General signs and symptoms

This category includes the evidence on the main signs and symptoms of bipolar disorder. These include mania, depression, and psychotic symptoms, and sleep disturbances, among others. Click on the links or the tabs below to access the information, or browse and search via the section on the left.

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Bereavement

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

Disorganisation

What are disorganised symptoms in bipolar disorder? 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…

Dissociation

What is dissociation in bipolar disorder? 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 in people with bipolar disorder? Moderate to low quality evidence suggests less dissociation in people with bipolar disorder than in people with dissociative disorders, post-traumatic stress…

Psychotherapy

Early detection

Why is early detection of bipolar disorder important? Early detection of bipolar disorder can prevent or delay the onset of the disorder, and improve clinical outcomes in people who develop it. What is the evidence regarding early detection of bipolar disorder? Moderate to high 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 was a medium-sized effect of higher risk of transition to bipolar disorder with early age of onset of depression, and a small effect of having a…

Mania

Mania

What are mania symptoms in bipolar disorder? 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…

Bipolar disorder

Mixed symptoms

What are mixed symptoms in bipolar disorder? Bipolar disorder is characterised by recurrent episodes of depression and mania. Some people with bipolar disorder also show episodes of mixed symptoms or states. Mixed states involves having three or more manic/hypomanic symptoms within a depressive episode, or depressive symptoms within a manic/hypomanic episode. A depressive episode is at least two weeks in which a person has at least five of the following symptoms. 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;…

Mood cycling

What is mood cycling in bipolar disorder? Bipolar disorder is characterised by recurrent episodes of depression and mania or hypomania. The duration of mood episodes varies from several days to several months, with usually a period of remission in between. The frequency of mood changes (cycling) also varies, with four or more episodes per year classified as rapid cycling. A depressive episode is a period of at least two weeks when 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…

Motor dysfunction

What are movement 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 in people with bipolar disorder? Moderate to low quality evidence finds the…

Neurological soft signs

What are neurological soft signs in bipolar disorder? Neurological soft signs (NSS) are abnormalities identified by clinical examination. They are referred to as ‘soft’ because they are not related to a localised pathological lesion and are not part of a well-defined neurological syndrome. NSS can be grouped into three categories: integrative sensory functioning, motor coordination, and complex motor sequencing. Integrative sensory functioning includes deficits in bilateral extinction (difficulty perceiving stimuli when presented to both hemispheres simultaneously), impaired audio-visual integration, agraphaesthesia (inability to recognise by touch letters and numbers drawn on the skin) and astereognosis (inability to identify an object by…

Olfactory functioning

What is olfactory functioning in bipolar disorder? Olfactory processes may be dysfunctional in people with bipolar disorder. These processes are hierarchical and involve 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…

Personality and temperament

What is personality and temperament in bipolar disorder? 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. What is the evidence for personality and temperament in people with bipolar disorder? Compared to controls Moderate to high quality evidence finds large effects of more harm avoidance, highs and lows, depression, irritability, and anxiousness. There is also less self-directedness and excessive positive mood compared to people without the disorder. Medium-sized effects were found of more…

Predominant polarity

What is predominant polarity in people with bipolar disorder? 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;…

Psychotic symptoms

What are psychotic symptoms in bipolar disorder? Psychotic symptoms are sometimes found in people with bipolar disorder, particularly in the manic phase of the illness. The severity of psychotic symptoms can significantly affect a person’s day-to-day functioning, quality of life, and cognition. 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…

Self-esteem

What is self-esteem in bipolar disorder? 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 in people with bipolar disorder? 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. September 2021 Image: ©jcomp – stock.adobe.com

Sleep disturbance

What is sleep disturbance in bipolar disorder? People with bipolar disorder 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…

NeuRA Libraries

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