How Is Bipolar Diagnosed In Adults

Why Is Bipolar Disorder No Longer Called Manic

In the last few decades, the medical world, especially the field of psychiatry, has intentionally made a shift from using manic-depressive illness or manic depression to describe bipolar disorder. There are several reasons for this shift, including:

• Healthcare providers used to use manic depression to describe a wide range of mental health conditions. As mental health condition classification systems, including the Diagnostic and Statistical Manual of Mental Disorders , have become more sophisticated, the new term bipolar disorder allows for more clarity in diagnosis.
• Theres a lot of stigma and negativity associated with the terms manic and mania, especially due to the use of maniac. Similarly, people use the term depression casually to describe periods of sadness that dont qualify as clinical depression. Using bipolar disorder takes the focus away from these two words. Bipolar disorder is more of a clinical, medical term and less emotionally loaded than manic depression.
• The term manic depression excludes the cyclothymic or hypomanic versions of the condition.

What You Can Do: Daily Habits Make A Difference

These healthy lifestyle habits, along with professional treatment, can help manage the symptoms of bipolar disorder:

Treatment Works. SAMHSA Can Help You Find It.

Effective treatments for bipolar disorder are available in your area. The earlier that you begin treatment, the greater likelihood of a better outcome. For confidential and anonymous help finding a specialty program near you, visit SAMHSAs Early Serious Mental Illness Treatment Locator.

If you, or someone you know, need help to stop using substances whether the problem is methamphetamine, alcohol or another drug call SAMHSAs National Helpline at or TTY: , or text your zip code to 435748 , or use the SAMHSAs Behavioral Health Treatment Services Locator to get help.

What Tests Are Used To Diagnose Bipolar Disorder

Diagnosing bipolar disorder typically involves several distinct types of testing. A psychiatrist will have you fill out a mood questionnaire or other mental health checklist to guide the interview process.

They also may want to assess your urine, blood, or hair to check for the presence of illicit or prescription drugs that might be causing your bipolar symptoms.

While blood work cant indicate the presence of bipolar disorder, its also useful in checking thyroid hormones, because depression is often linked to sluggish thyroid action .

Psychiatrists dont typically depend on brain imaging or scans during a bipolar diagnosis. However, some neuroimaging can be helpful for making a targeted diagnosis of other conditions.

Because of this, sometimes a CT scan or an MRI may be ordered, particularly if youve had a sudden change in behavior, mood, or thinking. Again, these tests are helpful in ensuring that no underlying neurological conditions are causing your symptoms.

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Women And Bipolar Disorder

• Women and people with bipolar II disorder are significantly more likely to experience periods of rapid cycling than men with the same condition. . Depression, anxiety and perceived stress in women with and without PCOS: A community-based study. Psychological Medicine, 49)
• Other research findings indicate that women with bipolar disorder may have more depressive episodes and more mixed episodes than do men with the illness.

Can You Get A Bipolar Disorder Diagnosis Removed Or Reversed

A diagnosis for bipolar disorder usually is not removed because its a lifelong disorder.

But if you feel that your condition has been misdiagnosed, do not hesitate to advocate for yourself and seek a second medical opinion. Additional healthcare professionals may be able to reverse or amend a misdiagnosis of bipolar disorder.

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Why The Diagnosis Is Difficult

• People with bipolar disorder spend much more time in a depressive state than in mania or hypomania. This is especially true of bipolar type II. Chances are, a doctor will not observe manic or hypomanic symptoms during an evaluation when the patient is in a depressed state.
• People with bipolar disorder don’t remember or even recognize mild or hypomanic symptoms as problematic. They assume these rare breaks from depression are what it feels like to be normal. Willa says: “I didn’t go to the doctor to complain that I wrote a book in one week. If I didn’t already have the appointment, the doctor would never have heard about it.”
• People with bipolar disorder may not understand the diagnostic criteria when asked about them especially if not asked in easily-understood language. Flight of ideas? Psychomotor agitation? As Willa says: Our very perspective during an episode prevents us from thinking we have ‘inflated self-esteem‘ and ‘irritability.’ Instead, we think other people are the ones who are irritating when they can’t acknowledge our importance. And an abnormally elevated mood is that the same as saying we are crazy? And who wants to think they are going on spending sprees or making foolish business decisions?”

Nature Of Bipolar Disorder

Several types of bipolar disorder are recognized by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association , differentiated by the severity and duration of manic symptoms. A diagnosis of bipolar I disorder is made based on a single lifetime episode of mania, which is in turn defined by euphoric or irritable mood, along with at least three additional symptoms that result in marked social or vocational impairment. The duration criterion for mania specifies that symptoms must last one week or require hospitalization. Bipolar II disorder, in contrast, is defined by a history of at least one hypomanic episode and at least one major depressive episode. Criteria for hypomania are similar to those of mania, but in milder form: instead of impairment, a hypomanic episode is marked by a distinct change in functioning. Cyclothymic disorder is an even milder subtype of bipolar disorder, and is diagnosed based on a period of at least two years of recurrent mood swings. By definition, these mood swings must be in both the up and the down directions, but do not meet full criteria for mania, hypomania, or depression. In addition, the symptomatic two-year period cannot include any two-month span that is free of mood swings.

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What Medications Are Used To Treat Bipolar Disorder

Certain medications can help manage symptoms of bipolar disorder. You may need to try several different medications, with guidance from your healthcare provider, before finding what works best.

Medications healthcare providers generally prescribe to treat bipolar disorder include:

• Mood stabilizers.
• Second-generation neuroleptics .
• Antidepressants.

If youre taking medication for bipolar disorder, you should:

• Talk with your healthcare provider to understand the risks, side effects and benefits of the medication.
• Tell your healthcare provider about any prescription drugs, over-the-counter medications or supplements youre already taking.
• Tell your healthcare provider right away if youre experiencing concerning side effects. They may need to change your dose or try a different medication.
• Remember that medication for bipolar disorder must be taken consistently, as prescribed.

Mood stabilizers for bipolar disorder

People with bipolar disorder typically need mood-stabilizing medication to manage manic or hypomanic episodes.

Types of mood stabilizers and their brand names include:

Thyroid gland and kidney problems can sometimes develop when taking lithium, so your healthcare provider will monitor the function of your thyroid and kidneys, as well as monitor the levels of lithium in your blood, as levels can easily become too high.

The following are signs of lithium toxicity . Call your healthcare provider immediately or go to the nearest emergency room if you experience:

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.

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What Is The Treatment For Mania Hypomania And Depression

You can check what treatment and care is recommended for bipolar disorders on the National Institute for Health and Care Excellence website.

NICE produce guidelines for how health professionals should treat certain conditions. You can download these from their website at:

The NHS doesnt have to follow these recommendations. But they should have a good reason for not following them.

What medications are recommended?

Mood stabilisers are usually used to manage mania, hypomania and depressive symptoms.

The mood stabilisers we talk about in this factsheet are:

• Certain benzodiazepine medication

Mania and hypomaniaYou should be offered a mood stabiliser to help manage your mania or hypomania. Your doctor may refer to your medication as antimanic medication.

If you are taking antidepressants your doctor may advise you to withdraw from taking them.

You will usually be offered an antipsychotic first. The common antipsychotics used for the treatment of bipolar disorder are:

If the first antipsychotic you are given doesnt work, then you should be offered a different antipsychotic medication from the list above.

If a different antipsychotic doesnt work, then you may be offered lithium to take alongside it. If the lithium doesnt work you may be offered sodium valproate to take with an antipsychotic. Sodium valproate is an anticonvulsive medication.

Sodium Valproate shouldnt be given to girls or young women who might want to get pregnant.

• Fluoxetine with Olanzapine

The Relationship Between Bipolar Disorder And Sex Drive

During manic episodes, people with bipolar disorder may engage in certain impulsive behaviors. For some people, this kind of behavior can involve a preoccupation with sex and a heightened sex drive, leading to unprotected sex or risky sexual situations with potentially damaging consequences, both physical and emotional. Hypersexuality, or an increased interest in sex, is known to be a symptom of bipolar disorder, though the research on the subject is limited.

Learn More About Bipolar Disorder and Sex Drive

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When Should I Go To The Emergency Room For Bipolar Disorder

If youre experiencing any of these situations, its essential to call 911 or get to the nearest emergency room:

• Thoughts of death or suicide.
• Thoughts or plans of hurting yourself or others.
• Experiencing hallucinations and delusions.
• Symptoms of lithium toxicity , such as severe nausea and vomiting, severe hand tremors, confusion and vision changes.

A note from Cleveland Clinic

Bipolar disorder is a lifelong illness. But long-term, ongoing treatment, such as medication and talk therapy, can help manage your symptoms and enable you to live a healthy, purposeful life. Its important to see your healthcare team regularly to monitor your treatment plan and symptoms. Know that your healthcare providers and loved ones are there to support you.

Last reviewed by a Cleveland Clinic medical professional on 04/12/2022.

References

Why Do Bipolar Disorder And Adhd Often Occur Together

Its still not entirely clear why bipolar disorder and ADHD often occur at the same time. One theory is that shared genetic and biological factors may be partially responsible for the association.

In a 2015 study , researchers examined data from 13,532 twins to try to understand the degree to which genetic factors play a role in the development of ADHD in people with bipolar disorder.

They found that genetic factors associated with mania were 25 to 42 percent associated with ADHD symptoms, suggesting that theres some biological connection between the two conditions.

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What Can I Do If I Think A Loved One Has Bipolar Disorder

If you suspect that a loved one has bipolar disorder, talk with the person about your concerns. Ask if you can make a doctorâs appointment for the person and offer to accompany the person to the visit. Here are some tips:

Summary Of Assessment Tools For Diagnosis

Overall, the SCID and the SADS are the most common means of diagnosing bipolar disorder in adults. With excellent psychometric characteristics for the assessment of bipolar I disorder, they fare less well in assessing bipolar II disorder. This may be due to issues related to the definition of hypomania.

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Can Bipolar Disorder Run In The Family

Yes, a family history of bipolar disorder is the most influential risk factor for bipolar disorder. If youre concerned about your mental health symptoms, make sure to ask grandparents or older family members if they remember anyone else in the family facing similar struggles.

Your doctor will ask about your familys history of mental health during your diagnosis.

A Story Of Misdiagnosis

Willa Goodfellow:

“Home from a weeks vacation in Costa Rica, I was at the office of my general practitioner to get a prescription for a different medication for my depression. I told the doctor that I had spent my vacation entirely in my hotel room ‘maniacally writing.’ While my wife went to the beach, explored neighborhoods, and visited my family who lived there, I just wrote. And wrote. And wrote. I wrote so much that I came home with seven chapters of what would become my first book.

“I needed a new prescription because my first prescription for depression, Prozac, had made me irritable. I also could not concentrate, couldn’t sleep, and my language was coarse. These symptoms had been taken by the doctor to indicate a deeper depression, and so she had originally increased the dosage. But a new problem, a side effect of diarrhea, pushed me to noncompliance. I quit taking the medication, and went to Costa Rica during the period needed to wash it out of my system before getting a different medication.

“But now, at this appointment, my use of the word ‘maniacally’ caused my doctor to pause. Antidepressants can cause people with bipolar disorder to ‘flip’ into mania or hypomania. So she screened me by asking just one question, ‘Are you manic?’

“I answered, ‘No. I’m not manic, I’m excited!’ With that, she gave me the next antidepressant.

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Bipolar Diagnosis For Children:

Bipolar can be diagnosed at any age. Because symptoms can mimic many other conditions, however, its often misdiagnosed as depression, anxiety, attention deficit disorder , or conduct disorders. Just like when diagnosing adults, theres no diagnostic test that can determine if a child has bipolar disorder.

A psychiatrist will ask several questions relating to a childs behavior and mood before making a diagnosis. They can include things such as:

• How long does the child sleep every night on average?
• How common and often are emotional outbursts?
• How common and often is the mood episode happening, is it intense irritability and aggressive behavior?

Theyll also want to discuss family history and will most often rule out thyroid dysfunction.

Bipolar simply means that the mood symptoms are fluctuating between two different poles. A lot of people keep on getting worse with depression treatment and never get to the right diagnosis. Getting an accurate diagnosis is the key to the best treatment. Its important to be honest with the psychiatrist and share the past mood symptoms as well as present ones. Its also important to share any drug use or risky behaviors during the psychiatric assessment. Its not that simple to diagnose bipolar disorder by just filling out an online rating scale. An expert evaluation by a psychiatrist is also needed.

What Are The Signs And Symptoms Of Bipolar Disorder

The defining sign of bipolar I disorder is a manic episode that lasts at least one week, while people with bipolar II disorder or cyclothymia experience hypomanic episodes.

But many people with bipolar disorder experience both hypomanic/manic and depressive episodes. These changing mood states dont always follow a set pattern, and depression doesnt always follow manic phases. A person may also experience the same mood state several times with periods of euthymia in between before experiencing the opposite mood.

Mood changes in bipolar disorder can happen over a period of weeks, months and sometimes even years.

An important aspect of the mood changes is that theyre a departure from your regular self and that the mood change is sustained for a long time. It may be many days or weeks in the case of mania and many weeks or months in the case of depression.

The severity of the depressive and manic phases can differ from person to person and in the same person at different times.

Signs and symptoms of manic episodes

Some people with bipolar disorder will have episodes of mania or hypomania many times throughout their life others may experience them only rarely.

Signs and symptoms of a manic episode include:

Most of the time, people experiencing a manic episode are unaware of the negative consequences of their actions. With bipolar disorder, suicide is an ever-present danger some people become suicidal in manic episodes, not just depressive episodes.

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