Description

Bipolar II (BP-2) is a mood disorder characterized by at least 1 episode of major depression and at least 1 episode of hypomania, a milder form of mania.

Geriatric Considerations
New onset in older patients (>50 years) requires a workup for organic or chemically induced pathology.

• Large overlap with symptoms of attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD)
• Depression often presents as irritable mood.

• Counsel women of childbearing age about potentially teratogenic effects of commonly used medications (e.g., lithium, valproic acid).
• Symptoms may be exacerbated in the postpartum period.

Epidemiology

More common in women

Prevalence
0.5–1.1% lifetime prevalence

Risk Factors

Genetics
Heritability estimate: >77%

General Prevention

No way to prevent the onset of BP-2, but treatment adherence and education can help to prevent further episodes.

Pathophysiology

Dysregulation of biogenic amines or neurotransmitters (particularly serotonin, norepinephrine, and dopamine)

Etiology

• Genetics
• Major life stressors (especially loss of parent or spouse)

Commonly Associated Conditions

Substance abuse or dependence, ADHD, anxiety disorders, and eating disorders