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Clinical Management of Bipolar Disorder

  • Authors: Author: Paul E. Keck, Jr, MD
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Target Audience and Goal Statement

This activity is intended for psychiatrists, mental health professionals, primary care physicians, registered nurses, and pharmacists.

The goal of this activity is to provide current treatment protocols and clinical strategies for the treatment and management of bipolar disorders.

On completion of this continuing medical education offering, participants will be able to:

  1. Recognize the clinical presentations of bipolar disorders.
  2. Evaluate the recent evidence based literature on treatment of bipolar disorders.
  3. Identify the current FDA approved treatments and the new strategies for treatment of bipolar disorder.


  • Paul E. Keck, MD

    Paul E. Keck, Jr., MD, Professor, Vice Chairman for Research, Department of Psychiatry; Chief, Division of Clinical Neuroscience, University of Cincinnati Hospital, Cincinnati, Ohio


    Disclosure: Paul E. Keck, MD, has disclosed that he receives research grant support from Abbott Laboratories, AstraZeneca, Eli Lilly and Company, Pfizer Inc., and Merck. Heserves as a consultant to Abbott Laboratories, AstraZeneca, Bristol-Myers Squibb, Eli Lilly and Company, Pfizer Inc., Pharmacia Corporation, and Janssen Pharmaceutical Products.

Accreditation Statements

    For Physicians

  • Medical Education Collaborative, a nonprofit education organization, is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

    Medical Education Collaborative designates this educational activity for a maximum of 1 category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those credits that he/she actually spent in the activity.
    This CME activity is cosponsored by Medical Education Collaborative and Medscape, also an ACCME-accredited provider.

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    For Nurses

  • 1.2 contact hours of continuing education for RNs, LPNs, LVNs, and NPs. This activity is cosponsored with Medical Education Collaborative, Inc. (MEC) and Medscape. MEC is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.
    Board of Nursing, Provider Number FBN 2773.
    California Board of Registered Nursing, Provider Number CEP 12990, for 1.2 contact hours.

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    For Pharmacists

  • Medical Education Collaborative, Inc. has assigned 1 contact hour (0.10 CEUs) of continuing pharmaceutical education credit. ACPE universal program number: 815-999-02-179-H04. Certificate is defined as a record of participation.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

Instructions for Participation and Credit

There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.

This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.

Follow these steps to earn CME/CE credit:

  1. Read the target audience, learning objectives, and author disclosures.
  2. Study the educational content online or printed out.
  3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. Medscape encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 5 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.

The credit that you receive is based on your user profile.


Clinical Management of Bipolar Disorder

Authors: Author: Paul E. Keck, Jr, MDFaculty and Disclosures



Bipolar disorder is a common, severe, and recurrent psychiatric illness and a major public health problem. In the United States, the lifetime prevalence rates of bipolar I and II disorders may be as high as 1% to 2%.[1] Bipolar disorder is characterized by mood, behavioral, cognitive, and perceptual symptoms and a propensity for recurrence in more than 90% of patients.[2,3] In 1990, bipolar disorder was the sixth leading cause of disability worldwide, and it was projected to remain a global health problem well into this century.[4] When untreated, this illness poses high risks of morbidity and mortality; morbidity is often not confined to discrete mood episodes. Full recovery of premorbid functioning may lag behind symptomatic and syndromal recovery by many months.[5-7]

In addition, multiple mood episodes can lead to progressive deterioration of functioning between episodes and adversely affect subsequent treatment response to specific agents (PE Keck, MD, unpublished data, 2001).[8] The cumulative effects of bipolar disorder can wreak havoc on psychosocial and vocational functioning and quality of life.[9-11] Bipolar disorder also carries a significant risk of mortality. At least 25% of patients are estimated to have attempted suicide. Patients with mixed episodes (co-occurring mania and depression) appear to have substantially higher suicidal ideation than patients with classic or pure manic episodes.[12,13]

Genetic underpinnings play a role in the majority of cases of bipolar illness.[14] For example, concordance rates in monozygotic twins range from 65% to 75% whereas rates for dizygotic twins are 14%.[15] The risk for mood disorders in first-degree relatives of probands with bipolar disorder is much higher than in the general population.[15] Children of parents with bipolar disorder appear to have an earlier age of onset of bipolar symptoms compared with their parents.[16] In clinical practice, evidence of a family history of mood disorder in a first-degree relative, especially of bipolar I or II disorder, can be useful in pointing to a diagnosis of bipolar illness in a patient presenting with new onset depressive symptoms or psychosis.[17]