Bipolar Disorder

Key points

• Bipolar I: ≥ 1 manic episode (≥ 7 days or hospitalisation): elevated/expansive mood, ↑ energy, grandiosity, ↓ need for sleep, pressured speech, reckless behaviour.
• Bipolar II: hypomania (≥ 4 days, no psychosis/hospitalisation) + depressive episodes.
• Acute mania: antipsychotic (e.g. olanzapine, risperidone) or valproate.
• Bipolar depression: quetiapine, olanzapine ± fluoxetine, or lamotrigine — avoid antidepressant monotherapy (switch to mania).
• Prophylaxis: lithium (check renal/thyroid/Ca²⁺ 6-monthly), valproate, lamotrigine; offer psychological intervention.

Decision points in this pathway

• Acute presentation?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.