Psychiatry Learning Map

Psychiatry: disorder groups

Bipolar disorders

Bipolar disorders cause episodes of abnormally elevated mood (mania or hypomania) and usually episodes of depression, separated by periods of more normal mood. Psychiatrists diagnose them, treat acute episodes and, above all, prevent relapse with long-term mood stabilisers.

Depth by stage, Pre-U → Consultant (details)

What is it?

Bipolar disorder is a long-term mood illness. During mania a person may sleep little yet feel full of energy, talk fast, spend recklessly, take risks or believe they have special powers; in severe cases they lose touch with reality. Hypomania is a milder form. Most people with bipolar disorder also have episodes of depression, which often last longer than the highs.

The illness usually starts in the late teens or twenties and tends to recur. Between episodes many people function well, but repeated episodes can damage relationships, studies, work and finances.

Good care combines medication to stabilise mood, education so the person and family can spot early warning signs, regular sleep and routines, and psychological support.

Why does a psychiatrist need it?

Psychiatrists see bipolar disorder on wards (acute mania is a common reason for admission), in clinics and in emergencies. They must distinguish it from depression, ADHD, personality disorder and drug effects, choose and monitor lithium, valproate and antipsychotics safely (including in pregnancy), and manage the high suicide risk.

What level is expected at each stage?

Scale: 1. Aware → 2. Understands → 3. Applies → 4. Masters / Teaches. What the levels mean.

  1. Pre-UNot expected
  2. Pre-clinicalAwareAware that mood can be abnormally high as well as low; knows lithium as a classic drug.
  3. ClinicalUnderstandsRecognises manic features on examination and can explain the difference between bipolar disorder and depression.
  4. HousemanshipUnderstandsRecognises lithium toxicity and manic presentations on general wards and refers appropriately.
  5. Medical officerAppliesManages acute mania with supervision, starts and monitors lithium levels, kidney and thyroid function.
  6. Psych traineeMasters / TeachesManages all phases, including bipolar depression, rapid cycling and pregnancy planning; core examination topic.
  7. Specialist / consultantMasters / TeachesHandles complex and treatment-resistant cases and leads relapse-prevention programmes.

What are the key topics?

Conditions

  • Bipolar type I disorder (at least one manic or mixed episode)
  • Bipolar type II disorder (hypomania plus depression)
  • Cyclothymic disorder
  • Substance- or medication-induced bipolar and related disorder
  • Mixed features and rapid cycling (four or more episodes a year)

Clinical features

  • Mania: elevated or irritable mood, reduced need for sleep, pressured speech, flight of ideas, grandiosity, distractibility, disinhibition
  • Psychotic features in severe mania or depression
  • Bipolar depression and its high suicide risk
  • Early warning signs and triggers: sleep loss, stress, antidepressants, substances
  • Comorbidity with anxiety, substance use and ADHD

Causes

  • Strong heritability, higher than for unipolar depression
  • Circadian rhythm and sleep disturbance
  • Life events and stress as triggers
  • Theories involving monoamines, intracellular signalling and neuroinflammation

Assessment

  • Careful lifetime history of highs and lows, with family members' account
  • Screening for past hypomania in anyone presenting with depression
  • Physical causes: thyroid disease, steroids, stimulants, brain lesions
  • Risk: suicide, reckless spending, sexual risk, aggression, driving
  • Baseline tests before lithium: kidney function, thyroid function, calcium, ECG where needed

Treatment

  • Acute mania: antipsychotics, lithium or valproate, short-term sedation, a calm environment
  • Bipolar depression: specific options such as quetiapine or lurasidone, lamotrigine; caution with antidepressant monotherapy
  • Long-term: lithium (reduces relapse and suicide), valproate, lamotrigine, some antipsychotics
  • Lithium monitoring: blood levels, kidney and thyroid function, toxicity signs, drug interactions
  • Valproate and pregnancy: high risk of birth defects, strict counselling and avoidance in women who could become pregnant
  • Psychoeducation, mood diaries, regular routines, family-focused therapy
  • ECT for severe or treatment-resistant episodes

How is it learned and assessed?

  • Undergraduate psychiatry posting cases and OSCE stations explaining lithium
  • Ward work as MO: admissions for mania, lithium clinics
  • MMed Part I (pharmacology of mood stabilisers) and Part II clinical exams
  • MRCPsych Paper A and B questions; CASC stations such as explaining lithium or assessing mania

Typical textbooks and resources

  • Shorter Oxford Textbook of Psychiatry — Oxford University Press
  • The Maudsley Prescribing Guidelines in Psychiatry — Wiley
  • Stahl's Essential Psychopharmacology — Cambridge University Press
  • NICE guideline on bipolar disorder — NICE (UK), widely used as a reference

Titles are widely used examples; editions change. Use university libraries or legitimate purchases.

Common questions

Is bipolar disorder just mood swings?

No. Everyday mood swings last hours and fit circumstances. Bipolar episodes last days to weeks, are a clear change from the person's usual self and affect sleep, energy, judgement and functioning.

Why is lithium still used?

Lithium remains one of the most effective long-term treatments for preventing manic and depressive relapses, and it lowers suicide risk. It needs regular blood tests because the safe range is narrow.

Related subjects

Official sources to check