Bipolar affective disorder

Bipolar affective disorder is characterised by disturbances in the woman’s mood and activity levels with episodes of hypomania/mania and depressed mood.

During episodes of hypomania/mania, they may present with elevation of mood and increased energy and activity.

During episodes of depression, they can present with depressed mood, decreased energy and activity.

There are four particular types of Bipolar affective disorder1:

  • Bipolar I disorder
    At least one manic episode of mania lasting longer than one week. The depressive episodes may be less intense with Bipolar I, but the mania is more severe.

  • Bipolar II disorder
    More than one episode of severe depression, while manic episodes tend to be milder.

  • Rapid cycling
    Four or more episodes of mania or depression in a 12-month period.

  • Cyclothymia
    While the extremes of mood with cyclothymia are not as severe as in other types of bipolar disorder, they can last longer. They can sometimes go on to develop into full bipolar disorder.

Women with a history of bipolar affective disorder have a 20% risk of suffering a severe recurrence following delivery and an even higher risk (approaching 50%) of experiencing any mood episode in the postpartum period, including non-psychotic major depression. 2,3 Risk of developing postpartum psychosis increases to 50% in women with a diagnosis of bipolar affective disorder and family history (mother or sister having postpartum psychosis).

For women with known diagnosis of bipolar affective disorder, the choice to continue medication during pregnancy balances the risks of an untreated illness with the risks of medication exposure. Abrupt discontinuation of psychotropic medications is associated with an increased risk for illness recurrence.

Please refer to ‘Postpartum psychosis’, ‘Severe Mental Illness’ and ‘Schizophrenia’ for further information on management and treatment.

Resources

RCPsych Patient Information Leaflet

References

1. American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders: DSM-5, 5th ed. Arlington, VA: American Psychiatric Association; 2013

2. Munk-Olsen T, Laursen TM, Mendelson T, Pedersen CB, Mors O, Mortensen PB. Risks and predictors of readmission for a mental disorder during the postpartum period. Arch Gen Psychiatry 2009.

3. Di Florio A, Forty L, Gordon-Smith K, et al. Perinatal episodes across the mood disorder spectrum. JAMA Psychiatry 2013

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PATH – PerinAtal menTal Health – is part of the Interreg VA 2Seas programme and receives funding from the European Regional Development Fund.

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