What Does A Doctor Need To Know To Diagnose Bipolar Disorder
A bipolar disorder diagnosis is made only by taking careful note of symptoms, including their severity, length, and frequency. “Mood swings” from day to day or moment to moment do not necessarily indicate a diagnosis of bipolar disorder. Rather, the diagnosis hinges on having periods of unusual elevation or irritability in mood that are coupled with increases in energy, sleeplessness, and fast thinking or speech. The patientâs symptoms are fully assessed using specific criteria from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders or DSM-5.
In making the diagnosis of bipolar disorder, the psychiatrist or other mental health expert will ask you questions about your personal and family history of mental illness and bipolar disorder or other mood disorders. Because bipolar disorder sometimes has a genetic component, family history can be helpful in making a diagnosis.
Also, the doctor will ask detailed questions about your bipolar symptoms. Other questions may focus on reasoning, memory, ability to express yourself, and ability to maintain relationships.
Tests And Scales For Depression
Medical and mental health professionals use established, research-backed guidelines, screening tools, checklists, and other criteria to help them make a diagnosis of depression.
A provider can use these tools to guide them through observing and talking to a person who might be experiencing symptoms of depression. For example, taking note of whether a person is showered and appropriately dressed, the tone and speed of their speech, and other aspects of their appearance and demeanor can provide clues.
Asking direct questions about a person’s day-to-day life and their feelings can also provide valuable insight into the cause of a person’s depressive symptoms. In some cases, a person may have symptoms of depression but not have a major depressive disorder.
Providers also use these guidelines to go through a list of other possible causes for a person’s symptoms that might be easily overlooked. Certain medical conditions and medications can cause symptoms of depression that will generally improve once the underlying cause is addressed.
In these cases, the guidelines may suggest that a provider refers the person to a colleague for additional testing or examinations. For example, if a doctor thinks a person’s symptoms could be stemming from a brain lesion, they may want them to see a neurologist or have an MRI scan.
Assessment Of Course Of Illness
There is little difficulty for the clinician in assessing early onset and recurrent episodic depression along with seasonality and hormonal status, and changes in the course of illness over time as long as attention is paid to past and prospective course in a methodical manner. This is imperative where there is early onset or a family history of bipolar disorder.
Pictorial graphing representation of the episodes can be particularly helpful and the patient can be engaged in the maintenance phase in depicting this . Unfortunately the use of pictorial graphing of episodes tends to be siloed in the bipolar disorder literature although it is helpful for both unipolar and bipolar illnesses and hence the pictorial representation of course tends to start with a hypo/manic episode and work backward. Staging models of bipolar disorder which identify depression as prodromal or non-specific or at increased risk of bipolar disorder are evolving and not currently yet of clinical help to the clinician’s dilemma .
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Symptoms Of Bipolar Disorder
During a depressive episode, a person may experience irritability, persistent sadness, or frequent crying. He or she may have thoughts of death or suicide and lose interest in activities that were previously enjoyable. Other signs include a low energy level, fatigue, poor concentration, and a change in eating or sleeping habits.
During a manic episode, a person may seem unusually happy or excited. He or she may also talk too much and too fast or appear distracted or overly confident and ambitious.
Mania may also involve psychosis, or being out of touch with reality. This symptom can be characterized by hallucinations, which involve hearing or seeing things that arent there, or delusions, which involve believing things that arent supported by evidence.
Other symptoms of mania include experiencing increased energy despite a lack of sleep, driving recklessly, being sexually promiscuous, and engaging in risky behavior, such as abusing drugs or alcohol.
Symptoms Of Bipolar Type 2 Disorder
Because bipolar disorder can look like other mental health disorders, it is often misdiagnosed. Symptoms of bipolar disorder can appear as depression, anxiety disorders, obsessive-compulsive disorders, personality disorders, and even schizophrenia. Understanding the symptoms of bipolar disorder, and specifically bipolar type 2 disorder, is an important way to ensure an accurate diagnosis and effective treatment.
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Changes To Depression In The Dsm
While the DSM-5 doesn’t introduce any new diagnostic tests for depression, it does promote a new integrated approach for clinicians to diagnose mental health disorders.
Clinicians who were used to using the older methods for diagnosing depression didn’t have to completely change how they approached the process with the DSM-5, as the new integrated approach is compatible with previous assessment tools.
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How Is Bipolar Disorder Diagnosed In A Teen
Bipolar disorder can be hard to spot. Thats because it may look like other health problems, such as depression. A teen must have both depressive and manic symptoms to a varying degree to be diagnosed with bipolar disorder.
A mental health provider will ask about your teens health history and symptoms. He or she will also do a mental health evaluation before making a diagnosis.
What Are The Different Types Of Bipolar Disorder
There are different types of bipolar disorder.
What is bipolar disorder I disorder?
A diagnosis of bipolar I disorder means you will have had at least 1 episode of mania that lasts longer than 1 week. You may also have periods of depression. Manic episodes will generally last 3-6 months if left untreated. Depressive episodes will generally last 6-12 months without treatment.
What is bipolar II disorder?
A diagnosis of bipolar II disorder means it is common to have symptoms of depression. You will have had at least 1 period of major depression. And at least 1 period of hypomania instead of mania.
What is bipolar I or II disorder with mixed features?
You will experience symptoms of mania or hypomania and depression at the same time. You may hear this being called mixed bipolar state. You may feel very sad and hopeless at the same time as feeling restlessness and being overactive.
What is bipolar I or II disorder with rapid cycling?
Rapid cycling means you have had 4 or more depressive, manic or hypomanic episodes in a 12-month period.
What is bipolar I or II with seasonal pattern?
Seasonal pattern means that either your depression, mania or hypomania is regularly affected in the same way by the seasons. For example, you may find that each winter you have a depressive episode, but your mania doesnt regularly follow a pattern.
There can be some similarities between bipolar I or II with seasonal pattern and another conditional called seasonal affective disorder.
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How Do I Get Help If I Think I Have Bipolar Disorder
The usual first step to getting help is to speak to your GP.
It can help to keep a record of your moods. This can help you and your GP to understand your mood swings. Bipolar UK have a mood diary and a mood scale on their website. You can find their details in the Useful contacts section at the bottom of this page.
Your GP cant diagnose bipolar disorder. Only a psychiatrist can make a formal diagnosis. Your GP may arrange an appointment with a psychiatrist if you have:
- depression, and
- ever felt very excited or not in control of your mood or behaviour for at least 4 days in a row.
They might refer you to a psychiatrist at your local NHS community mental health team .
Your GP should make an urgent referral to the CMHT if they think that you might have mania or severe depression. Or there is a chance that you are a danger to yourself or someone else.
Your GP should refer you to your local NHS early intervention team if you have an episode of psychosis and its your first one.
Bipolar disorder can be difficult to diagnose because it affects everyone differently. Also, the symptoms of bipolar disorder can be experienced by people who have other mental illness diagnoses. It can take a long time to get a diagnosis of bipolar disorder.
You can find more information about:
- NHS mental health teams by clicking here.
Information For Family Carers And Friends
How can I get support?
You can speak to your GP. You should be given your own assessment through NHS mental health services to work out what effect your caring role is having on your health. And what support you need. Such as practical support and emergency support.
These are some other options for you:
- Join a carers service
- Join a carers support group
- Ask your local authority for a carers assessment
- Read about the condition
- Apply for welfare benefits for carers
Rethink Mental Illness run carers support groups in some areas. You can also search for groups on the Carers Trust website:
- Rethink Mental Illness: www.rethink.org/about-us/our-support-groups
- Carers Trust: www.carers.org/search/network-partners
How can I support the person I care for?
You might find it easier to support someone with bipolar disorder if you understand their symptoms, treatment and self-management skills.
You should be aware of what you can do if you are worried about their mental state. It can be helpful to know contact information for their mental health team or GP.
You could find out from your relative if they have a crisis plan. You could help your relative to make a crisis plan if they dont have one.
As a carer you should be involved in decisions about care planning. But you dont have a legal right to this. The medical team should encourage the person that you care for to allow information to be shared with you.
You can find out more information about:
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Other Treatments And Suicide
Evidence is growing that the glutamate NMDA-receptor antagonist ketamine and its active S-enantiomer can exert rapid, short-term reduction of suicidal ideation along with rapid reduction of symptoms of depression, including in BD patients, although effects on suicidal behavior are uncertain . There is considerable uncertainty about how to continue use of racemic or S-ketamine following initial benefits, and some concern that its discontinuation may provoke adverse clinical responses . ECT often appears to be lifesaving in suicidal emergencies but lacks evidence of sustained antisuicidal efficacy . Other methods of external electrical or magnetic stimulation of brain, vagal nerve stimulation, and deep brain stimulation are being investigated or introduced for the treatment of otherwise treatment-resistant depression but remain to be tested adequately for specific effects on suicidal behavior, particularly in BD.
Additional interventions of potential value include emergency hospitalization as well as psychotherapies, in particular cognitive-behavioral, dialectic, and interpersonal methods, which can improve depressive symptoms and may reduce suicidal risk . However, results from studies of psychosocial interventions may be limited by the self-selection of patients who adhere to such prolonged treatments.
Talk To Family About Their Mental Health
Because mental health conditions tend to run in families, its helpful to know your relatives mental health experiences.
In fact, an estimated 8090% of people with bipolar disorder have a relative with depression or bipolar disorder.
You might ask family:
- Have you experienced extreme mood shifts in your life?
- Have you felt down a lot? Or not like yourself?
- Have other relatives struggled with their mental health?
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Manic Symptoms In Children
Symptoms of mania in children can include:
- acting very silly and feeling overly happy
- talking fast and rapidly changing subjects
- having trouble focusing or concentrating
- doing risky things or experimenting with risky behaviors
- having a very short temper that leads quickly to outbursts of anger
- having trouble sleeping and not feeling tired after sleep loss
Specialty Intensive Outpatient Programming:
The MendCenter provides two speciality intensive outpatient programs. While they both address the therapeutic needs of chronic / severe mental illness, one is geared toward schizophrenia spectrum disorders and the other toward bipolar disorders.
Learn more about how our approach to intensive outpatient treatment differs from traditional approaches.
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Living With Bipolar Disorder
Treatment can help you manage mood episodes and cope with the symptoms they cause.
Creating a care team can help you get the most out of treatment. Your team might involve:
- your primary doctor
- a psychiatrist who manages your medications
- a therapist or counselor who provides talk therapy
- other professionals or specialists, such as a sleep specialist, acupuncturist, or massage therapist
- a bipolar disorder support group, or community of other people also living with bipolar disorder
You may need to try a few treatments before you find one that leads to improvement. Some medications work well for some people but not others. In a similar vein, some people find CBT very helpful, while others may see little improvement.
Its always best to be open with your care team about what works and what doesnt. If something doesnt help or makes you feel even worse, dont hold back from letting them know. Your mental health matters, and your care team should always support you in finding the most helpful approach.
A little self-compassion can go a long way, too. Keep in mind that bipolar disorder, like any other mental health condition, didnt happen by choice. Its not caused by anything you did or didnt do.
Its OK to feel frustrated when treatment doesnt seem to work. Try to have patience and treat yourself kindly as you explore new approaches.
Bipolar Disorder Symptoms In Women Vs Men
Men and women are diagnosed with bipolar disorder in roughly equal numbers. However, the main symptoms of the disorder may vary, depending on both sex you were assigned at birth and your gender.
Women with bipolar disorder tend to receive diagnoses later in life, often in their 20s or 30s. In some cases, they might first notice symptoms during pregnancy or after childbirth. Theyre also more likely to be diagnosed with bipolar II than bipolar I.
Additionally, women with bipolar disorder tend to experience:
- milder episodes of mania
- more depressive episodes than manic episodes
- rapid cycling, or 4 or more episodes of mania and depression in 1 year
- more co-occurring conditions
Women with bipolar disorder may also experience relapse more often, which may happen in part due to hormone changes related to menstruation, pregnancy, and menopause. In terms of bipolar disorder, relapse means having a mood episode after not having one for some time.
Men with bipolar disorder, on the other hand, may:
- get a diagnosis earlier in life
- experience less frequent but more severe episodes, especially manic episodes
- be more likely to also have a substance use disorder
- show more aggression during episodes of mania
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What Are The Symptoms Of Bipolar Ii Disorder
During a hypomanic episode, elevated mood can manifest itself as either euphoria or as irritability.
Symptoms during hypomanic episodes include:
- Flying suddenly from one idea to the next
- Having exaggerated self confidence
- Rapid, “pressured” and loud speech
- Increased energy, with hyperactivity and a decreased need for sleep
People experiencing hypomanic episodes are often quite pleasant to be around. They can often seem like the “life of the party” — making jokes, taking an intense interest in other people and activities, and infecting others with their positive mood.
What’s so bad about that, you might ask? Hypomania can also lead to erratic and unhealthy behavior. Hypomanic episodes can sometimes progress onward to full manias that affect a person’s ability to function . In mania, people might spend money they don’t have, seek out sex with people they normally wouldn’t, and engage in other impulsive or risky behaviors with the potential for dangerous consequences.
The vast majority of people with bipolar II disorder experience more time with depressive than hypomanic symptoms. Depressions can occur soon after hypomania subsides, or much later. Some people cycle back and forth between hypomania and depression, while others have long periods of normal mood in between episodes.
Untreated, an episode of hypomania can last anywhere from a few days to several months. Most commonly, symptoms continue for a few weeks to a few months.
Challenges With Getting A Diagnosis
The symptoms of bipolar disorder can overlap with other mental health problems. Different people may experience or express their symptoms in different ways. And professionals do not always get it right.
Because of this, you might:
- Not get a diagnosis of bipolar disorder when you feel you should have one.
- Get a diagnosis of a different mental health problem, which you don’t agree with.
- Get a diagnosis of bipolar disorder that you think is incorrect.
Even if you think your diagnosis is correct, you may still feel that it doesn’t completely fit your experiences.
If you are unhappy or concerned about your diagnosis, it’s important to discuss this with your doctor.
You can make sure your voice is heard, seek a second opinion and take steps if you’re not happy with your doctor. For more information, see our pages on:
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