Challenges of diagnosis and treatment of bipolar disorder. A literature review

Tautvydas Juška1  Andrius Martišius1

1Lithuanian University of Health Sciences, Academy of Medicine,
Kaunas, Lithuania.


Bipolar disorder is a severe mental illness that causes atypical changes in mood, energy, concentration, and ability to perform daily activities. Bipolar disorder is one of the leading causes of disability in the world and is associated with a high number of early deaths from suicide and comorbidities. A meta-analysis of 25 studies five years ago found a 1.06% chance of developing type 1 bipolar disorder and a 1.57% chance of developing type 2 bipolar disorder. Bipolar disorder presents with episodes of mania, hypomania, and depression, so the clinic and diagnosis are based on these specific symptoms. The diagnosis of bipolar disorder is particularly complex and requires the in-depth knowledge of a medical psychiatrist and an impeccable collection of anamnesis. The choice of treatment tactics depends on the predominant symptomatology, but pharmacotherapy is a main part of the successful treatment of the bipolar disorder. This literature review covers the essential principles of clinic, diagnosis, and treatment.
The aim of the study: to review bipolar disorder, epidemiology and specific risk factors, principles and features of diagnosis and treatment.

Methods: Search, review and analysis of scientific sources were performed. Publications were searched in English in the international medical databases UpToDate, PubMed. Certain keywords and their combinations were used to find specific medical articles.

Conclusions: Bipolar disorder is a severe mental illness that affects up to 2% of the population. Risk factors for this disorder vary and include genetics, prenatal, perinatal, and postnatal periods. Emotional, physical, and sexual abuse in childhood is a significant and extensively confirmed risk factor. An important association is found between bipolar disorder and irritable bowel syndrome, asthma, obesity, migraine and head trauma. Bipolar disorder manifests as episodes of mania, hypomania, depression and combinations of the latter. Diagnosis is complicated because the patient will be characterized by a single-pole clinic during the consultation. The main challenge is to differentiate bipolar disorder from classical depression. Treatment is based on pharmacotherapy, psychotherapy, cognitive behavioral therapy and family therapy.

Keywords: bipolar disorder, mania, depression.