General signs and symptoms

This category includes the evidence on overall signs and symptoms of bipolar disorder.

Depression

What is bipolar depression? Bipolar disorder is characterised by recurrent episodes of depression and mania, hypomania, or mixed symptoms. A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including one of the first two): intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes in appetite; loss of energy; difficulty concentrating, remembering or making decisions; and/or thoughts of death or suicide….

Disorganised symptoms

What are disorganised symptoms? Key features of the symptoms of disorganisation include disorganised speech and behaviour, as well as inappropriate affect. Severely disorganised speech is difficult to follow, being incoherent, irrelevant and/or illogical. These symptoms are sometimes called positive formal thought disorder symptoms. Disorganised speech may also be deprived of content, which is sometimes called negative formal thought disorder symptoms. Disorganised behaviour includes bizarre or inappropriate behaviour, actions or gestures. Inappropriate (incongruous) affect involves exhibiting incorrect emotional responses for a given context. Symptoms of disorganisation have been identified as risk factors for poor illness outcome, and have a significant negative…

Dissociation

What is dissociation? Dissociation is described as disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, or behaviour. Common dissociative experiences include mild forms of absorption, such as daydreaming. Less common and more severe dissociative experiences include amnesia, derealisation, depersonalisation, and fragmentation of identity. Dissociative features may play a role in the pathology of bipolar disorder. What is the evidence for dissociation symptoms? Moderate to low quality evidence suggests less dissociation in people with bipolar disorder than people with dissociative disorders, posttraumatic stress disorder, borderline personality disorder, or conversion disorder. Similar dissociation…

Early detection

Why is early detection of bipolar disorder important? Detection of the early stages of bipolar disorder may help develop interventions that prevent or delay the onset of the disorder. Early intervention can also result in improved clinical outcomes should the disorder develop. To achieve early detection, accurate identification of individuals at highest risk of onset of symptoms is paramount. What is the evidence for early detection of bipolar disorder? Moderate quality evidence suggests large effects of having psychotic symptoms or a family history of bipolar disorder as risk factors for transition to bipolar disorder in people with major depression. There…

Impulsivity

What is impulsivity? Impulsivity is a predisposition towards unplanned reactions to internal or external stimuli, without regard to the consequences. Impulsivity is a major feature in a variety of psychiatric disorders, and is a common feature of manic episodes in people with bipolar disorder. It may also be present during remission/euthymia and depression phases of bipolar disorder. What is the evidence for impulsivity? Moderate to low quality evidence suggests increased impulsivity in non-planning, motor and cognitive domains in people with bipolar disorder during remission of illness compared to controls. March 2019

Mania

What is mania? A manic episode is a period of at least one week when a person is high spirited or irritable in an extreme way most of the day for most days. A manic episode involves changes in normal behaviour, including showing exaggerated self-esteem or grandiosity, less need for sleep, talking more than usual, talking more loudly and quickly, being easily distracted, doing many activities at once, scheduling more events in a day than can be accomplished, embarking on risky behaviour, uncontrollable racing thoughts, and/or quickly changing ideas or topics. These changes in behaviour are significant and clear to…

Mixed states

What are mixed states? Bipolar disorder is characterised by recurrent episodes of depression and mania or hypomania. Some people with bipolar disorder also show episodes of mixed states. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines mixed states as having three or more manic or hypomanic symptoms within a depressive episode, or depressive symptoms within a manic or hypomanic episode. A depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including one of the first two): intense sadness or despair; feelings of helplessness, hopelessness or…

Mood cycling

What is mood cycling? Bipolar disorder is characterised by recurrent episodes of depression and mania or hypomania. The duration of mood episodes varies between patients, from several days to several months, with usually a period of remission in between. The frequency of mood changes (cycling) also varies between patients, with four or more episodes per year classified as rapid cycling. A depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including one of the first two): intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss…

Motor dysfunction

What are motor disorders? Movement disorders have been reported in people with bipolar disorder, with tardive dyskinesia among the most commonly reported. This disorder is a ‘hyper-kinetic’ (excessive movement) disorder, characterised by jerky, involuntary movements, usually of the face and/or limbs. Parkinsonism is another movement disorder, which is a ‘hypo-kinetic’ (reduced movement) disorder, characterised by slowness of movement and rigidity. Movement disorders are primarily associated with the use of antipsychotics, however they have also been reported in people who are antipsychotic-naïve. What is the evidence for movement disorders? Low quality evidence is unclear of the prevalence of movement disorders in…

Neurological soft signs

What are neurological soft signs (NSS)? NSS are neurological abnormalities that can be identified by clinical examination using valid and reliable testing measures. They are referred to as ‘soft’ because they are not related to a localised pathological lesion and are not thought to be part of a well-defined neurological syndrome. Categories of NSS are varied but they are commonly grouped into three categories: integrative sensory functioning, motor coordination, and complex motor sequencing. Integrative sensory functioning can include deficits in bilateral extinction (difficulty perceiving stimuli when presented to both hemispheres simultaneously), impaired audio-visual integration, agraphaesthesia (inability to recognise by touch…

Olfactory functioning

What is olfactory functioning? Olfactory functioning is hierarchical and involves lower-order processing (detection of the stimulus) and higher-order processing (discrimination and identification of the stimulus). Measures of olfactory acuity include odor detection, identification, discrimination, intensity, and quality. Odour detection occurs at the lowest chemical concentration needed to register an odourant. Odour identification draws on a person’s knowledge and memory to correctly label the smell. Odour discrimination involves comparing the differences between multiple stimuli, judging odours as pleasant or unpleasant, or comparing the relative concentration of odours. What is the evidence for olfactory functioning? Moderate to low quality evidence suggests poorer…

Personality and temperament

What is personality and temperament? Personality and temperament are relatively stable over time and include innate emotional, reactive, and attentional traits. These traits may differ according to genetic differences and the extent of the risk a person has to psychiatric disorders such as bipolar disorder. What is the evidence for personality and temperament? Compared to controls Moderate to high quality evidence suggests large effects of more harm avoidance, highs and lows, depression, irritability, and anxiousness, and less self-directedness and excessive positive mood in people with bipolar disorder. There were medium-sized effects of more self-transcendence and less cooperativeness and excessive positive…

Predominent polarity

What is predominent polarity? Bipolar disorder is characterised by recurrent episodes of depression and mania, hypomania, or mixed symptoms. Some, but not all, people with bipolar disorder show a predominance of either depression or manic episodes. A major depressive episode is a period of at least two weeks in which a person has at least five of the following symptoms (including one of the first two): intense sadness or despair; feelings of helplessness, hopelessness or worthlessness; loss of interest in activities once enjoyed; feelings of guilt, restlessness or agitation; sleeping too little or too much; slowed speech or movements; changes…

Psychotic symptoms

What are psychotic symptoms? Psychotic symptoms most commonly involve hallucinations and delusions. Hallucinations are defined as a perceptual experience that occurs in the absence of any corresponding external sensory input. They are most commonly auditory, but can occur in any modality. Delusions are fixed, false beliefs that persist regardless of contradictory evidence, and are not explained by cultural beliefs. Persecutory delusions involve the belief that people are attempting to harm or even kill the individual. Delusions of reference refer to beliefs that neutral events are directed specifically towards the individual. Somatic delusions involve the belief that the individual has a…

Self-esteem

What is self-esteem? Self-esteem reflects an individual’s overall subjective emotional evaluation of his or her own worth. High self-esteem has been linked to happiness and satisfaction, while low self-esteem has been linked to pessimism, general distress, adjustment problems, and psychiatric illness, particularly depression. What is the evidence for self-esteem? Moderate to high quality evidence suggests a large effect of lower self-esteem in people with remitted bipolar disorder when compared to controls, but higher self-esteem when compared to people with remitted major depression. March 2019

Sleep disturbance

What is sleep disturbance? People with a mental illness may show disturbances in the amount or quality of sleep they receive. Typically sleep follows a characteristic pattern of four stages, where stage 1 is a state of drowsiness and early sleep; stage 2 comprises the largest component of the sleep cycle and is the first complete loss of awareness of the external environment; stage 3 is a deep, slow-wave sleep; and the fourth stage is rapid eye movement (REM) sleep where memorable dreaming and muscle paralysis occurs. Sleep disturbance can be measured in many ways, including the total sleep time,…

NeuRA Libraries

Title Colour Legend:
Green - Topic summary is available.
Orange - Topic summary is being compiled.
Red - Topic summary has no current systematic review available.