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Initial Assessment for Bipolar Disorder

Bipolar disorder, also known as manic depression, is a treatable illness marked by extreme changes in mood, thoughts, energy and behavior. A person suffering from bipolar disorder can alternate between “poles”– mania (highs) and depressions (lows). These changes can last for hours, days, weeks or months. Almost 2 million adult Americans suffer from bipolar disorder, often having been misdiagnosed as depressed as a teenager. 

An equal number of men and women develop this illness, with men usually exhibiting manic episodes at the onset and women exhibiting depressive episodes. Bipolar disorder is found amongst all races, ages, ethnic groups and social classes. Like depression and other mental illnesses, genetics play a factor in developing bipolar disorder. If a family member has been diagnosed with bipolar disorder, there is an increased risk for other members of the family. 

Types of Bipolar Disorder

There are different types of bipolar disorder that require different levels of treatment. These types are determined by the pattern and severity of symptoms during both highs and lows. 

Bipolar I disorder is characterized by one or more manic episodes, lasting at least a week or requiring hospitalization. These manic episodes are the either preceded or followed by hypomanic or major depressive episodes. Behavior during the mania can lead to severe financial, family and social disruptions or trigger a break from reality (called psychosis).

Bipolar II disorder is characterized by one or more depressive episodes accompanies by at least one hypomanic episode, but never a true manic episode. Hypomanic episodes mimic manic symptoms but don’t last as long and are not as severe. 

Cyclothymic disorder is characterized by chronic mood fluctuations but does not reach the levels of full mania or full depression. This does not mean that symptoms don’t cause serious distress in personal relationships, work or school and other areas of life. Symptoms are considered more mild than bipolar I and II, but, if left untreated, someone with cyclothymic disorder may do one to develop a more serious case of bipolar disorder.

There are other types of bipolar disorder. These include bipolar and other related disorders induced by certain drugs, alcohol, or medical conditions, such as Cushing’s disease or a stroke.

Symptoms of Bipolar Disorder

Most people who suffer from bipolar disorder can describe experiencing the highs and the lows associated with the condition. These mood swings can be severe, with a range of extreme activity and deep despair. The severity of the swings and the disruption to regular activities is what distinguishes bipolar disorder from ordinary mood changes. 

Symptoms of mania include:

Symptoms of depression include:

Bipolar Disorder in Children and Teens

Typically, bipolar disorder is diagnosed sometime in the later teenage years or early 20s, though children can be affected. If a child’s parent is found to have bipolar disorder, that child’s chances of developing bipolar disorder is increased by 15-30 percent. When both parents are diagnosed, that risk increases to 50-75 percent. Children can have bipolar disorder, but their symptoms are often misinterpreted as age-appropriate emotions and behaviors. They are sometimes even misdiagnosed with depression; in the United States, one-third of the 3.4 million children diagnosed with depression are estimated to actually be suffering from early onset of bipolar disorder. 

Some children may even be bipolar but misdiagnosed as ADHD. If the child is being treated for ADHD, the family is consistent with treatment and the symptoms are not improving, it may be time to discuss treatment for bipolar disorder. 

Assessing Bipolar Disorder

Making the assessment of bipolar disorder can seem difficult, and, following the onset of symptoms, may take years to properly diagnose. Other conditions are typically ruled out before considering bipolar disorder as there are no specific brain scans or blood tests that can definitively identify the illness. Diseases such as hypothyroidism or medication side effects must be ruled out to effectively treat any symptoms. During our initial assessment, we ask questions surrounding the overall mental health of the patient. We will cover the length of symptoms, how much they disrupt everyday life, and any risk factors for developing bipolar disorder. 

Our diagnosis for bipolar disorder requires at least one episode of depression and one episode of mania or hypomania. We will ask patients what their thoughts are during these episodes, if they feel in control and how they feel. We may need to interview family and friends to better understand our patient’s history. 

This condition shares symptoms with many other conditions, making it tricky to diagnose. Anxiety, depression, OCD, ADHD, eating disorders and personality disorders can all mimic bipolar disorders, causing diagnosis to be unclear. However, if patients give a strong family history and history of symptoms, diagnosis can become easier and treatment can begin faster.

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