Bipolar disorder is heterogeneous in phenomenology, illness trajectory, and response to treatment. Despite evidence for the efficacy of multimodal-ity interventions, the majority of persons affected by this disorder do not achieve and sustain full syndromal recovery. It is eagerly anticipated that combining datasets across various information sources (e.g., hierarchical "multi-omic" measures, electronic health records), analyzed using advanced computational methods (e.g., machine learning), will inform future diagnosis and treatment selection. In the interim, identifying clinically meaningful subgroups of persons with the disorder having differential response to specific treatments at point-of-care is an empirical priority. This paper endeavours to synthesize salient domains in the clinical characterization of the adult patient with bipolar disorder, with the overarching aim to improve health outcomes by informing patient management and treatment considerations. Extant data indicate that characterizing select domains in bipolar disorder provides actionable information and guides shared decision making. For example, it is robustly established that the presence of mixed features - especially during depressive episodes - and of physical and psychiatric comorbidities informs illness trajectory, response to treatment, and suicide risk. In addition, early environmental exposures (e.g., sexual and physical abuse, emotional neglect) are highly associated with more complicated illness presentations, inviting the need for developmentally-oriented and integrated treatment approaches. There have been significant advances in validating subtypes of bipolar disorder (e.g., bipolar I vs. II disorder), particularly in regard to pharmacological interventions. As with other severe mental disorders, social functioning, interpersonal/family relationships and internalized stigma are domains highly relevant to relapse risk, health outcomes, and quality of life. The elevated standardized mortality ratio for completed suicide and suicidal behaviour in bipolar disorder invites the need for characterization of this domain in all patients. The framework of this paper is to describe all the above salient domains, providing a synthesis of extant literature and recommendations for decision support tools and clinical metrics that can be implemented at point-of-care.

3rd Department of Psychiatry Division of Neurosciences School of Medicine Aristotle University of Thessaloniki Thessaloniki Greece

Allgemeinpsychiatrie Ost Klinikum am Weissenhof Weinsberg Germany

Bipolar and Depressive Disorders Unit Institute of Neuroscience Hospital Clinic University of Barcelona IDIBAPS CIBERSAM Barcelona Catalonia Spain

Bipolar Collaborative Network Bethesda MD USA

Copenhagen Affective Disorder Research Center Psychiatric Center Copenhagen Copenhagen Denmark

Department of Child and Adolescent Psychiatry Charité Universitätsmedizin Berlin Berlin Germany

Department of Molecular Medicine University of Siena Siena Italy

Department of Pharmacology University of Toronto Toronto ON Canada

Department of Psychiatry and Behavioural Sciences Stanford School of Medicine and VA Palo Alto Health Care System Palo Alto CA USA

Department of Psychiatry and Biobehavioral Sciences University of California Los Angeles Semel Institute Los Angeles CA USA

Department of Psychiatry and Molecular Medicine Zucker School of Medicine at Hofstra Northwell Hempstead NY USA

Department of Psychiatry and Psychology Mayo Clinic Rochester MN USA

Department of Psychiatry Baylor College of Medicine Houston TX USA

Department of Psychiatry Dalhousie University Halifax NS Canada

Department of Psychiatry University of Campania L Vanvitelli Naples Italy

Department of Psychiatry University of Toronto Toronto ON Canada

Department of Psychiatry Zucker Hillside Hospital Northwell Health Glen Oaks NY USA

Department of Psychological Medicine Institute of Psychiatry Psychology and Neuroscience King's College London London UK

Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark

Harvard Medical School Boston MA USA

IMPACT Strategic Research Centre School of Medicine Deakin University Geelong VIC Australia

International Consortium for Bipolar and Psychotic Disorders Research McLean Hospital Belmont MA USA

Mailman Research Center McLean Hospital Belmont MA USA

Mood Disorders Psychopharmacology Unit University Health Network Toronto ON Canada

National Institute of Mental Health Klecany Czech Republic

Orygen National Centre of Excellence in Youth Mental Health Centre for Youth Mental Health University of Melbourne Melbourne VIC Australia

Paracelsus Medical Private University Nuremberg Nuremberg Germany

School of Medicine and Health Sciences George Washington University Washington DC USA

School of Psychiatry University of New South Wales Sydney NSW Australia

South London and Maudsley NHS Foundation Trust Bethlem Royal Hospital Beckenham UK

University Hospital Carl Gustav Carus Technische Universität Dresden Dresden Germany

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