Bipolar II Disorder

Bipolar II Disorder is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or .

Medicine Central™ is a quick-consult mobile and web resource that includes diagnosis, treatment, medications, and follow-up information on over 700 diseases and disorders, providing fast answers—anytime, anywhere. Explore these free sample topics:

-- The first section of this topic is shown below --

Basics

Description

Bipolar II (BP-II) is a mood disorder characterized by at least one episode of major depression (with or without psychosis) and at least one episode of hypomania, a nonsevere mood elevation.

Geriatric Considerations
In new onset in older patients (>50 years of age) a workup for organic or chemically induced pathology is strongly recommended. Medications for adults are generally found efficacious in older adults, although high quality studies are lacking. Pay strict attention to pharmacokinetic issues, drug-drug interactions, side effects, and need for ongoing monitoring (e.g., lithium level and renal monitoring q3–6mo with lithium use).

Pediatric Considerations
Diagnosis is based on the same set of symptoms applied to adults. Need for clarity of symptoms is critical to differentiate between attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), disruptive mood dysregulation, and other diagnoses with overlapping symptoms that are common in childhood.

Pregnancy Considerations

  • Pregnancy does not reduce risk of mood episodes.
  • Need to weigh risk of exposure to mood episode to that of medication
  • Avoid divalproex due to high teratogenicity risk.
  • Postpartum caries high risk of severe acute episode with psychosis and/or infanticidal ideation.

Epidemiology

Onset usually between 15 and 30 years of age

Prevalence
  • 0.5–1.0% lifetime prevalence
  • More common in women

Etiology and Pathophysiology

Dysregulation of biogenic amines or neurotransmitters (particularly serotonin, norepinephrine, and dopamine)

Genetics
Heritability estimate: >77%

Risk Factors

Genetics, major life stressors, or substance abuse

General Prevention

No known way to prevent onset, but treatment adherence and education can help to prevent further episodes.

Commonly Associated Conditions

Substance misuse, ADHD, anxiety disorders, and eating disorders

-- To view the remaining sections of this topic, please or --

Basics

Description

Bipolar II (BP-II) is a mood disorder characterized by at least one episode of major depression (with or without psychosis) and at least one episode of hypomania, a nonsevere mood elevation.

Geriatric Considerations
In new onset in older patients (>50 years of age) a workup for organic or chemically induced pathology is strongly recommended. Medications for adults are generally found efficacious in older adults, although high quality studies are lacking. Pay strict attention to pharmacokinetic issues, drug-drug interactions, side effects, and need for ongoing monitoring (e.g., lithium level and renal monitoring q3–6mo with lithium use).

Pediatric Considerations
Diagnosis is based on the same set of symptoms applied to adults. Need for clarity of symptoms is critical to differentiate between attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), disruptive mood dysregulation, and other diagnoses with overlapping symptoms that are common in childhood.

Pregnancy Considerations

  • Pregnancy does not reduce risk of mood episodes.
  • Need to weigh risk of exposure to mood episode to that of medication
  • Avoid divalproex due to high teratogenicity risk.
  • Postpartum caries high risk of severe acute episode with psychosis and/or infanticidal ideation.

Epidemiology

Onset usually between 15 and 30 years of age

Prevalence
  • 0.5–1.0% lifetime prevalence
  • More common in women

Etiology and Pathophysiology

Dysregulation of biogenic amines or neurotransmitters (particularly serotonin, norepinephrine, and dopamine)

Genetics
Heritability estimate: >77%

Risk Factors

Genetics, major life stressors, or substance abuse

General Prevention

No known way to prevent onset, but treatment adherence and education can help to prevent further episodes.

Commonly Associated Conditions

Substance misuse, ADHD, anxiety disorders, and eating disorders

There's more to see -- the rest of this entry is available only to subscribers.