Summary
The protocol describes bipolar affective disorder as a chronic, recurrent condition marked by episodes of major change in mood and activity. Its course may include mania, hypomania, depression, and mixed states, sometimes with psychotic symptoms, followed by full or partial recovery between episodes. It addresses bipolar I and II disorders, the characteristics of the current episode, remission, and rapid-cycling patterns.
Diagnosis requires assessment of the lifetime course, not only the current presentation. Clinicians review previous episodes of the opposite polarity, possible past hypomania in a person presenting with depression, family history, and collateral information from relatives. Psychoactive substances, medications, medical illness, and organic causes of affective symptoms are considered. Suicide-risk assessment is essential. Laboratory and instrumental tests do not independently diagnose bipolar disorder, but help exclude other causes, establish metabolic, cardiovascular, endocrine, and neurological status, and support safe monitoring.
Treatment is selected according to episode polarity and severity, agitation, psychosis, suicide risk, comorbidity, and reproductive considerations. Mood-stabilizing and antipsychotic medicines are used for mania, while bipolar depression requires episode-specific strategies. The protocol warns against unjustified antidepressant monotherapy because of the risk of switching into mania or worsening episode cycling. Moderate or severe mania, marked disorganization, or substantial risk commonly requires hospitalization. Long-term relapse prevention includes mood-stabilizing therapy, psychoeducation, individual and family-based psychosocial support, stabilization of sleep and daily rhythms, laboratory monitoring, and recognition of early warning signs. The goals are sustained euthymia, preservation of social functioning, and quality of life. This text summarizes the protocol and is not a personalized treatment plan.