It is not uncommon for clinicians to misclassify such patients as depressed or schizophrenic on the basis of their mental status. It is important to make the diagnosis of dysphoric mania because mistaken administration of antidepressants can seriously worsen the clinical picture. Psychotic symptoms are common during manic episodes. The correct diagnosis is based on the presence of typical manic symptoms, course of illness, and family history. Course of Illness Bipolar disorder typically begins in young adulthood, most commonly in the second or third decade of life, although onset in childhood is increasingly being recognized.
Late onset is less common, but first manias can occur even in the elderly.
Although a minority of patients may have only an isolated episode, patients with bipolar disorder most commonly have a pattern of recurrent illness. The rate of cycling between mania and depression varies widely among individuals. A common pattern of illness is for episodes to become more frequent with age. Commonly, manic and depressive episodes occur within three months of each other. Between episodes of depression and mania, the majority of patients are free of symptoms, but as many as one third of patients may have some residual symptoms.