Information for Patients
What is bipolar disorder?
Bipolar disorder is a mood disorder that can cause intense mood swings:
- Sometimes you may feel extremely "up," elated, irritable, or energized. This is called a manic episode.
- Other times you may feel "down," sad, indifferent, or hopeless. This is called a depressive episode.
- You may have both manic and depressive symptoms together. This is called a mixed episode.
Along with the mood swings, bipolar disorder causes changes in behavior, energy levels, and activity levels.
Bipolar disorder used to be called other names, including manic depression and manic-depressive disorder.
What are the types of bipolar disorder?
There are three main types of bipolar disorder:
- Bipolar I disorder involves manic episodes that last at least 7 days or manic symptoms so severe that you need immediate hospital care. Depressive episodes are also common. Those often last at least two weeks. This type of bipolar disorder can also involve mixed episodes.
- Bipolar II disorder involves depressive episodes. But instead of full-blown manic episodes, there are episodes of hypomania. Hypomania is a less severe version of mania.
- Cyclothymic disorder, or cyclothymia, also involves hypomanic and depressive symptoms. But they are not as intense or as long-lasting as hypomanic or depressive episodes. The symptoms usually last for at least two years in adults and for one year in children and teenagers.
With any of these types, having four or more episodes of mania or depression in a year is called "rapid cycling."
What causes bipolar disorder?
The exact cause of bipolar disorder is unknown. Several factors likely play a role in the disorder. They include genetics, brain structure and function, and your environment.
Who is at risk for bipolar disorder?
You are at higher risk for bipolar disorder if you have a close relative who has it. Going through trauma or stressful life events may raise this risk even more.
What are the symptoms of bipolar disorder?
The symptoms of bipolar disorder can vary. But they involve mood swings known as mood episodes:
- The symptoms of a manic episode can include
- Feeling very up, high, or elated
- Feeling jumpy or wired, more active than usual
- Having a very short temper or seeming extremely irritable
- Having racing thoughts and talking very fast
- Needing less sleep
- Feeling like you are unusually important, talented, or powerful
- Do risky things that show poor judgment, such as eating and drinking too much, spending or giving away a lot of money, or having reckless sex
- The symptoms of a depressive episode can include
- Feeling very sad, hopeless, or worthless
- Feeling lonely or isolating yourself from others
- Talking very slowly, feeling like you have nothing to say, or forgetting a lot
- Having little energy
- Sleeping too much
- Eating too much or too little
- Lack of interest in your usual activities and being unable to do even simple things
- Thinking about death or suicide
- The symptoms of a mixed episode include both manic and depressive symptoms together. For example, you may feel very sad, empty, or hopeless, while at the same time feeling extremely energized.
Some people with bipolar disorder may have milder symptoms. For example, you may have hypomania instead of mania. With hypomania, you may feel very good and find that you can get a lot done. You may not feel like anything is wrong. But your family and friends may notice your mood swings and changes in activity levels. They may realize that your behavior is unusual for you. After the hypomania, you might have severe depression.
Your mood episodes may last a week or two or sometimes longer. During an episode, symptoms usually occur every day for most of the day.
How is bipolar disorder diagnosed?
To diagnose bipolar disorder, your health care provider may use many tools:
- A physical exam
- A medical history, which will include asking about your symptoms, lifetime history, experiences, and family history
- Medical tests to rule out other conditions
- A mental health evaluation. Your provider may do the evaluation or may refer you to a mental health specialist to get one.
What are the treatments for bipolar disorder?
Treatment can help many people, including those with the most severe forms of bipolar disorder. The main treatments for bipolar disorder include medicines, psychotherapy, or both:
- Medicines can help control the symptoms of bipolar disorder. You may need to try several different medicines to find which one works best for you. Some people need to take more than one medicine. It's important to take your medicine consistently. Don't stop taking it without first talking with your provider. Contact your provider if you have any concerns about side effects from the medicines.
- Psychotherapy (talk therapy) can help you recognize and change troubling emotions, thoughts, and behaviors. It can give you and your family support, education, skills, and coping strategies. There are several different types of psychotherapy that may help with bipolar disorder.
- Other treatment options include
- Electroconvulsive therapy (ECT), a brain stimulation procedure that can help relieve symptoms. ECT is most often used for severe bipolar disorder that is not getting better with other treatments. It may also be used when someone needs a treatment that will work more quickly than medicines. This might be when a person has a high risk of suicide or is catatonic (unresponsive).
- Getting regular aerobic exercise may help with depression, anxiety, and trouble sleeping
- Keeping a life chart can help you and your provider track and treat your bipolar disorder. A life chart is a record of your daily mood symptoms, treatments, sleep patterns, and life events.
Bipolar disorder is a lifelong illness. But long-term, ongoing treatment can help manage your symptoms and enable you to live a healthy, successful life.
NIH: National Institute of Mental Health
General Equivalence Map Definitions
The ICD-9 and ICD-10 GEMs are used to facilitate linking between the diagnosis codes in ICD-9-CM and the new ICD-10-CM code set. The GEMs are the raw material from which providers, health information vendors and payers can derive specific applied mappings to meet their needs.
- Approximate Flag - The approximate flag is on, indicating that the relationship between the code in the source system and the code in the target system is an approximate equivalent.
- No Map Flag - The no map flag indicates that a code in the source system is not linked to any code in the target system.
- Combination Flag - The combination flag indicates that more than one code in the target system is required to satisfy the full equivalent meaning of a code in the source system.
Index of Diseases and Injuries Definitions
- And - The word "and" should be interpreted to mean either "and" or "or" when it appears in a title.
- Code also note - A "code also" note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction.
- Code first - Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- Type 1 Excludes Notes - A type 1 Excludes note is a pure excludes note. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is used when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.
- Type 2 Excludes Notes - A type 2 Excludes note represents "Not included here". An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time. When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate.
- Includes Notes - This note appears immediately under a three character code title to further define, or give examples of, the content of the category.
- Inclusion terms - List of terms is included under some codes. These terms are the conditions for which that code is to be used. The terms may be synonyms of the code title, or, in the case of "other specified" codes, the terms are a list of the various conditions assigned to that code. The inclusion terms are not necessarily exhaustive. Additional terms found only in the Alphabetic Index may also be assigned to a code.
- NEC "Not elsewhere classifiable" - This abbreviation in the Alphabetic Index represents "other specified". When a specific code is not available for a condition, the Alphabetic Index directs the coder to the "other specified” code in the Tabular List.
- NOS "Not otherwise specified" - This abbreviation is the equivalent of unspecified.
- See - The "see" instruction following a main term in the Alphabetic Index indicates that another term should be referenced. It is necessary to go to the main term referenced with the "see" note to locate the correct code.
- See Also - A "see also" instruction following a main term in the Alphabetic Index instructs that there is another main term that may also be referenced that may provide additional Alphabetic Index entries that may be useful. It is not necessary to follow the "see also" note when the original main term provides the necessary code.
- 7th Characters - Certain ICD-10-CM categories have applicable 7th characters. The applicable 7th character is required for all codes within the category, or as the notes in the Tabular List instruct. The 7th character must always be the 7th character in the data field. If a code that requires a 7th character is not 6 characters, a placeholder X must be used to fill in the empty characters.
- With - The word "with" should be interpreted to mean "associated with" or "due to" when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List. The word "with" in the Alphabetic Index is sequenced immediately following the main term, not in alphabetical order.