In Great Britain an estimated 650,000 patients are living with bipolar disorder. People with the condition die 10-20 years prematurely, partly due to cardiovascular disease driven by weight gain, but also due to suicide, which is among the highest for any psychiatric disorder. 

Bipolar disorder is a cyclical mood disorder that involves episodes of disruption to mood and behaviour, interspersed with periods of recovery. Episodes can either be depressive or manic (either mania or hypomania) and can culminate in psychosis and exhaustion if left untreated.

Diagnosis

Diagnosis is made by identifying the core symptoms of mania or hypomania. In primary care, adults can often present with depression but if there have been any signs of over-activity or disinhibited behaviour, especially if lasting over four days, the diagnosis may change. Bipolar I is diagnosed when the episodes are mainly manic in nature and Bipolar II is where depressive episodes are more prominent with hypomania.

Since substance misuse is a common comorbidity in bipolar disease, it is important to clarify if any agent has been taken. Medications such as corticosteroids (especially in high doses), levodopa and prescribed stimulants (such as methylphenidate) can also cause manic-like symptoms.

Physical health

All people with bipolar disorder should have an annual health check. This should include: 

• Weight or BMI and assessment of diet, nutritional status and level of physical activity
• Cardiovascular status, including pulse and blood pressure
• Metabolic status, including fasting blood glucose, glycated haemoglobin (HbA1c) and blood lipid profile
• Liver function
• Renal and thyroid function and calcium levels for people taking long-term lithium.