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Bipolar Disorder, Emergency Medicine

Reviewed 06/2017



  • Mania:

    • Presentation is diverse and may be difficult to recognize as mania:

      • Simple irritability

      • Cheerfulness

      • Psychosis

      • Delirium

      • Agitation

    • Full extent of pathology often revealed only by outs...


Signs and Symptoms


  • Psychiatric history:

    • Recent symptoms of mania (often collateral sources critical): Elevated, expansive, or irritable mood; increased energy and activity; decreased ne...


Initial Stabilization/Therapy

  • High violence potential:

    • Quiet environment

    • Prompt evaluation

    • Nonconfrontational manner

    • Adequate security backup

    • Physical restraint and sedation, as needed

  • For cooperat...



Admission Criteria

  • Involuntary hospitalization is required by danger to self:

    • Suicidal risk, especially if mixed or labile mood or psychotic

    • Unsafe behaviors due to impaired judgment

    • ...

Pearls and Pitfalls

  • Manic patients are more likely to appear dysphoric or irritable, rather than “happy.”

  • Patients presenting with depression should be asked about features suggesting mania and hypoman...

Additional Reading

  • Anderson  IM, Haddad  PM, Scott  J. Bipolar disorder. BMJ.  2012;345:e8508.

  • Lukens  TW, Wolf  SJ, Edlow  JA, et al. Clinical policy: Critical issues in the diagnosis and managem...



  • 296.00 Manic disorder, single episode, unspecified degree

  • 296.50 Bipolar affective disorder, depressed, unspecified degree

  • 296.80 Bipolar disorder, unspecified

  • 296.60 Bipolar affective disorder...

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