Bipolar illness

This chapter records the historical significance of the disorder, mania, which dates back to antiquity. It shows the development of the concept of bipolarity and the more recent broadening of the concept. It starts with the Diagnostic and Statistical Manual, 4th edition (DSM-IV) definitions of the disorder, is followed by etiologic considerations, which emphasize the genetic component, then its epidemiology, risk factors, clinical picture, course, complications, differential diagnosis, and treatment. In this revision of the DSM, the major changes emphasize the much broader concept of bipolar II disorder and a discussion of how these changes will ultimately lead in new directions for understanding the etiology and treatment of the disorder. It is written with an understanding that DSM-V will most likely change the definitions of this aspect of the disorder. Although we have a separate chapter on treatment, as a practicing psychiatrist, this chapter stresses the importance of the use of lithium first, the maximization in maintenance of the dose of whatever medication is used, and the addition of lamotrigine to the treatment armamentarium.