The diagnosis of bipolar disorder is made according to the fulfillment of symptom criteria as operationally defined by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. These criteria encompass both cross-sectional and historical data, along with pertinent corroborative features such as family history, chronobiological sensitivities, treatment outcomes, longitudinal course, and patterns of recurrence. In addition, one classifies a current illness state as involving pure mania, hypomania, a mixed episode, a depressed phase, or euthymia. Mixed states, as originally described by Kraepelin, were thought to represent transitional phenomena en route to the emergence of a frank manic or depressive episode. Today, however, mixed episodes are thought to comprise an important subgroup of syndromically ill individuals with bipolar disorder.

Bipolar disorder is a lifelong condition, and pharmacotherapy is essential to its long-term management. Once a comprehensive diagnostic assessment for acute or mixed mania has been completed, it is important to look at an evidence-based data set to guide treatment selection for mood stabilization.

For most patients, lifetime adherence to pharmacotherapy is necessary for maximal mood stability. Pharmacotherapy is the primary treatment for bipolar disorder, as it has been found to be efficacious in treating acute episodes and preventing future episodes of bipolar I disorder. Combination therapy, including at least one mood stabilizer, may be necessary to treat acute depression and mania and to further prevent both depressive and manic recurrences. The goal is to minimize frequency, duration, and severity of depressive and manic symptoms with a treatment regimen, ideally a combination of pharmacotherapy and psychotherapy, that is positioned to maximize treatment adherence and minimize side effects.

This discussion reviews some treatment guidelines for acute manic and mixed episodes associated with bipolar I disorder. Through the context of a case study, this discussion will attempt to provide an understanding and appreciation of Food and Drug Administration-approved and non-FDA-approved treatments for acute mania. In addition, the impact of alcohol as an example of drugs of abuse and its impact on the presentation of acute mania will be discussed.

Prevention of mania and maintenance treatment in bipolar disorder is largely routed in the decision to use monotherapy or combination therapy in the treatment regimen. The ability to weigh efficacy against adverse effects is of particular importance in maintenance of this disorder, as most bipolar patients require lifelong use of medication. This discussion will focus on the above mentioned topics, using a case presentation as an example.

This discussion will focus on medical comorbidity and recovery in individuals with bipolar disorder. The complexity of care will be discussed in the context of a case study, with particular focus on the medical burden of mania, aging and bipolar disorder, and treatment approaches that promote functional recovery.