Functional and Neurochemical Brain Changes in First-episode Bipolar Mania

Inclusion Criteria - First-episode manic bipolar patients (N=100; 15-20 patients/year): 1. Patients meet DSM-IV criteria for type I bipolar disorder, manic or mixed. 2. Patients have an index Young Mania Rating Scale (YMRS)70 total score \>20. 3. Patients have \<3 months of lifetime anti-manic or anti-depressant medication exposure, including no active psychotropic medication in the one weeks prior to the index admission. Importantly, patients will NOT be taken off medications for this study; this criterion is to exclude subjects receiving active treatment at the time of admission to support the 'first-episode' criterion. 4. Patients have no more than two prior episodes of major depression. 5. Patients are between 12 and 35 years old; subjects \< 18 yrs old have a Tanner greater than or equal to 4 Exclusion criteria: All subjects will be excluded from participation for the following reasons. 1. Any chemical use disorder within 3 months. 2. Any medical or neurological disorder that could influence fMRI and MRS results. 3. A history of mental retardation or an estimated IQ total score \<85. 4. An MRI scan is contraindicated in the subject. 5. The patient cannot attend follow-up visits. 6. A positive urine pregnancy test (in women).