A review of bipolar disorder in adults.
OBJECTIVE
This article reviews the epidemiology, etiology, assessment, and management of bipolar disorder. Special attention is paid to factors that complicate treatment, including nonadherence, comorbid disorders, mixed mania, and depression.


METHODS
A Medline search was conducted from January of 1990 through December of 2005 using key terms of bipolar disorder, diagnosis, and treatment. Papers selected for further review included those published in English in peer-reviewed journals, with preference for articles based on randomized, controlled trials and consensus guidelines. Citations de-emphasized original mania trials as these are generally well known.


RESULTS
Bipolar disorder is a major public health problem, with diagnosis often occurring years after onset of the disorder. comorbid conditions are common and difficult to treat. Management includes a lifetime course of medication, usually more than one, and attention to psychosocial issues for patients and their families. Management of mania is well-established. Research is increasing regarding management of depressive, mixed and cycling episodes, as well as combination therapy.


CONCLUSIONS
Bipolar disorder is a complex psychiatric disorder to manage, even for psychiatrists, because of its many episodes and comorbid disorders and nonadherence to treatment.
Dr. Hilty is Associate Professor of Clinical Psychiatry and Behavioral Sciences at University of Califorinia, Davis.
Donald M
DM
Hilty
Martin H
MH
Leamon
Russell F
RF
Lim
Rosemary H
RH
Kelly
Robert E
RE
Hales