Bipolar and Related Disorder Due to Another Medical Condition

Bipolar and Related Disorder Due to Another Medical Condition is a mood disorder diagnosis given when there is a prominent and persistent period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy that is attributable to another medical condition. Medical conditions commonly known to cause bipolar mania or hypomania include Cushing's disease, multiple sclerosis, stroke, and traumatic brain injuries.^[1] In particular, for Cushing's disease, once it is cured or in remission, the hypomania/mania typically will not recur.

• There are no epidemiological studies on the incidence or prevalence.^[2]
• Frequency and gender prevalence depends on the underlying medical condition (e.g. - lupus is more common in females, and stroke is more common in older males)

• The symptoms may resolve before or just after the medical condition is resolved, particularly if the treatment of the mania/hypomania is effective.^[3]

A prominent and persistent period of abnormally elevated, expansive, or irritable mood and abnormally increased activity or energy that predominates in the clinical picture.

There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition.

The disturbance is not better explained by another mental disorder.

The disturbance does not occur exclusively during the course of a delirium.

The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning, or necessitates hospitalization to prevent harm to self or others, or there are psychotic features.

To establish a diagnosis of bipolar disorder due to another medical condition, it is important to ensure that the mania or hypomania appears during the initial presentation of the medical condition (i.e. - within 1 month).

• Delirium, catatonia, and acute anxiety
  • It is important to differentiate symptoms of mania from excited or hypervigilant delirious symptoms; from excited catatonic symptoms; and from agitation related to acute anxiety states.
• Medication-induced depressive or manic symptoms
  • An important differential diagnostic observation is that the other medical condition may be treated with medications (e.g. - steroids or alpha-interferon) that can induce depressive or manic symptoms. In these cases, clinical judgment using all of the evidence in hand is the best way to try to separate the most likely and/or the most important of two etiological factors (i.e. - association with the medical condition vs. a substance/medication-induced syndrome).

• Standard medical workups for the underlying medical condition should be ordered as per clinical practice (e.g. - steroid levels in blood or urine diagnosis Cushing's disease; neuroimaging or laboratory tests to confirm the diagnosis of multiple sclerosis).

• Treatment should be guided by the treatment of the underlying medical condition.