Bipolar disorder, marked by hypomania or mania and predominantly depression, affects about 40 million people worldwide and carries substantial psychosocial, medical, and financial burdens, along with increased suicide risk. Diagnosis is often delayed due to symptom overlap with ADHD, major depression, psychotic disorders, and personality disorders. Recent research points to multigene risk and possible infectious and mitochondrial causes. Treatment combines pharmacotherapy, psychotherapy, and lifestyle changes, tailored to individual goals. Future priorities include expanding self-management psychosocial interventions, addressing treatment-resistant depression, deepening understanding of pathophysiology, and exploring novel options like ketamine, esketamine, and neuromodulation.
Psychotic men with high urinary cannabinoid levels on admission showed more hypomania and agitation but less affective flattening, auditory hallucinations, incoherence of speech, and hysteria than matched cannabis-free controls. Clouding of consciousness was absent in most cannabis patients. After one week the cannabis group improved markedly, especially in psychotic syndromes, while controls remained virtually unchanged. Medication amounts did not differ between groups. High cannabis intake may relate to a rapidly resolving psychosis with marked hypomanic features, often presenting as schizophrenia-like illness.