Statistical Manual, fourth edition (DSM-IV) still rely on the course of the illness (see table 8-1 and table 8-2) [9]:

  • Bipolar I = at least one manic (elevated mood) episode (hypomania = less severe presentation without the need for hospitalization or impediment to occupational or social functioning).

  • Bipolar II = at least one episode of mania or hypomania and a full major depressive episode.

In contrast with other psychoses, the psychotic symptoms of bipolar disorder must be congruent with the prevailing elated or depressed mood state. For these purposes, irritability is presumed to be congruent with an elated or elevated mood state.



The evidence clearly reveals the exceedingly high mortality rate from suicide exacted by bipolar disorder. Evidence from developed countries has shown varying rates for attempted suicide of between 25 and 50 percent among patients with the disorder.[10,11] Follow-up studies have found that as many as 15 percent were completed suicides. This rate is approximately 30 times greater than the rate for general populations.[11,12]

In developing countries, similar rates of suicide have been observed.[ 13,14] High rates of attempted suicide (24 percent) were found in a study conducted in a psychiatric hospital in Taiwan.[15] An earlier age of onset, interpersonal problems with partners and close family members, and occupational maladjustment rather than demographic characteristics are suggested as collectively identifying those with bipolar disorder at high risk of suicide attempt.

Social and Economic Costs

In light of the findings of the 1996 Global Burden of Disease study and more recent estimates of the same measurements of disability-adjusted life years (DALYs), neuropsychiatric conditions have been recognized as a significant social and economic burden (see Chapter 2).[16,17] Bipolar disorder is considered to represent 11 percent of the disease burden from neuropsychiatric conditions in low- and-middle income countries. Moreover, within these estimates for low- and middle-income countries, bipolar disorder is estimated to account for a full 1.1 percent of all categories of disease burden. When estimating the disability weight measurements for the Global Burden of Disease study, the burden of bipolar disorder was weighted somewhere between that of paraplegic and quadriplegic physical disability.[16]

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