up^{</a>&nbsp};Trinh NH, Forester B (2007). <a rel="nofollow" href="http://www.psychiatrictimes.com/bipolar-disorder/article/10168/54481">"Bipolar Disorder in the Elderly: Differential Diagnosis and Treatment"</a>.Psychiatric Times 24 (14).</li>

</ol>

</div>

<h2>References</h2>

<div>

<ul>

<li>Barker, P., ed. (2003). Psychiatric and mental health nursing: the craft and caring. London: Arnold.</li>

<li>Basco, Monica Ramírez (2005). <a rel="nofollow" href="http://books.google.com/books?id=TPq0nHiWd6EC">The bipolar workbook: tools for controlling your mood swings</a>. Guilford Press.<a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1-59385-162-0" title="Special:BookSources/978-1-59385-162-0">978-1-59385-162-0</a>.</li>

<li>Basco, Monica Ramirez; Rush, A. John (2005). Cognitive-Behavioral Therapy for Bipolar Disorder (Second ed.). New York: The Guilford Press. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1-59385-168-2" title="Special:BookSources/978-1-59385-168-2">978-1-59385-168-2</a>. <a href="http://en.wikipedia.org/wiki/OCLC" title="OCLC">OCLC</a> <a rel="nofollow" href="http://www.worldcat.org/oclc/300306925">300306925</a>.</li>

<li>Bergen, M. (1999). <a rel="nofollow" href="http://books.google.com/?id=s4dVLeND9l0C&lpg=PP1&dq=riding%20the%20roller%20coaster%2C%20living%20with%20mood&pg=PA26#v=onepage&q=">Riding the Roller Coaster: Living with Mood Disorders</a>. Wood Lake Publishing. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1-896836-31-7" title="Special:BookSources/978-1-896836-31-7">978-1-896836-31-7</a>.</li>

<li>Brown, Malcomb R.; Basso, Michael R. (2004). Focus on Bipolar Disorder Research. <a href="http://en.wikipedia.org/wiki/Nova_Science_Publishers" title="Nova Science Publishers">Nova Science Publishers</a>.<a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1-59454-059-2" title="Special:BookSources/978-1-59454-059-2">978-1-59454-059-2</a>.</li>

<li>Diagnostic and statistical manual of mental disorders: DSM-IV. Washington, DC: American Psychiatric Association. 1994. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-89042-061-4" title="Special:BookSources/978-0-89042-061-4">978-0-89042-061-4</a>. <a href="http://en.wikipedia.org/wiki/OCLC" title="OCLC">OCLC</a> <a rel="nofollow" href="http://www.worldcat.org/oclc/29953039">29953039</a>.

<ul>

<li><a rel="nofollow" href="http://books.google.com/?id=3SQrtpnHb9MC">Diagnostic and statistical manual of mental disorders: DSM-IV</a> (4th, text revision ed.). Washington, DC: American Psychiatric Association. 2000. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-89042-025-6" title="Special:BookSources/978-0-89042-025-6">978-0-89042-025-6</a>. <a href="http://en.wikipedia.org/wiki/OCLC" title="OCLC">OCLC</a> <a rel="nofollow" href="http://www.worldcat.org/oclc/742067027">742067027</a>.</li>

</ul>

</li>

<li>Joseph, Chris (2008). Manicdotes: There's Madness in His Method. London: Austin & Macauley. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1-905609-07-9" title="Special:BookSources/978-1-905609-07-9">978-1-905609-07-9</a>. <a rel="nofollow" href="http://www.amazon.co.uk/Manicdotes-Theres-Madness-His-Method/dp/1905609078/ref=lh_ni_t">Amazon review</a>.</li>

<li>Goodwin, F. K.; Jamison, K. R. (2007). <a rel="nofollow" href="http://books.google.com/?id=rnr_OxfcqDcC">Manic–depressive illness: bipolar disorders and recurrent depression</a>(2nd. ed.). Oxford University Press. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-19-513579-4" title="Special:BookSources/978-0-19-513579-4">978-0-19-513579-4</a>. <a href="http://en.wikipedia.org/wiki/OCLC" title="OCLC">OCLC</a> <a rel="nofollow" href="http://www.worldcat.org/oclc/70929267">70929267</a>.</li>

<li>Jamison, Kay Redfield (1995). An Unquiet Mind: A Memoir of Moods and Madness. New York: Knopf.<a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-330-34651-1" title="Special:BookSources/978-0-330-34651-1">978-0-330-34651-1</a>.</li>

<li>Leahy, Robert L.; Johnson, Sheri L. (2003). Psychological Treatment of Bipolar Disorder. New York: The Guilford Press. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1-57230-924-1" title="Special:BookSources/978-1-57230-924-1">978-1-57230-924-1</a>. <a href="http://en.wikipedia.org/wiki/OCLC" title="OCLC">OCLC</a> <a rel="nofollow" href="http://www.worldcat.org/oclc/52714775">52714775</a>.</li>

<li><a href="http://en.wikipedia.org/wiki/Henry_George_Liddell" title="Henry George Liddell">Liddell, Henry George</a>; <a href="http://en.wikipedia.org/wiki/Robert_Scott_(philologist)" title="Robert Scott (philologist)">Scott, Robert</a> (1980). <a href="http://en.wikipedia.org/wiki/A_Greek-English_Lexicon" title="A Greek-English Lexicon">A Greek-English Lexicon</a> (Abridged ed.). <a href="http://en.wikipedia.org/wiki/Oxford_University_Press" title="Oxford University Press">Oxford University Press</a>.<a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-19-910207-5" title="Special:BookSources/978-0-19-910207-5">978-0-19-910207-5</a>.</li>

<li>Millon, Theordore (1996). Disorders of Personality: DSM-IV-TM and Beyond. New York: John Wiley and Sons.<a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-471-01186-6" title="Special:BookSources/978-0-471-01186-6">978-0-471-01186-6</a>.</li>

<li>Robinson, D. J. (2003). Reel Psychiatry: Movie Portrayals of Psychiatric Conditions. Port Huron, Michigan: Rapid Psychler Press. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1-894328-07-4" title="Special:BookSources/978-1-894328-07-4">978-1-894328-07-4</a>.</li>

<li>Sadock, Benjamin J.; Kaplan, Harold I.; Sadock, Virginia A. (2007). <a rel="nofollow" href="http://books.google.com/?id=u-ohbTtxCeYC&pg=PA1268&lpg=PA1268&dq=bipolar+%2220+times%22#v=snippet&q=20%20times&f=false">Kaplan & Sadock's synopsis of psychiatry: behavioral sciences/clinical ...</a> <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-7817-7327-0" title="Special:BookSources/978-0-7817-7327-0">978-0-7817-7327-0</a>.</li>

<li>Yatham, Lakshmi (2010). Bipolar Disorder. New York: Wiley. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-0-470-72198-8" title="Special:BookSources/978-0-470-72198-8">978-0-470-72198-8</a>.</li>

</ul>

</div>

<h2>Further reading</h2>

<ul>

<li>Healy, David (2011). Mania: A Short History of Bipolar Disorder. Baltimore, MD: Johns Hopkins University Press. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1421403977" title="Special:BookSources/978-1421403977">978-1421403977</a>.</li>

<li>Mondimore, Francis Mark (2014). Bipolar Disorder: A Guide for Patients and Families (3rd. ed.). Baltimore, MD: Johns Hopkins University Press. <a href="http://en.wikipedia.org/wiki/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="http://en.wikipedia.org/wiki/Special:BookSources/978-1421412061" title="Special:BookSources/978-1421412061">978-1421412061</a>.</li>

</ul>

<h2>External links</h2>

<tr>

<td><a href="http://en.wikipedia.org/wiki/Wikipedia:LIBRARY" title="Wikipedia:LIBRARY">Library resources</a> about

Bipolar disorder

<hr />

</td>

</tr>

<tr>

<td>

<ul>

<li><a href="http://tools.wmflabs.org/ftl/cgi-bin/ftl?st=wp&su=Bipolar+disorder">Resources in your library</a></li>

<li><a href="http://tools.wmflabs.org/ftl/cgi-bin/ftl?st=wp&su=Bipolar+disorder&library=0CHOOSE0">Resources in other libraries</a></li>

</ul>

</td>

</tr>

</tbody></table>

<tr>

<div>Find more about

Bipolar disorder

at Wikipedia's <a href="http://en.wikipedia.org/wiki/Wikipedia:Wikimedia_sister_projects" title="Wikipedia:Wikimedia sister projects">sister projects</a></div>

</td>

</tr>

<tr>

<td><a href="http://en.wiktionary.org/wiki/bipolar_disorder" title="wikt:bipolar disorder">Definitions</a> from Wiktionary</td>

</tr>

<tr>

<td><a href="http://commons.wikimedia.org/wiki/Special:Search/Bipolar_disorder" title="commons:Special:Search/Bipolar disorder">Media</a> from Commons</td>

</tr>

<tr>

<td><a href="http://en.wikinews.org/wiki/Special:Search/Bipolar_disorder" title="n:Special:Search/Bipolar disorder">News stories</a> from Wikinews</td>

</tr>

<tr>

<td><a href="http://en.wikibooks.org/wiki/Psychiatric_Disorders/Mood_Disorders/Bipolar_Disorder" title="b:Psychiatric Disorders/Mood Disorders/Bipolar Disorder">Textbooks</a> from Wikibooks</td>

</tr>

<tr>

<td><a href="http://www.wikidata.org/wiki/Q131755" title="d:Q131755">Database entry Q131755</a>on Wikidata</td>

</tr>

</tbody></table>

<ul>

<li><a rel="nofollow" href="https://www.dmoz.org/Health/Mental_Health/Disorders/Mood/Bipolar_Disorder">Bipolar Disorder</a> at <a href="http://en.wikipedia.org/wiki/DMOZ" title="DMOZ">DMOZ</a></li>

<li><a rel="nofollow" href="http://www.nimh.nih.gov/health/publications/bipolar-disorder/complete-index.shtml">Bipolar Disorder overview</a> from the U.S. <a href="http://en.wikipedia.org/wiki/National_Institute_of_Mental_Health" title="National Institute of Mental Health">National Institute of Mental Health</a> website</li>

<li><a rel="nofollow" href="http://www.nice.org.uk/Guidance/CG38">NICE Bipolar Disorder clinical guidelines</a> from the U.K. <a href="http://en.wikipedia.org/wiki/National_Institute_for_Health_and_Clinical_Excellence" title="National Institute for Health and Clinical Excellence">National Institute for Health and Clinical Excellence</a> website</li>

</ul>

<tr>

<td>

<tr>

<th scope="col" colspan="2">[<a id="collapseButton0" href="http://en.wikipedia.org/wiki/Bipolar_disorder#">show</a>]

<div>

<ul>

</ul>

</div>

<div><a href="http://en.wikipedia.org/wiki/Mental_disorder" title="Mental disorder">Mental</a> and <a href="http://en.wikipedia.org/wiki/Emotional_and_behavioral_disorders" title="Emotional and behavioral disorders">behavioral disorders</a> (<a href="http://en.wikipedia.org/wiki/ICD-10_Chapter_V:Mental_and_behavioural_disorders" title="ICD-10 Chapter V: Mental and behavioural disorders">F</a> <a href="http://en.wikipedia.org/wiki/List_of_ICD-9_codes_290%E2%80%93319:mental_disorders" title="List of ICD-9 codes 290–319: mental disorders">290–319</a>)</div>

</th>

</tr>

</tbody></table>

</td>

</tr>

</tbody></table>

<tr>

<td>

<tr>

<th scope="col" colspan="2">[<a id="collapseButton10" href="http://en.wikipedia.org/wiki/Bipolar_disorder#">hide</a>]

<div>

<ul>

</ul>

</div>

<div><a href="http://en.wikipedia.org/wiki/Mood_disorder" title="Mood disorder">Mood disorder</a> (<a href="http://en.wikipedia.org/wiki/ICD-10_Chapter_V:Mental_and_behavioural_disorders#.28F30.E2.80.93F39.29_Mood.28affective.29_disorders" title="ICD-10 Chapter V: Mental and behavioural disorders">F30–F39</a>, <a href="http://en.wikipedia.org/wiki/List_of_ICD-9_codes_290%E2%80%93319:mental_disorders#Other_psychoses.28295.E2.80.93299.29" title="List of ICD-9 codes 290–319: mental disorders">296</a>)</div>

</th>

</tr>

<tr>

</tr>

<tr>

<th scope="row"><a href="http://en.wikipedia.org/wiki/History_of_bipolar_disorder" title="History of bipolar disorder">History</a></th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Emil_Kraepelin" title="Emil Kraepelin">Emil Kraepelin</a></li>

<li><a href="http://en.wikipedia.org/wiki/Karl_Leonhard" title="Karl Leonhard">Karl Leonhard</a></li>

<li><a href="http://en.wikipedia.org/wiki/Mogens_Schou" title="Mogens Schou">Mogens Schou</a></li>

<li><a href="http://en.wikipedia.org/wiki/Frederick_K._Goodwin" title="Frederick K. Goodwin">Frederick K. Goodwin</a></li>

<li><a href="http://en.wikipedia.org/wiki/Kay_Redfield_Jamison" title="Kay Redfield Jamison">Kay Redfield Jamison</a></li>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<th scope="row"><a href="http://en.wikipedia.org/wiki/Symptom" title="Symptom">Symptoms</a></th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Hallucination" title="Hallucination">Hallucination</a></li>

<li><a href="http://en.wikipedia.org/wiki/Delusion" title="Delusion">Delusion</a></li>

<li><a href="http://en.wikipedia.org/wiki/Emotional_dysregulation" title="Emotional dysregulation">Emotional dysregulation</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Anhedonia" title="Anhedonia">Anhedonia</a></li>

<li><a href="http://en.wikipedia.org/wiki/Dysphoria" title="Dysphoria">Dysphoria</a></li>

<li><a href="http://en.wikipedia.org/wiki/Suicidal_ideation" title="Suicidal ideation">Suicidal ideation</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Sleep_disorder" title="Sleep disorder">sleep disorder</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Hypersomnia" title="Hypersomnia">Hypersomnia</a></li>

<li><a href="http://en.wikipedia.org/wiki/Insomnia" title="Insomnia">Insomnia</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Psychosis" title="Psychosis">Psychosis</a></li>

<li><a href="http://en.wikipedia.org/wiki/Racing_thoughts" title="Racing thoughts">Racing thoughts</a></li>

<li><a href="http://en.wikipedia.org/wiki/Depression_(differential_diagnoses)" title="Depression (differential diagnoses)">Depression (differential diagnoses)</a></li>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<th scope="row"><a href="http://en.wikipedia.org/wiki/Affective_spectrum" title="Affective spectrum">Spectrum</a></th>

<td>

<div>

<ul>

<li>Bipolar disorder

<ul>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_I_disorder" title="Bipolar I disorder">Bipolar I</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_II_disorder" title="Bipolar II disorder">Bipolar II</a></li>

<li><a href="http://en.wikipedia.org/wiki/Cyclothymia" title="Cyclothymia">Cyclothymia</a></li>

<li><a href="http://en.wikipedia.org/wiki/Bipolar_disorder_not_otherwise_specified" title="Bipolar disorder not otherwise specified">Bipolar NOS</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Depression_(mood)" title="Depression (mood)">Depression</a></li>

<li>(<a href="http://en.wikipedia.org/wiki/Major_depressive_disorder" title="Major depressive disorder">Major depressive disorder</a></li>

<li><a href="http://en.wikipedia.org/wiki/Dysthymia" title="Dysthymia">Dysthymia</a></li>

<li><a href="http://en.wikipedia.org/wiki/Seasonal_affective_disorder" title="Seasonal affective disorder">Seasonal affective disorder</a></li>

<li><a href="http://en.wikipedia.org/wiki/Atypical_depression" title="Atypical depression">Atypical depression</a></li>

<li><a href="http://en.wikipedia.org/wiki/Melancholic_depression" title="Melancholic depression">Melancholic depression</a>)</li>

<li><a href="http://en.wikipedia.org/wiki/Schizoaffective_disorder" title="Schizoaffective disorder">Schizoaffective disorder</a></li>

</ul>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Mania" title="Mania">Mania</a></li>

<li><a href="http://en.wikipedia.org/wiki/Mixed_state_(psychiatry)" title="Mixed state (psychiatry)">Mixed state</a></li>

<li><a href="http://en.wikipedia.org/wiki/Hypomania" title="Hypomania">Hypomania</a></li>

<li><a href="http://en.wikipedia.org/wiki/Major_depressive_episode" title="Major depressive episode">Major depressive episode</a></li>

<li><a href="http://en.wikipedia.org/wiki/Rapid_cycling" title="Rapid cycling">Rapid cycling</a></li>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<th scope="row"><a href="http://en.wikipedia.org/wiki/Treatment_of_bipolar_disorder" title="Treatment of bipolar disorder">Treatment</a></th>

<td>

<tr>

<div><a href="http://en.wikipedia.org/wiki/Anticonvulsant" title="Anticonvulsant">Anticonvulsants</a></div>

</th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Carbamazepine" title="Carbamazepine">Carbamazepine</a></li>

<li><a href="http://en.wikipedia.org/wiki/Lamotrigine" title="Lamotrigine">Lamotrigine</a></li>

<li><a href="http://en.wikipedia.org/wiki/Oxcarbazepine" title="Oxcarbazepine">Oxcarbazepine</a></li>

<li><a href="http://en.wikipedia.org/wiki/Valproic_acid" title="Valproic acid">Valproic acid</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Sodium_valproate" title="Sodium valproate">Sodium valproate</a></li>

<li><a href="http://en.wikipedia.org/wiki/Valproate_semisodium" title="Valproate semisodium">Valproate semisodium</a></li>

</ul>

</li>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<div>Other <a href="http://en.wikipedia.org/wiki/Mood_stabilizer" title="Mood stabilizer">mood stabilizers</a></div>

</th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Lithium_(medication)" title="Lithium (medication)">Lithium</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Lithium_carbonate" title="Lithium carbonate">Lithium carbonate</a></li>

<li><a href="http://en.wikipedia.org/wiki/Lithium_citrate" title="Lithium citrate">Lithium citrate</a></li>

<li><a href="http://en.wikipedia.org/wiki/Lithium_sulfate" title="Lithium sulfate">Lithium sulfate</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Atypical_antipsychotic" title="Atypical antipsychotic">Atypical antipsychotics</a></li>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<div>Non-pharmaceutical</div>

</th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Clinical_psychology" title="Clinical psychology">Clinical psychology</a></li>

<li><a href="http://en.wikipedia.org/wiki/Electroconvulsive_therapy" title="Electroconvulsive therapy">Electroconvulsive therapy</a></li>

<li><a href="http://en.wikipedia.org/wiki/Involuntary_commitment" title="Involuntary commitment">Involuntary commitment</a></li>

<li><a href="http://en.wikipedia.org/wiki/Light_therapy" title="Light therapy">Light therapy</a></li>

<li><a href="http://en.wikipedia.org/wiki/Psychotherapy" title="Psychotherapy">Psychotherapy</a></li>

<li><a href="http://en.wikipedia.org/wiki/Transcranial_magnetic_stimulation" title="Transcranial magnetic stimulation">Transcranial magnetic stimulation</a></li>

<li><a href="http://en.wikipedia.org/wiki/Cognitive_behavioral_therapy" title="Cognitive behavioral therapy">Cognitive behavioral therapy</a></li>

</ul>

</div>

</td>

</tr>

</tbody></table>

</td>

</tr>

<tr>

</tr>

<tr>

<tr>

<div>

<div>Index of <a href="http://en.wikipedia.org/wiki/Psychology" title="Psychology">psychology</a> and <a href="http://en.wikipedia.org/wiki/Psychiatry" title="Psychiatry">psychiatry</a>

<div>

<ul>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<th scope="row">Description</th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Template:Mental_processes" title="Template:Mental processes">Mental processes</a></li>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<th scope="row">Disorders</th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Template:Mental_and_behavioral_disorders" title="Template:Mental and behavioral disorders">Mental and behavioral</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Template:Tourette_syndrome" title="Template:Tourette syndrome">Tourette's</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Template:Psychoactive_substance_use" title="Template:Psychoactive substance use">Substance-related</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Template:Alcohol_and_health" title="Template:Alcohol and health">alcohol</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Template:Cognition,perception,emotional_state_and_behaviour_symptoms_and_signs" title="Template:Cognition, perception, emotional state and behaviour symptoms and signs">Symptoms and signs</a>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Template:Eponymous_medical_signs_for_nervous_system" title="Template:Eponymous medical signs for nervous system">eponymous</a></li>

</ul>

</li>

<li><a href="http://en.wikipedia.org/wiki/Template:Psychological_and_psychiatric_evaluation_and_testing" title="Template:Psychological and psychiatric evaluation and testing">Evaluation and testing</a></li>

</ul>

</div>

</td>

</tr>

<tr>

</tr>

<tr>

<th scope="row">Treatment</th>

<td>

<div>

<ul>

<li><a href="http://en.wikipedia.org/wiki/Template:Psychotherapy" title="Template:Psychotherapy">Psychotherapy</a>

<ul>

</ul>

</li>

<li>Drugs

<ul>

<li><a href="http://en.wikipedia.org/wiki/Template:Antidepressants" title="Template:Antidepressants">depression</a></li>

<li><a href="http://en.wikipedia.org/wiki/Template:Antipsychotics" title="Template:Antipsychotics">antipsychotics</a></li>

<li><a href="http://en.wikipedia.org/wiki/Template:Anxiolytics" title="Template:Anxiolytics">anxiety</a></li>

<li><a href="http://en.wikipedia.org/wiki/Template:Anti-dementia_drugs" title="Template:Anti-dementia drugs">dementia</a></li>

<li><a href="http://en.wikipedia.org/wiki/Template:Hypnotics_and_sedatives" title="Template:Hypnotics and sedatives">hypnotics and sedatives</a></li>

<li><a href="http://en.wikipedia.org/wiki/Template:Nootropics" title="Template:Nootropics">psychostimulants, ADHD and nootropics</a></li>

</ul>

</li>

</ul>

</div>

</td>

</tr>

</tbody></table>

</td>

</tr>

</tbody></table>

</td>

</tr>

</tbody></table>

</div>

<div id="mw-normal-catlinks"><a href="http://en.wikipedia.org/wiki/Help:Category" title="Help:Category">Categories</a>:

<ul>

<li><a href="http://en.wikipedia.org/wiki/Category:Bipolar_disorder" title="Category:Bipolar disorder">Bipolar disorder</a></li>

<li><a href="http://en.wikipedia.org/wiki/Category:Mood_disorders" title="Category:Mood disorders">Mood disorders</a></li>

<li><a href="http://en.wikipedia.org/wiki/Category:Psychiatric_diagnosis" title="Category:Psychiatric diagnosis">Psychiatric diagnosis</a></li>

<li><a href="http://en.wikipedia.org/wiki/Category:Depression_(psychology)" title="Category:Depression (psychology)">Depression (psychology)</a></li>

</ul>

</div>

</td>

</tr>

</table>