Bipolar Disorder Assessment & Treatment

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People with bipolar disorder (previously called manic-depressive illness or manic depression) experience a cycle of mood swings between depression and mania (elation). A less severe form of mania is termed hypomania. Both the manic and depressive phases vary widely in intensity and duration. People with bipolar disorder often spend more time in the depressive phase of illness than the manic or hypomanic phase.

Common symptoms of bipolar disorders are (1):

Emotional changes:

  • Experiencing an elevated, expansive or irritable mood for at least one week
  • Rapid changes in mood between depression and mania, or a mixture of both
  • Moodiness
  • Irritability or anger

Cognitive changes:

  • Feeling excessively good about the self (inflated self esteem)
  • Exaggerated ideas about how important one is (grandiosity)
  • Difficulty concentrating, paying attention and remembering things
  • Easily distracted or impulsive
  • Having many ideas or thoughts at the one time (flight of ideas)

Behavioural changes:

  • More talkative or having pressured speech
  • Problems with work, social or family life
  • Increased goal-directed activity
  • Involvement in pleasurable or risky activities that have the potential for serious negative consequences (eg, excessive spending, increased sexual activity)
  • Increase in impulsivity

Physical changes:

  • Decreased need for sleep
  • Changes in energy levels and appetite

Onset, prevalence, and burden of bipolar disorders in young people

At least one in every 100 people will experience bipolar disorder at some time during their lives. In Australia, it is estimated that approximately 1.8% of males and 1.7% of females have had bipolar disorder in the previous 12 months (2). In young Australians aged 16-24 years, it is estimated that approximately 3.2% of males and 3.6% of females have had bipolar disorder in their lifetime (3).

Bipolar disorder is the ninth leading contributor to the burden of disease and injury in Australian females aged 15-24 years, and the tenth leading contributor for males of the same age (3).

Overall, about 50% of people who develop bipolar disorder will do so by the time they are in their early to mid 20s (4). Bipolar disorder in young people may sometimes be misdiagnosed as depression. Australian researchers have found that from the average age of symptom onset (17.5 years), there was a delay of approximately 12.5 years before a diagnosis of bipolar disorder was made (5).

Risk factors

A number of factors are known to increase the likelihood that a person will develop bipolar disorder (6). These include:

  • Genetic vulnerability (for example, bipolar disorder in other family members)
  • Physiological or biological factors including complications during gestation or birth, or abnormal regulation of daily (circadian) rhythms
  • Psychological factors including a childhood history of physical or sexual abuse
  • Stressful life events


1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

2. Slade, T., Johnston, A., Oakley Browne, M. A., Andrews, G., & Whiteford, H. (2009). 2007 National Survey of Mental Health and Wellbeing: methods and key findingsAustralasian Psychiatry43(7), 594-605.

3. Australian Institute of Health and Welfare 2011. Young Australians: their health and wellbeing 2011. Cat. no. PHE 140 Canberra: AIHW

4. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey ReplicationArchives of General Psychiatry62(6), 593-602.

5. Berk, M., Dodd, S., Callaly, P., Berk, L., Fitzgerald, P., de Castella, A.R., & Kulkarni, J. (2007). History of illness prior to a diagnosis of bipolar disorder or schizoaffective disorderJournal of Affective Disorders, 103(1-3), 181-186.

6. Berk, M., Conus, P., Lucas, N., Hallam, K., Malhi, G. S., Dodd, S., Yatham, L., Yung, A., & McGorry, P. (2007). Setting the stage: from prodrome to treatment resistance in bipolar disorderBipolar Disorders9(7), 671-678


Formal systems for the diagnosis of mental illness (1,2) describe a number of different types of bipolar disorder, including:

  • Bipolar I disorder (manic episodes have occurred)
  • Bipolar II disorder (hypomanic episodes have occurred)
  • Cyclothymia (chronic, fluctuating mood symptoms that are milder than those in Bipolar I or II disorder)
  • Bipolar disorder not otherwise specified (NOS)

Assessment Tools

To decide whether a young person may be experiencing bipolar disorder, a comprehensive assessment by a mental health professional is required.  As a first step, the assessment involves asking questions about a range of aspects of a person's life including their:

  • Home and environment;
  • Education and employment;
  • Activities;
  • Drugs and alcohol;
  • Relationships and sexuality;
  • Conduct difficulties and risk-taking;
  • Anxiety and eating;
  • Depression and suicide;
  • Psychosis and mania

To specifically assess for the presence of manic symptoms consistent with bipolar disorder, a comprehensive Mental State Examination by a mental health professional trained in clinical assessment is required. It may also be beneficial to use a standardized assessment rating scale, such as the Young Mania Rating Scale (YMRS) (3) to comprehensively assess symptoms of mania.


1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.

2. World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization.

3. Young, R. C., Biggs, J. T., Ziegler, V. E., & Meyer, D. A. (1978). A rating scale for mania: reliability, validity and sensitivityThe British Journal of Psychiatry133(5), 429-435.



Early detection and treatment of bipolar disorder can improve its long-term outcome (1,2).  Accurate diagnosis is essential to provide appropriate treatment, but this can be difficult in the early stages of bipolar disorder as (3,4):

  • There can be an overlap in symptoms with other disorders (for example, psychosis or ADHD)
  • Bipolar disorder can only be diagnosed after a full episode of mania or hypomania has occurred. Therefore, people whose bipolar disorder commences with an episode of depression and/or hypomanic symptoms that do not meet diagnostic threshold may be diagnosed initially with a depressive disorder
  • Co-existing disorders (eg, medical illness, substance use) can complicate the process

Every person is different, but treatment of bipolar disorder could include (5):

  • Assertive case management
  • Appropriate medication (using mood stabilizers, antidepressants or antipsychotics as needed)
  • Psychological therapy
  • Family and group therapy (including family psychoeducation)
  • Vocational interventions

The importance of early intervention has been noted. Young people with bipolar disorder have been found to have a higher rate of response to treatment with appropriate medication, as compared to adults (6). The long-term use of medication may also be needed to prevent relapse.

In areas where specialised early intervention services do not exist, general practitioners have an opportunity to make an early diagnosis and provide initial treatment before review by a psychiatrist (7). A psychiatrist will generally develop a treatment strategy and may provide continued clinical management individually or in conjunction with the GP (see (8) for further information).


1. Berk, M., Hallam, K., Malhi, G. S., Henry, L., Hasty, M., Macneil, C., ... & McGorry, P. D. (2010). Evidence and implications for early intervention in bipolar disorder.  Journal of Mental Health19(2), 113-126.

2. Kapczinski, F., Magalhães, P. V. S., Balanzá-Martinez, V., Dias, V. V., Frangou, S., Gama, C. S., ... & Berk, M. (2014). Staging systems in bipolar disorder: an International society for bipolar disorders task force reportActa Psychiatrica Scandinavica130(5), 354-363.

3. Danner, S., Fristad, M. A., Arnold, L. E., Youngstrom, E. A., Birmaher, B., Horwitz, S. M., ... & LAMS Group. (2009). Early-onset bipolar spectrum disorders: Diagnostic issuesClinical Child and Family Psychology Review12(3), 271-293.

4. Berk, M., Moss, K., Berk, L., Malhi, G. S., & Dodd, S. (2006). Diagnosing bipolar disorder: How can we do it betterMedical Journal of Australia, (9). 459.

5. Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorderThe Lancet3811672-1682. doi:10.1016/S0140-6736(13)60857-0

6. Mao, A., & Findling, R. (2007). Growing evidence to support early intervention in early onset bipolar disorderAustralian & New Zealand Journal Of Psychiatry41(8), 633-636.

7. Faust, D. S., Walker, D., & Sands, M. (2006). Diagnosis and management of childhood bipolar disorder in the primary care settingClinical Pediatrics45(9), 801-808.

8. Bipolar Disorder: Australian treatment guidelines for consumers and carers 2009. Royal Australian and New Zealand College of Psychiatrists



The following authoritative guidelines provide evidence-based information about the practical treatment of bipolar disorders:

Bipolar disorder. The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. (2014) National Institute for Health and Clinical Excellence (NICE) CG 185, United Kingdom

Guidelines for the management of patients with bipolar disorder: update 2013 (2013) Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD)

Practice Parameter for the Assessment and Treatment of Children and Adolescents with Bipolar Disorder. (2007) American Academy of Child and Adolescent Psychiatry

Treatment Guidelines for Children and Adolescents with Bipolar Disorder. (2005) Child Psychiatric Workgroup on Bipolar Disorder

Australian and New Zealand Clinical Practice Guidelines for the Treatment of Bipolar Disorder. (2004) Royal Australian and New Zealand College of Psychiatrists

More Information

The following selected articles provide more information about bipolar disorder:

Cochrane systematic reviews on bipolar disorder

Macneil, C. A., Hasty, M. K., Berk, M., Henry, L., Evans, M., Redlich, C., ... & Conus, P. (2011). Psychological needs of adolescents in the early phase of bipolar disorder: implications for early intervention. Early intervention in psychiatry, 5(2), 100-107.

Berk, M., Hallam, K., Malhi, G. S., Henry, L., Hasty, M., Macneil, C., ... & McGorry, P. D. (2010). Evidence and implications for early intervention in bipolar disorderJournal of Mental Health19(2), 113-126.

Berk, M., Hallam, K., Lucas, N., Hasty, M., McNeil, C. A., Conus, P., ... & McGorry, P. D. (2007). Early intervention in bipolar disorders: opportunities and pitfalls. Med J Aust, 187(7 Suppl), S11-S14.

Birmaher, B., & Axelson, D. (2006). Course and outcome of bipolar spectrum disorder in children and adolescents: a review of the existing literatureDevelopment and psychopathology18(04), 1023-1035.

Kowatch, R. A., Youngstrom, E. A., Danielyan, A., & Findling, R. L. (2005). Review and meta-analysis of the phenomenology and clinical characteristics of mania in children and adolescentsBipolar Disorders7(6), 483-496

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