In bipolar disorder – colloquially called manic-depressive illness – (synonyms: bipolar affective disorder; bipolar affective psychosis; bipolar affective psychosis in mixed episode; bipolar affective psychosis in major depressive episode with psychotic symptoms; bipolar affective disorder; bipolar affective disorder in mixed episode; bipolar affective disorder in hypomanic episode; bipolar affective disorder in mild depressive episode; bipolar affective disorder in manic episode with psychotic symptoms; bipolar affective disorder in manic episode without psychotic symptoms; bipolar affective disorder in moderate depressive episode; bipolar affective disorder in major depressive episode with psychotic symptoms; bipolar affective disorder in major depressive episode without psychotic symptoms; bipolar affective psychosis; bipolar psychosis; bipolar disorder; bipolar II disorder; bipolar I disorder; chronic mania; depressive episode; currently remitted bipolar affective psychosis; currently remitted bipolar affective disorder; hypomania; hypomanic form of manic-depressive reaction; short cycling; mania; manic-depressive illness; manic-depressive psychosis; manic-depressive reaction; manic-depressive mixed state; manic-depressive stupor; manic-depressive mania; manic-depressive syndrome; manic-depressive symptomatology; manic depression; manic episode; manic form of manic-depressive reaction; rapid cycler; rapid cycling; recurrent manic episodes; cyclic stupor; cyclothymia with depression; cyclothymia with mania; ICD-10-GM F30. -: Manic episode; ICD-10-GM F31.-: Bipolar affective disorder; ICD-10-GM F32.-: Depressive Episode) is an affective (changing basic mood) disorder in which both depressive and manic phases occur. The mood of those affected is characterized by fluctuations: extreme high phases (mania) alternate with phases of complete listlessness. Between the episodes of illness, the affected person always returns to an inconspicuous normal state. The following forms can be distinguished according to ICD-10-GM:
| Manic episode | Hypomania (attenuated form of mania) (ICD-10-GM F30.0) |
| Mania without psychotic symptoms (ICD-10-GM F30.1) | |
| Mania with psychotic symptoms (synthymic/parathymic) (ICD-10-GM F30.2) | |
| Other manic episodes (ICD-10-GM F30.8) | |
| Manic episode, unspecified (ICD-10-GM F30.9) | |
| Depressive episode | Mild depressive episode (without/with somatic syndrome) (ICD-10-GM F32.0) |
| Moderate depressive episode (without/with somatic syndrome) (ICD-10-GM F32.1) | |
| Major depressive episode (without psychotic symptoms) (ICD-10-GM F32.2) | |
| Major depressive episode (with psychotic symptoms) (ICD-10-GM F32.3) | |
| Other depressive episodes (atypical depression) (ICD-10-GM F32.8) | |
| Depressive episode, unspecified (ICD-10-GM F32.9) |
To be diagnosed with bipolar disorder, at least two distinct affective episodes must have occurred. Of these, at least one episode must be a manic, hypomanic, or mixed episode. Bipolar disorder can be differentiated according to the duration, frequency, and intensity of each episode into:
- Bipolar I disorder (BD-I) – This form has at least one manic episode in addition to depression; manic phase lasts at least 14 days and is very pronounced.
- Bipolar-II disorder (BD-II) – This form is characterized by depressive episodes and at least one manic episode, which in most cases is rather weak (hypomania).
Furthermore, there are subsyndromal courses and cyclothymia (ICD-10 F 34.0). Sex ratio: men and women are equally affected. Frequency peak: The disease usually begins in adolescence (period of life between late childhood and adulthood) or early adulthood, i.e. between 15 and 30 years of age. First symptoms appear before the age of 18. The lifetime prevalence (frequency of illness throughout life) is 3-5%.The prevalence for Bipolar I Disorder is 0.5-2% and for Bipolar II Disorder 0.2-5% (in Germany). Course and prognosis: The course varies greatly from individual to individual. Often the manic phases last somewhat shorter than the depressive phases. There may even be several years of symptom-free time between phases. However, with each episode of illness, the duration of the illness-free intervals decreases. Many years usually pass before a final diagnosis is made. Bipolar disorders are prone to relapse (recurrence of the illness). Around 10% of those affected suffer more than ten episodes in their lifetime. So-called rapid cycling, in which there is a rapid change between depressive and manic phases (≥ 4 affective episodes in 12 months), affects up to 20% of patients. One study showed that patients with bipolar disorder were euthymic (balanced mood) only half of the time. Patients with BD-I and BD-II differed little in their tendency toward depressive states. The disorder is associated with increased suicidality (suicide risk). Patients with bipolar disorder die an average of 9 to 20 years of life earlier. Comorbidities (concomitant disorders): 10-year follow-up data show a statistically significant association between cannabis use and the onset of bipolar disorder. The same is known to be true for harmful alcohol use.
