Bipolar Disorders

  • Samantha L. ConnollyEmail author
  • Christopher J. Miller


Bipolar and related disorders are complex, chronic conditions characterized by periods of significantly depressed and elevated mood. Individuals with bipolar disorder experience marked impairments in occupational and interpersonal functioning, and these difficulties have been shown to persist despite clinical remission in approximately half of the diagnosed population (Sanchez-Moreno et al., 2009). Indeed, bipolar disorder ranks as the ninth leading cause of disability worldwide (World Health Organization, 2001). The majority of patients with bipolar disorder will have at least one other comorbid psychiatric diagnosis; substance use and anxiety disorders are particularly prevalent and can contribute to poorer illness outcomes (American Psychiatric Association, 2013; Bauer et al., 2005). Rates of completed suicide among individuals with bipolar disorder are between 15 and 60 times that of the general population, and 25–50% of those with the diagnosis will attempt suicide within their lifetime (Baldessarini, Pompili, & Tondo, 2006; Jamison, 2000). Bipolar disorder has a strong genetic component (McGuffin et al., 2003), but environmental influences such as stress or trauma may impact illness onset and severity (Aldinger & Schulze, 2017). Some research has suggested that psychological factors including temperamental differences or cognitive dysfunction may also serve as vulnerabilities for the development of the disorder (McKinnon, Cusi, & MacQueen, 2013). Accurate diagnosis is crucial to ensure the effective treatment and management of this often debilitating condition.


Bipolar disorders Mania Assessment Psychopathology Interviewing 


  1. Akiskal, H. S., & Benazzi, F. (2005). Optimizing the detection of bipolar II disorder in outpatient private practice: Toward a systematization of clinical diagnostic wisdom. Journal of Clinical Psychiatry, 66(7), 914–921.Google Scholar
  2. Akiskal, H. S., Walker, P., Puzantian, V. R., King, D., Rosenthal, T. L., & Dranon, M. (1983). Bipolar outcome in the course of depressive illness. Phenomenologic, familial, and pharmacologic predictors. Journal of Affective Disorders, 5(2), 115–128.Google Scholar
  3. Aldinger, F., & Schulze, T. G. (2017). Environmental factors, life events, and trauma in the course of bipolar disorder. Psychiatry and Clinical Neuroscience, 71(1), 6–17. Scholar
  4. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.., text rev.). Washington, DC: Author. Scholar
  5. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Scholar
  6. Angst, J., Adolfsson, R., Benazzi, F., Gamma, A., Hantouche, E., Meyer, T. D., … Scott, J. (2005). The HCL-32: Towards a self-assessment tool for hypomanic symptoms in outpatients. Journal of Affective Disorders, 88(2), 217–233. Scholar
  7. Baldessarini, R. J., Pompili, M., & Tondo, L. (2006). Suicide in bipolar disorder: Risks and management. CNS Spectrums, 11(6), 465–471.Google Scholar
  8. Bauer, M. S., Altshuler, L., Evans, D. R., Beresford, T., Williford, W. O., Hauger, R., & Team, V. A. C. S. (2005). Prevalence and distinct correlates of anxiety, substance, and combined comorbidity in a multi-site public sector sample with bipolar disorder. Journal of Affective Disorders, 85(3), 301–315. Scholar
  9. Bauer, M. S., Kirk, G. F., Gavin, C., & Williford, W. O. (2001). Determinants of functional outcome and healthcare costs in bipolar disorder: A high-intensity follow-up study. Journal of Affective Disorders, 65(3), 231–241.Google Scholar
  10. Brewerton, T. D. (1994). Hyperreligiosity in psychotic disorders. Journal of Nervous and Mental Disorders, 182(5), 302–304.Google Scholar
  11. Brodey, B. B., First, M., Linthicum, J., Haman, K., Sasiela, J. W., & Ayer, D. (2016). Validation of the NetSCID: An automated web-based adaptive version of the SCID. Comprehensive Psychiatry, 66, 67–70. Scholar
  12. Chen, Y. R., Swann, A. C., & Johnson, B. A. (1998). Stability of diagnosis in bipolar disorder. Journal of Nervous and Mental Disorders, 186(1), 17–23.Google Scholar
  13. De Fazio, P., Gaetano, R., Caroleo, M., Cerminara, G., Giannini, F., Jaen Moreno, M. J., … Segura-Garcia, C. (2015). Religiousness and spirituality in patients with bipolar disorder. International Journal of Psychiatry in Clinical Practice, 19(4), 233–237. Scholar
  14. Depue, R. A., Slater, J. F., Wolfstetter-Kausch, H., Klein, D., Goplerud, E., & Farr, D. (1981). A behavioral paradigm for identifying persons at risk for bipolar depressive disorder: A conceptual framework and five validation studies. Journal of Abnormal Psychology, 90(5), 381.Google Scholar
  15. Dunner, D. L., & Tay, L. K. (1993). Diagnostic reliability of the history of hypomania in bipolar II patients and patients with major depression. Comprehensive Psychiatry, 34(5), 303–307.Google Scholar
  16. Endicott, J., & Spitzer, R. L. (1978). A diagnostic interview: The schedule for affective disorders and schizophrenia. Archives of General Psychiatry, 35(7), 837–844.Google Scholar
  17. First, M., Williams, J., Karg, R., & Spitzer, R. (2015a). Structured clinical interview for DSM-5—Research version (SCID-5 for DSM-5, research version; SCID-5-RV). Arlington, VA: American Psychiatric Association.Google Scholar
  18. First, M., Williams, J., Karg, R., & Spitzer, R. (2015b). Structured clinical interview for DSM-5 disorders, clinician version (SCID-5-CV). Arlington, VA: American Psychiatric Association.Google Scholar
  19. First, M. B., & Gibbon, M. (2004). The structured clinical interview for DSM-IV Axis I disorders (SCID-I) and the structured clinical interview for DSM-IV Axis II disorders (SCID-II). In M. J. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment, Vol. 2. Personality assessment (pp. 134–143). Hoboken, NJ: John Wiley & Sons Inc.Google Scholar
  20. Ghaemi, S. N., Ko, J. Y., & Goodwin, F. e. i. K. (2002). “Cade's disease” and beyond: Misdiagnosis, antidepressant use, and a proposed definition for bipolar spectrum disorder. The Canadian Journal of Psychiatry, 47(2), 125–134.Google Scholar
  21. Ghaemi, S. N., Miller, C. J., Berv, D. A., Klugman, J., Rosenquist, K. J., & Pies, R. W. (2005). Sensitivity and specificity of a new bipolar spectrum diagnostic scale. Journal of Affective Disorders, 84(2), 273–277.Google Scholar
  22. Hergueta, T., Baker, R., & Dunbar, G. C. (1998). The MINI-international neuropsychiatric interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IVand ICD-10. Journal of Clinical Psychiatry, 59.(Suppl 20, 2233.Google Scholar
  23. Hirschfeld, R. M., Holzer, C., Calabrese, J. R., Weissman, M., Reed, M., Davies, M., … Hazard, E. (2003). Validity of the mood disorder questionnaire: A general population study. American Journal of Psychiatry, 160(1), 178–180. Scholar
  24. Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck, P. E., Jr., … Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The mood disorder questionnaire. American Journal of Psychiatry, 157(11), 1873–1875. Scholar
  25. Hwang, S. H., Childers, M. E., Wang, P. W., Nam, J. Y., Keller, K. L., Hill, S. J., & Ketter, T. A. (2010). Higher prevalence of bipolar I disorder among Asian and Latino compared to Caucasian patients receiving treatment. Asia-Pacific Psychiatry, 2(3), 156–165.Google Scholar
  26. Jamison, K. R. (2000). Suicide and bipolar disorder. Journal of Clinical Psychiatry, 61(Suppl 9), 47–51.Google Scholar
  27. Jones, B. E., & Gray, B. A. (1986). Problems in diagnosing schizophrenia and affective disorders among blacks. Psychiatric Services, 37(1), 61–65.Google Scholar
  28. Kennedy, N., Boydell, J., van Os, J., & Murray, R. M. (2004). Ethnic differences in first clinical presentation of bipolar disorder: Results from an epidemiological study. Journal of Affective Disorders, 83(2-3), 161–168. Scholar
  29. Kessler, R. C., Akiskal, H. S., Angst, J., Guyer, M., Hirschfeld, R. M., Merikangas, K. R., & Stang, P. E. (2006). Validity of the assessment of bipolar spectrum disorders in the WHO CIDI 3.0. Journal of Affective Disorders, 96(3), 259–269. Scholar
  30. Kessler, R. C., Calabrese, J. R., Farley, P. A., Gruber, M. J., Jewell, M. A., Katon, W., … Wittchen, H. U. (2013). Composite international diagnostic interview screening scales for DSM-IV anxiety and mood disorders. Psychological Medicine, 43(8), 1625–1637. Scholar
  31. Kessler, R. C., & Ustun, T. B. (2004). The world mental health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13(2), 93–121.Google Scholar
  32. Kilbourne, A. M., Bauer, M. S., Pincus, H., Williford, W. O., Kirk, G. F., Beresford, T., & Veterans Administration Cooperative Study, T. (2005). Clinical, psychosocial, and treatment differences in minority patients with bipolar disorder. Bipolar Disorders, 7(1), 89–97. Scholar
  33. Lecrubier, Y., Sheehan, D. V., Weiller, E., Amorim, P., Bonora, I., Sheehan, K. H., … Dunbar, G. C. (1997). The MINI international neuropsychiatric interview (MINI). A short diagnostic structured interview: Reliability and validity according to the CIDI. European Psychiatry, 12(5), 224–231.Google Scholar
  34. Lin, K.-M., & Cheung, F. (1999). Mental health issues for Asian Americans. Psychiatric Services, 50(6), 774–780.Google Scholar
  35. McGuffin, P., Rijsdijk, F., Andrew, M., Sham, P., Katz, R., & Cardno, A. (2003). The heritability of bipolar affective disorder and the genetic relationship to unipolar depression. Archives of General Psychiatry, 60(5), 497–502. Scholar
  36. McKinnon, M. C., Cusi, A. M., & MacQueen, G. M. (2013). Psychological factors that may confer risk for bipolar disorder. Cognitive Neuropsychiatry, 18(1-2), 115–128.Google Scholar
  37. Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A., … Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of General Psychiatry, 68(3), 241–251. Scholar
  38. Meyer, T. D., Schrader, J., Ridley, M., & Lex, C. (2014). The hypomania checklist (HCL) - systematic review of its properties to screen for bipolar disorders. Comprehensive Psychiatry, 55(5), 1310–1321. Scholar
  39. Michalak, E. E., Yatham, L. N., Kolesar, S., & Lam, R. W. (2006). Bipolar disorder and quality of life: A patient-centered perspective. Quality of Life Research, 15(1), 25–37. Scholar
  40. Miller, C. J., Johnson, S. L., & Eisner, L. (2009). Assessment tools for adult bipolar disorder. Clinical Psychology: Science and Practice, 16(2), 188–201.Google Scholar
  41. Miller, C. J., Klugman, J., Berv, D. A., Rosenquist, K. J., & Ghaemi, S. N. (2004). Sensitivity and specificity of the mood disorder questionnaire for detecting bipolar disorder. Journal of Affective Disorders, 81(2), 167–171. Scholar
  42. Mitchell, A. J. (2012). Clinical utility of screening for clinical depression and bipolar disorder. Current Opinion in Psychiatry, 25(1), 24–31. Scholar
  43. Mukherjee, S., Shukla, S., Woodle, J., Rosen, A. M., & Olarte, S. (1983). Misdiagnosis of schizophrenia in bipolar patients: A multiethnic comparison. American Journal of Psychiatry, 140(12), 1571–1574. Scholar
  44. Munk-Olsen, T., Laursen, T. M., Pedersen, C. B., Mors, O., & Mortensen, P. B. (2006). New parents and mental disorders: A population-based register study. Journal of the American Medical Association, 296(21), 2582–2589. Scholar
  45. Neighbors, H. W., Trierweiler, S. J., Ford, B. C., & Muroff, J. R. (2003). Racial differences in DSM diagnosis using a semi-structured instrument: The importance of clinical judgment in the diagnosis of African Americans. Journal of Health and Social Behavior, 44(3), 237–256.Google Scholar
  46. Perugi, G., Passino, M. C. S., Toni, C., Maremmani, I., & Angst, J. (2007). Is unipolar mania a distinct subtype. Comprehensive Psychiatry, 48(3), 213–217.Google Scholar
  47. Phelps, J. R., & Ghaemi, S. N. (2006). Improving the diagnosis of bipolar disorder: Predictive value of screening tests. Journal of Affective Disorders, 92(2-3), 141–148. Scholar
  48. Rogers, R. (2001). Handbook of diagnostic and structured interviewing. New York, NY: Guilford Press.Google Scholar
  49. Rogers, R., Jackson, R. L., & Cashel, M. (2004). The schedule for affective disorders and schizophrenia (SADS). In M. Hilsenroth & D. L. Segal (Eds.), Comprehensive handbook of psychological assessment (Vol. 2, pp. 144–152). Hoboken, NJ: John Wiley & Sons Inc.Google Scholar
  50. Rouget, B. W., Gervasoni, N., Dubuis, V., Gex-Fabry, M., Bondolfi, G., & Aubry, J. M. (2005). Screening for bipolar disorders using a French version of the mood disorder questionnaire (MDQ). Journal of Affective Disorders, 88(1), 103–108.Google Scholar
  51. Sanchez-Moreno, J., Martinez-Aran, A., Tabares-Seisdedos, R., Torrent, C., Vieta, E., & Ayuso-Mateos, J. L. (2009). Functioning and disability in bipolar disorder: An extensive review. Psychotherapy and Psychosomatics, 78(5), 285–297. Scholar
  52. Schneck, C. D., Miklowitz, D. J., Calabrese, J. R., Allen, M. H., Thomas, M. R., Wisniewski, S. R., … Sachs, G. S. (2004). Phenomenology of rapid-cycling bipolar disorder: Data from the first 500 participants in the systematic treatment enhancement program. American Journal of Psychiatry, 161(10), 1902–1908. Scholar
  53. Sharma, V., Doobay, M., & Baczynski, C. (2017). Bipolar postpartum depression: An update and recommendations. Journal of Affective Disorders, 219, 105–111. Scholar
  54. Sheehan, D., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., … Dunbar, G. (1997). The validity of the MINI international neuropsychiatric interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(5), 232–241.Google Scholar
  55. Sherazi, R., McKeon, P., McDonough, M., Daly, I., & Kennedy, N. (2006). What's new? The clinical epidemiology of bipolar I disorder. Harvard Review of Psychiatry, 14(6), 273–284. Scholar
  56. Simon, N. M., Otto, M. W., Wisniewski, S. R., Fossey, M., Sagduyu, K., Frank, E., … Pollack, M. H. (2004). Anxiety disorder comorbidity in bipolar disorder patients: Data from the first 500 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). American Journal of Psychiatry, 161(12), 2222–2229. Scholar
  57. Simpson, S. G., McMahon, F. J., McInnis, M. G., MacKinnon, D. F., Edwin, D., Folstein, S. E., & DePaulo, J. R. (2002). Diagnostic reliability of bipolar II disorder. Archives of General Psychiatry, 59(8), 736–740.Google Scholar
  58. Spitzer, R. L., Endicott, J., & Robins, E. (1978). Research diagnostic criteria: Rationale and reliability. Archives of General Psychiatry, 35(6), 773–782.Google Scholar
  59. Spitzer, R. L., Williams, J. B., Gibbon, M., & First, M. B. (1992). The structured clinical interview for DSM-III-R (SCID). I: History, rationale, and description. Archives of General Psychiatry, 49(8), 624–629.Google Scholar
  60. Weissman, M. M., Bland, R. C., Canino, G. J., Faravelli, C., Greenwald, S., Hwu, H. G., … Yeh, E. K. (1996). Cross-national epidemiology of major depression and bipolar disorder. Journal of the American Medical Association, 276(4), 293–299.Google Scholar
  61. Williams, J. B., Gibbon, M., First, M. B., Spitzer, R. L., Davies, M., Borus, J., et al. (1992). The structured clinical interview for DSM-III-R (SCID). II. Multisite test-retest reliability. Archives of General Psychiatry, 49(8), 630–636.Google Scholar
  62. Wittchen, H. U. (1994). Reliability and validity studies of the WHO–composite international diagnostic interview (CIDI): A critical review. Journal of Psychiatric Research, 28(1), 57–84.Google Scholar
  63. World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Diagnostic criteria for research (Vol. 2). Geneva: World Health Organization.Google Scholar
  64. World Health Organization. (2001). The world health report 2001: Mental health: New understanding, new hope. Geneva: World Health Organization.Google Scholar
  65. Zimmerman, M., & Mattia, J. I. (1999). Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Comprehensive Psychiatry, 40(3), 182–191.Google Scholar

Copyright information

© Springer International Publishing AG 2019

Authors and Affiliations

  • Samantha L. Connolly
    • 1
    • 2
    Email author
  • Christopher J. Miller
    • 1
    • 2
  1. 1.VA Boston Healthcare System, Center for Healthcare Organization and Implementation Research (CHOIR)BostonUSA
  2. 2.Harvard Medical School, Department of PsychiatryBostonUSA

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