Classically, bipolar disorder is seen as a relapsing-remitting condition with episodes of dizzying and capricious highs (manic episodes) that are clearly separated from melancholic lows and inertia (depressive episodes) and interspersed with remission. Yet, in the clinical setting, the picture is often far more complicated. Bipolar disorder lies on a spectrum with subtypes that are defined by arbitrary and often unfulfilled criteria for the severity and duration of mood episodes, which leads to high rates of “unspecified” diagnoses. “Mixed affective” episodes, in which depressive and manic symptoms co-occur, are the norm rather than the exception. Mood instability also persists out of episode, causing as much impairment as within-episode symptoms1 and muddying the classically episodic presentation.
Mason L, Eldar E, Rutledge RB. Mood Instability and Reward Dysregulation—A Neurocomputational Model of Bipolar Disorder. JAMA Psychiatry. 2017;74(12):1275–1276. doi:10.1001/jamapsychiatry.2017.3163
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