Overview
Mixed bipolar affective disorder is characterized by recurrent episodes of depression, mania, hypomania, or mixed states 1. These disorders are associated with alternating intervals of extreme positive and negative affect 3. Early diagnosis and comprehensive treatment are linked to a more favorable prognosis 1.Diagnosis
Bipolar disorder is characterized by recurrent episodes of depression, mania, hypomania, or mixed states 1.
Potentially familial traits of bipolar disorder include age of onset, bipolar type, lithium response, polarity at onset, psychotic features, mood-incongruent psychosis, puerperal psychosis, rapid cycling, suicide attempt, alcoholism, obsessive-compulsive disorder, panic disorder, and specific phobia 2.
Bipolar spectrum disorders may be related to dysregulated reinforcement sensitivity, with a potential diathesis for both manic (BAS hypersensitivity) and depressive (BIS hypersensitivity) states 3.Management
The basic drugs for bipolar disorder are mood stabilizers of the first and second generation 1.
Recommended drugs for mania and mixed states include lithium, aripiprazole, quetiapine, risperidone, olanzapine, asenapine, and ziprasidone 1.
For depressive episodes in bipolar disorder, lurasidone monotherapy or olanzapine plus fluoxetine combination therapy are recommended 1.
Prophylactic treatment is necessary to prevent recurrence 1.Special Populations
The general principles for drug use in children and adolescents are similar to adults, but efficacy and safety profiles may differ 1.
Common adverse reactions in children and adolescents include gastrointestinal and neurological effects with mood stabilizers, and weight gain and sedation with antipsychotics 1.Key Recommendations
Mood stabilizers of the first and second generation are the basic drugs for bipolar disorder 1. (Evidence: Expert opinion)
Lithium, aripiprazole, quetiapine, risperidone, olanzapine, asenapine, and ziprasidone are recommended for the treatment of mania and mixed states 1. (Evidence: Expert opinion)
Lurasidone as monotherapy or olanzapine plus fluoxetine as combination therapy are recommended for the treatment of depressive episodes in bipolar disorder 1. (Evidence: Expert opinion)References
1 Lewandowska A, Janas-Kozik M, Tyszkiewicz-Nwafor M, Dudek D, Gałecki P, Remberk B. Bipolar disorder in children, adolescents and young adults. Part 2. Therapeutic management. Recommendations under the patronage of the Executive Board of the Polish Psychiatric Association, National Consultants in the field of Psychiatry and National Consultants in Child and Adolescent Psychiatry. Psychiatria polska 2025. link
2 Scott K, Nunes A, Pavlova B, Meier S, Alda M. Familial traits of bipolar disorder: A systematic review and meta-analysis. Acta psychiatrica Scandinavica 2023. link
3 Katz BA, Naftalovich H, Matanky K, Yovel I. The dual-system theory of bipolar spectrum disorders: A meta-analysis. Clinical psychology review 2021. link