Description

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.

Pediatric Considerations
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 protect against risk of mood episodes.
• Need to weigh risk of exposure to mood episode to that of medication
• Avoid divalproex (Depakote) 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% 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 misuse

General Prevention

Treatment adherence and education can help to prevent further episodes.

Commonly Associated Conditions

Substance misuse, ADHD, anxiety disorders, and eating disorders