Psychiatry
Bipolar I Disorder
양극성장애 1형
Chronic mood disorder with ≥1 manic episode
- How common
- Lifetime prevalence 1%
- Typical age
- Mean onset 18–25 yrs
What is it?
Dopamine/glutamate hyperactivity, mitochondrial dysfunction, circadian instability are core.
Commonly affected: Amygdala, PFC, striatum, hypothalamus (SCN)
How it develops
- Genetic loadingCACNA1C, ANK3 calcium-channel genes
- Neurotransmitter swingMania=DA/GLU↑, depression=5-HT↓
- Circadian disruptionCLOCK gene, melatonin dysregulation
- Circuit changesWeakened amygdala-PFC connectivity, hyperactive reward
Symptoms
- Elevated/irritable moodAbnormally euphoric or irritable
- Decreased sleep needEnergetic on 3 hrs sleep
- Impulsive behaviorReckless spending, sex, travel
- Depressive episodeSame as MDD criteria
- Grandiosity/pressured speechGrandiose ideas, racing thoughts
How it is examined
- DSM-5 maniaElevated mood ≥1 wk + ≥3 symptoms (DIGFAST)
- YMRSYoung Mania Rating Scale
- Rule out medicalHyperthyroidism, stimulants (cocaine/amphetamine)
Imaging
MRI: white-matter hyperintensities, amygdala volume changes.
- White-matter lesions
- Amygdala changes
fMRI: hyperactive reward circuit during mania.
- Reward hyperactivity
Non-surgical care
- Lithium (first-line)Therapeutic 0.6–1.2 mEq/L, antisuicidal
- ValproateAcute mania, mixed episodes
- Atypical antipsychoticsQuetiapine, olanzapine, aripiprazole
- LamotrigineBipolar depression maintenance
- Psychoeducation/CBTAdherence, early warning signs
Conservative options are generally tried first. Medications listed here can have side effects — discuss them with your prescriber.
When surgery is considered
Treatment-resistant, suicide risk, pregnancy-safe option
Procedures that may be discussed
- ECT
- rTMS
- Inpatient hospitalization (acute)
Outlook
Lifelong chronic illness. ~90% stable with adherence. Suicide rate 15–20%.