DIFFERENTIAL DIAGNOSIS OF BIPOLAR DISORDER

Bipolar (affective) disorder, originally called manic depressive illness, is one of the most challenging psychiatric disorders to manage. Although it has been associated with creativity, it has a negative impact on the lives of most patients and more 6% die although suicide in the two decades after diagnosis.

How is bipolar disorder diagnosed?

  1. Unipolar depression: Have a high index of suspicion of bipolar disorder in early onset severe depression or if there is a strong family history. Look for a history of elevated mood and remember that irritable agitation can be a presenting feature of bipolar disorder.
  2. Reaction to stress: Check for associated symptoms suggestive of bipolar disorder when prominent fluctuating mood arise from stressful life events.
  3. Substance misuse: Check whether mood changes came before or after an increase in drug or alcohol use because elevated mood can lead to loss of control of drug or alcohol intake.
  4. Personality disorders, traits, or cyclothymia: Should be suspected if there is a long history of relatively mild, brief and often rapidly varying mood fluctuation starting in adolescence, without definite episodes of mania or hypomania or long periods of stable mood.
  5. Attention deficit hyperactivity disorder (ADHD): ADHD and bipolar disorder have similar symptoms; because ADHD is more common, bipolar disorder should not be diagnosed before adulthood unless there are clear episodes of euphoric mood.
  6. Schizophrenia or schizoaffective disorder: Prominent psychotic symptoms, especially if bizarre or not congruent with elevated or depressed mood, should raise the possibility of schizophrenia or schizoaffective disorder, particularly if the psychotic symptoms are-dale, or dominate, the mood symptoms.
  7. Medical and organic brain condition: Suspect an underlying organic cause in atypical or fluctuating presentations or when manic-like or depressive a symptoms occur in the context of illness or drugs known to cause behavioral change. These include neurological conditions, cerebrocrine disorders and after administration of steroids. 

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