Bipolar disorder: diagnostic issues.
Bipolar disorders are cyclical mood disorders with clinical features including distinct sustained periods of mood elevation. Briefer (4 days or more), mild episodes of mood elevation define bipolar II disorder; lengthier (7 days or more), more severe episodes (or those requiring hospitalisation), with or without psychotic features, define bipolar I disorder. Depressive periods are more common and lengthier than manic or hypomanic states, and are the main cause of disability. Bipolar depression may respond poorly to antidepressants and these medications may destabilise the illness. The diagnosis of bipolar disorder should be considered when a patient with depression is treatment resistant. Irritability is a common symptom in bipolar disorder, particularly during mixed states (during which patients have features of mood elevation and depression concurrently) or when there is rapid cycling of mood (more than four episodes of mood disorder per year). Alcohol misuse and use of illicit drugs may simulate mood changes in bipolar disorder. Accurate diagnosis and assessment of bipolar disorder is essential for clinical decision making and determining prognosis and treatments.
Tiller
John W G
JW
Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, VIC. TillerJ@ramsayhealth.com.au
Schweitzer
Isaac
I
D001714:Bipolar Disorder / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D011569:Psychiatric Status Rating Scales