Bipolar disorder

Jeffrey Hsu, M.D., Andrew Angelino , M.D., Glenn Treisman, M.D., PH.D.
Bipolar disorder is a topic covered in the Johns Hopkins HIV Guide.

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  • Episodic disorder characterized by shifts or changes in mood, vital sense and self-attitude lasting days to weeks or longer. Mood-congruent psychotic Sxs may be present.
  • BPAD I characterized by lifetime occurrence of ≥1 lifetime or current manic episode(s). BPAD II characterized by >1 lifetime or current hypomanic and depressive episodes.
  • Depressive episodes more common during course of illness but do not need to be present to make Dx of BPAD I.
  • Lifetime prevalence of BPAD in general population 0.4-1.6%. Prevalence in HIV population unclear but likely to be elevated (up to 3x more prevalent).
  • Equally common in men and women. Mean age of onset of first episode is 21.
  • Mania in HIV+ pts can either be primary (preexisting BPAD) or secondary (HIV disease).
  • Secondary mania (AIDS mania) differs from BPAD in later age of onset and lower occurrence of family or personal history of mood disorder. Typically occurs at later stages of HIV illness and characterized by more irritability, more psychomotor slowing, and increased talkativeness. May be associated with cognitive impairment/dementia and structural brain abnormalities on CT or MRI.
  • Common medical conditions mimicking BPAD include cocaine/amphetamine use, steroid treatment, multiple sclerosis, temporal lobe epilepsy, hyperthyroidism, Cushing syndrome, neurosyphillis, lupus, herpes encephalitis, subcortical dementias, Interferon, CNS lesions.
  • AIDS mania, described early in epidemic associated with low CD4 and HAD, is less common now, but still may occur in advanced patients who are nonadherent with treatment.

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Last updated: January 6, 2018