Learn
A prominent and persistent disturbance of mood characterized by elevated, expansive, or irritable mood, with or without depressed mood, that is judged, from history, physical exam, or laboratory findings, to be the direct pathophysiological consequence of another medical condition (such as Cushing's disease, multiple sclerosis, or a stroke affecting mood-regulating circuitry).
This diagnosis is for manic or hypomanic-type symptoms that are a direct biological effect of a medical illness -- not a psychological reaction to being sick, but a physiological consequence, such as a hormone-secreting tumor or a brain lesion directly producing mood elevation. Establishing this requires medical evidence, such as timing that matches the course of the medical condition, and it's more likely when the mood disturbance is unusual for a primary mood disorder (for example, first manic episode very late in life).
A first manic or hypomanic episode occurring for the first time in later adulthood, especially with a known medical illness present, should raise suspicion for this diagnosis rather than late-onset Bipolar I Disorder.
Functional impact depends on both the mood symptoms themselves and the course of the underlying medical condition; effective treatment of the medical condition often (but not always) improves the mood disturbance.
May co-occur with other neuropsychiatric or physical signs of the underlying medical condition; the specific pattern of mood symptoms can sometimes point toward the affected brain region or hormonal system involved.
Access to medical workup varies by setting, which can affect how readily an underlying medical condition is identified versus a presentation being labeled a primary psychiatric disorder by default.
A common misconception is that any mood change during a serious illness qualifies -- for example, understandable distress or irritability while coping with a diagnosis. This category specifically requires a direct physiological mechanism (such as a hormonal or neurological effect), not an emotional reaction to being ill.
If mood episodes continue or recur after the medical condition is successfully treated, reconsider an independent Bipolar I or II Disorder diagnosis.
A woman with no psychiatric history develops her first-ever manic episode -- elevated mood, grandiosity, and pressured speech -- at age 68, and workup reveals a cortisol-secreting adrenal tumor; the atypical age of onset and demonstrated hormonal abnormality support Bipolar and Related Disorder Due to Another Medical Condition rather than late-onset Bipolar I Disorder.
Know
This diagnosis requires medical evidence of a direct pathophysiological link between a specific medical condition and manic-type symptoms -- not just co-occurring illness or an understandable emotional reaction to being sick.
Notice
In a case, notice medical findings (hormonal, neurological, imaging) offered as evidence of a direct link, and note whether the age of onset or symptom pattern is atypical for a primary bipolar disorder.
Distinguish
Distinguish this from Substance/Medication-Induced Bipolar and Related Disorder (the cause is a substance/medication, not the medical condition itself) and from an independent Bipolar I/II Disorder in someone who happens to also be medically ill.
Recognize
Prominent, persistent elevated/expansive/irritable mood with a demonstrated direct pathophysiological link to a specific medical condition, established via history, physical exam, or laboratory/imaging findings, and not better explained by an independent mental disorder or delirium.
Distinguish
Distinguish this from Substance/Medication-Induced Bipolar and Related Disorder (the cause is a substance/medication, not the medical condition itself) and from an independent Bipolar I/II Disorder in someone who happens to also be medically ill.
An independent Bipolar I or II Disorder coincidentally occurring alongside a medical illness should be distinguished from mania that is a direct physiological consequence of that illness; delirium and a substance/medication-induced presentation should also be ruled out, particularly when the medical condition is being actively treated with psychoactive medications.
An incidental medical finding in a patient with mood elevation does not automatically mean the mood disturbance is medically caused -- a direct physiological link needs to be established, not just co-occurrence, before defaulting away from the residual category.
When a person with a medical illness is also taking a psychoactive medication for that illness, it can be genuinely difficult to know whether the mania is 'due to the illness' or 'due to the medication' — both possibilities should be documented and considered rather than assumed.
A chronic pattern of mood fluctuation is sometimes assumed to be Cyclothymic Disorder by default, without a medical workup to rule out an underlying cause -- particularly important given how many endocrine, neurological, and other medical conditions can produce a bipolar-spectrum presentation.
Reason
Apply
Distinguish mania caused directly by a medical condition from mania caused by a medication used to treat that condition.
Retrieve
2 question(s) reference this disorder. Practice Bipolar and Related Disorder Due to Another Medical Condition →
Master