The First Steps Towards Proper Diagnosis

The first step in getting treatment for bipolar disorder is getting a correct diagnosis. This can be a more difficult than it might seem because the symptoms of bipolar can be similar at times to other major brain disorders, such as schizophrenia or major Depression.  Because many regular family doctors may not be very familiar with bipolar, it is important to see a good psychiatrist that is experienced in the diagnosis and treatment of bipolar or schizophrenia.

One way to do this is to contact a local support group that deals with brain disorders such as schizophrenia and talk to the other members that already have experience with the local psychiatrists. If that is not convenient, we recommend you join in our discussion areas and ask there if anyone can recommend a good psychiatrist in your area. Local members may be able to recommend a good psychiatrist that they have worked with. As with most serious illnesses, its important to get diagnosis and treatment as quickly as possible.

The Common Symptoms of Bipolar Disorder

Classic bipolar disorder (or Bipolar Disorder I) is characterized by episodes of mania and episodes of Depression. In a manic state, a person may have extreme euphoria or optimism, to the point of impairing judgement. They may be hyperactive and stay up all night, talk and move extremely fast, have increased sexual drive and decreased inhibition. 75% of manic episodes include delusions of some sort (most often delusions of grandeur), one of the reasons why it is sometimes confused with schizophrenia. Untreated manic episodes can last for weeks or even months. Conversely, during a depressive episode, the same person can feel hopeless and personally worthless. They may lose interest in their normal activities (including sex), have very little energy or motivation, be unable to concentrate, and have disturbances in sleep and eating habits. Mania and Depression do not necessarily follow one after the other; sometimes a person may experience a long symptom-free period before having another mood disturbance.

Bipolar Disorder II is characterized by episodes of milder Depression and milder mania, called hypomania. A hypomanic episode is different from full mania in that it does not include psychotic symptoms (i.e. delusions) and it does not include symptoms that might be dangerous to the person or to others. Although it has it’s own name, bipolar disorder II is reliably diagnosed less often than Bipolar I, and some experts question characterizing it as a milder version of the disorder (Source: “Bipolar Disorder.” New England Journal of Medicine 2004:351:5:476-486).

A mixed episode is characterized by symptoms of both mania and depression occuring together (i.e. during the same day) for at least one week. A person experiencing a mixed episode might be very anxious and disorganized, unable to sleep or concentrate. In children, it can resemble Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder. Mixed episodes are generally followed by depression, and occur most often in people under 25 or over 60 years of age.

Rapid cycling refers to someone experiencing four or more episodes of mania or depression within the period of one year. Rapid cycling may last a few years and then slow down into less frequent episodes; conversely, someone may develop rapid cycling well after being diagnosed with fewer episodes.

Diagnosis and Misdiagnosis - Some Conditions with Overlapping Symptoms

 
• Bipolar and Schizophrenia - What’s the Difference?       o Bipolar disorder is one of the many brain diseases that shares symptoms with schizophrenia; this leads to mistaken diagnoses, especially in children. It’s important to know that individuals with bipolar disorder, even those that display psychotic symptoms as a feature of their illness, never meet the full diagnostic criteria for schizophrenia. Someone with bipolar disorder is not always in either a manic or a depressive phase; he or she may have long periods during which they seem virtually symptom-free (does not have the disordered thinking, delusions, voices, or other symptoms that characterize schizophrenia). Likewise, any psychotic symptoms associated with bipolar disorder should occur within the context of a manic or a depressive state - delusions of grandeur and hallucinations may be either wildly optimistic and grandiose, or completely disastrous and guilt-ridden.         Schizo-affective disorder is a disease that does contain elements of both schizophrenia and bipolar - it can be described as “schizophrenia with a mood component.” The major distinguishing difference between schizo-affective and bipolar with psychotic symptoms is that to be diagnosed schizoaffective, an individual must display the symptoms of schizophrenia (i.e. hallucinations, delusions, etc) without accompanying mood symptoms of mania or depression. In a diagnosis of bipolar, an individual may not always be symptomatic, but within an episode schizophrenia-like symptoms are in the context of mania or depression.  
• Bipolar and Psychosis - What’s the Difference?       o It is valuable to understand the difference between psychosis and bipolar disorder. Psychosis is a general term used to describe psychotic symptoms. Bipolar may include a kind of psychosis. Several different brain disorders can lead to psychotic symptoms, including lesions in the brain resulting from head traumas, strokes, tumors, infections or the use of illegal drugs. If a serious depression goes untreated for a long time psychotic symptoms may develop. These examples demonstrate that not all psychosis is schizophrenia. If is for this reason that doctors may take quite some time (6 months or more) to diagnose someone, because while the symptoms of bipolar disorder may be quite obvious - the fact that the symptoms are not being caused by some other brain disorder is frequently not obvious.  
• Bipolar and Depression - What’s the Difference?       o The main distinguishing diffference between bipolar disorder and major clinical depression is, of course, the presence of manic episodes. This is why depression alone is not enough to diagnose an individual with bipolar, even if this disease runs in the family. However, even one manic episode (meeting DMS-IV criteria) is sufficient to make a bipolar diagnosis. Distinguishing between these two illnesses makes a big impact on treatment choice; while depression is treated primarily with anti-depressant medication, someone with bipolar disorder needs a mood-stabilizing medication such as lithium or valproate. Taking anti-depressants with a diagnosis of bipolar disorder is a tricky business, because the medication can sometimes trigger a manic episode.