What Are Other Tests Appropriate For Diagnosing Bipolar Disorder
It may seem odd, and perhaps a little frustrating that the first step in diagnosing the bipolar disorder is to schedule a comprehensive physical examination. There are very good reasons for this. It’s crucial to rule out any physical problems that may be the cause of emotional dysregulation.
A physician will conduct a physical examination, check your vital signs, and test your blood and urine. They’ll also ask about the history of your symptoms, take a brief family history, ask about other illnesses or other health conditions, and any medications that you’re currently taking.
If all of those things check out well, the doctor may ask a few questions about your moods and behaviors and perhaps do an initial mental health screening. When it’s warranted, the doctor will refer you to see a psychiatrist, therapist, or both for an appropriate assessment, diagnosis, and treatment.
How Professionals Diagnose Bipolar Disorder
Mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders as the criteria for properly diagnosing bipolar disorder. Be aware that it can be a bit confusing even for mental health professionals to properly diagnose bipolar disorder. This is because many of the symptoms of bipolar disorder overlap with symptoms of other mental health disorders. A good mental health professional will want to get it right. Bear in mind that getting a proper diagnosis may take at least a few sessions, so be patient with your doctors and therapists.
Screening For Bipolar Disorder
Robert M. A. Hirschfeld, MDSupplements and Featured Publications
Bipolar disorder is a recurrent and sometimes chronic illness involving episodes of depression and mania or hypomania. The most frequent presentation is depression: more than 1 of 5 primary care patients with depression have bipolar disorder. The symptoms of bipolar depression often differ from those of unipolar depression. Age of onset for bipolar disorder is usually the late teens slightly older for bipolar II subtype. Nearly all patients with bipolar disorder suffer from a comorbid psychiatric disorder, most frequently an anxiety disorder. Although the most dramatic presentation of bipolar disorder is the acutely manic patient who presents to the emergency department, this presentation is much less frequently encountered in physiciansâ offices, both primary care and psychiatric. Bipolarity is often missed in these situations. About half of bipolar patients have consulted 3 or more professionals before receiving a correct diagnosis, and the average time to first treatment is 10 years. It is imperative that clinicians carefully assess patients for bipolar disorder, especially those presenting with depression. In addition to patient and family history, administration of a screening instrument can be very helpful. The most widely used screening tool is the Mood Disorder Questionnaire. This screening tool will be discussed in this article regarding its use in outpatient clinics and the community.
Mania: Screening And Assessment
by Roger S McIntyre, .
There is typically a long delay between symptom onset and correct diagnosis and treatment.
The key elements of bipolar depression include:
- initial presentation of depression that progressed into treatment-resistant depression
- hypomania that is exacerbated or unmasked by antidepressant monotherapy
- prominent anxiety, agitation and hyperactivity
- poor impulse control
- family history of mental illness
- early-age onset of disturbance
- seasonal pattern
- high recurrence/vulnerability
- pattern of comorbidity .
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Who Is A Candidate For Diagnosis
Mood episodes are the main characteristic of bipolar disorder, and everyone experiences these a little differently. Most people who live with bipolar disorder experience manic episodes and depressive episodes .
These episodes can last for several days, weeks, or more. People with bipolar disorder tend to fluctuate rapidly between mania and depression. Some people with bipolar disorder have long periods of time with neutral moods as well.The way people experience manic episodes varies from one person to another, but the episodes are
Assessment Tools For Diagnosis
The diagnosis of bipolar disorder is based on a review of symptoms and potential medical explanations for those symptoms, as there is no biological marker for the disorder. In clinical practice, symptoms are frequently reviewed in an unstructured manner. It should be noted, though, that when practitioners do not use structured diagnostic tools, as many as half of comorbid conditions go undetected . Furthermore, many practitioners report that they do not routinely screen for bipolar disorder even among people with a history of major depression, many of whom would meet the diagnostic criteria for bipolar disorder . Due to informal or poor screening, the average time between onset of symptoms and formal diagnosis is more than seven years . Improper diagnosis has serious repercussions because antidepressant treatment without mood-stabilizing medication can trigger iatrogenic mania .
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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.
What Is Already Known On This Topic
When presenting for treatment, patients with bipolar disorder are more likely to experience symptoms of depression and anxiety than symptoms of mania or hypomania. Bipolar disorder is therefore prone to being overlooked because its diagnosis is more often based on retrospective report than cross-sectional assessment. Recommendations for improving the detection of bipolar disorder include the use of screening questionnaires. Most studies on the performance of bipolar disorder screening scales rely on structured diagnostic interviews to assess bipolar disorder, and few studies have been of psychiatric inpatients. A previous meta-analysis of studies of the Mood Disorders Questionnaire ,1 the most frequently studied bipolar disorders screening measure, reported an overall sensitivity of 66%.2
In clinical practice, a diagnosis of bipolar disorder from a
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Diagnostic Assessment Of Bipolar Ii Disorder In Adults
Hypomania is unique among DSM syndromes, in that by definition it does not cause any functional impairment. Perhaps because of this quality, the presence of at least one major depressive episode is also required to achieve a diagnosis of bipolar II disorder. This presents a unique diagnostic challenge: the hypomanic episodes that separate bipolar II disorder from unipolar depression are by definition of only limited severity, making this a hard diagnosis to reliably detect. Complicating this picture is the fact that there are important disagreements in the field regarding the best criteria for hypomanic episodes. For instance, current DSM criteria require three or four symptoms, in addition to elevated or irritable mood, lasting at least four days. In contrast, RDC criteria only require three symptoms lasting two days. Given this uncertainty and relative lack of severity of hypomania, it is not surprising that the accurate assessment of bipolar II disorder is more difficult to achieve than bipolar I disorder.
These difficulties have led some researchers to suggest that interviews aimed at detecting bipolar II disorder should start with questions about behavioral activation and increases in goal-directed behaviors rather than mood . Although promising, such approaches have not yet been fully validated.
What Tests Will The Doctor Use To Make A Bipolar Diagnosis
Your doctor may have you fill out a mood questionnaire or checklist to help guide the clinical interview when they assesses mood symptoms. In addition, your doctor may order blood and urine tests to rule out other causes of your symptoms. In a toxicology screening, blood, urine, or hair are examined for the presence of drugs. Blood tests also include a check of thyroid stimulating hormone level, since depression is sometimes linked to thyroid function.
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Screening For Bipolar Depression In The Primary Care Setting
Jay M. Pomerantz, MD
Primary care physicians are the main prescribers of antidepressant medications in the United States. In a typical HMO setting, psychiatrists write 15% of initial antidepressant prescriptions, with the bulk of the rest written by PCPs. The prescribing of antidepressants, even for clearly depressed patients, is not without risk. One danger is when antidepressants are prescribed for the depressed phase of bipolar disorder. The use of antidepressants to treat bipolar patients in the depressed phase if they are not concurrently taking mood stabilizers can induce mania or cycle acceleration and possibly worsen long-term outcomes. In a well-documented retrospective study of patients with bipolar disorder in whom unipolar depression had been misdiagnosed, 55% of patients treated with antidepressants who received an incorrect diagnosis experienced a manic or hypomanic episode, and 23% developed new or accelerated rapid cycling.
The peak age at onset of the first symptoms of bipolar disorder is between 15 and 19 years, followed closely by ages 20 to 24 years. Bipolar disorder at first may be difficult to diagnose in teenagers and young adults because it is often confused with, or comorbid with, attention-deficit hyperactivity disorder. Bipolar disorder combined with a comorbid substance use disorder is also a common presentation. Large epidemiologic studies have found rates of alcohol abuse and/or drug abuse in more than 40% of patients with bipolar disorder.
Ruling Out Other Conditions
There are no specific blood tests or brain scans to diagnose bipolar disorder. Even so, a doctor may perform a physical exam and order lab tests, including a thyroid function test and urine analyses. These tests can help determine if other conditions or factors could be causing your symptoms.
A thyroid function test is a blood test that measures how well your thyroid gland functions. The thyroid produces and secretes hormones that help regulate many bodily functions.
If your body does not receive enough of the thyroid hormone, which is known as hypothyroidism, your brain may not function as expected. As a result, you may have problems with depressive symptoms or develop a mood disorder.
Sometimes, certain thyroid issues cause symptoms that are similar to those of bipolar disorder. Symptoms may also be a side effect of medications. After other possible causes are ruled out, your doctor will likely refer you to a mental health specialist.
Is This Quiz Accurate
This online screening is not a definitive tool. It will not conclusively guarantee that you may be diagnosed with bipolar disorder.
However, it can be useful if youre experiencing symptoms and want to determine if additional help or support from a mental health professional is the right option for you.
Only a trained medical professional, such as a doctor or mental health professional, can help you determine the next best steps for you.
What Are The Different Types Of Bipolar Disorder You Can Receive A Diagnosis For
A bipolar disorder diagnosis will most likely fit into one of these categories:
- Bipolar I disorder involves one or more manic episodes or mixed episodes, and it may include a major depressive episode. The episodes are not due to a medical condition or substance use.
- Bipolar II disorder has one or more severe major depressive episodes with at least one hypomanic episode. There are no manic episodes, but you may experience a mixed episode.
- Rapid-cycling bipolar disorder is a severe form of bipolar disorder. It occurs when you have at least four episodes of major depression, mania, hypomania, or mixed states within a year.
- Not otherwise specified is a category for symptoms of bipolar disorder that do not clearly fit into other types. NOS is diagnosed when multiple symptoms of bipolar disorder are present but not enough to meet the label for any of the other subtypes. This category can also include rapid mood changes that do not last long enough to be true manic or depressive episodes. NOS includes multiple hypomanic episodes without a major depressive episode.
To be exact with a diagnosis, doctors use the Diagnostic and Statistical Manual of Mental Disorders .
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Types Of Bipolar Test
These are some that a Doctor can perform to examine if you have Bipolar Disorder:
This is one of the bipolar disorder test. This blood test is used to rule out other illnesses that can trigger bipolar disorder. Its also used to determine if the patient has any thyroid issues. . It may screen for anemia as well as various illnesses. You can also test vitamins and calcium using these tests.
Tests for a variety of diseases and disorders are also done, including MRA to look for organ abnormalities. Blood tests, thyroid function tests, hormone levels.
The doctor will now inquire about your symptoms, treatments used. He or she can also ask about other medications youre taking. He or she will enquire any other relevant information to diagnose Bipolar Disorder. These are some of the screening exams that can help:
Some Other Tests
A Story Of Misdiagnosis
“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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Summary Of Symptom Severity Measures
At least two interview measures , as well as some self-report measures , have received psychometric support. Self-report measures can be completed quickly, but brevity and ease of use may also result in reduced precision. Self-monitoring may also be useful to help increase awareness about symptoms and to track progress over time, but further research is required in this domain.
Preparing For An Adult Bipolar Disorder Diagnosis
If you think you may have bipolar disorder, you can start by visiting a healthcare professional. They will likely do a physical examination, discuss your medical history, and ask you some basic questions about your symptoms, family history, and life experiences.
If your healthcare professional believes you may have bipolar disorder, they will probably refer you to a psychiatrist who will do a more detailed mental health evaluation. Some of the questions a psychiatrist may ask include:
- What symptoms are you experiencing?
- What are your thoughts and feelings like during a manic or depressive episode?
- Do you feel in control of your mania or how long an episode lasts?
- When did you first start experiencing these symptoms?
- Do you ever have suicidal thoughts or thoughts of self-harm?
- Do you have a history of substance misuse?
- Did anyone in your family have similar symptoms or a diagnosis of bipolar disorder?
They might also ask your permission to ask friends and family about your behavior.
The diagnosis for bipolar disorder requires at least one depressive and one manic or hypomanic episode. Any diagnosis will take into account other aspects of your medical history and the medications youve taken.
- emotional outbursts
- periods of sadness
- How often does your child have emotional outbursts?
- How many hours does your child sleep a day?
- How often does your child have periods of aggression and irritability?
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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.
About Your Mental Health
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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.