Diagnosing Depressive And Bipolar Disorders

Janniece Dailey

Disorder of Interest

PSY/275

I choose to talk about bipolar. So many people think that this is not a serious issue but in fact it is. Bipolar disorder is a mental illness marked by extreme shifts in mood ranging from a manic to a depressive state. Bipolar disorder is also called bipolar disease or manic depression. A person with mania will feel excited, impulsive, euphoric, and full of energy. There are different behaviors associated with being bipolar. you have different treatments just as well as the whole impairment of it, and the implications of bipolar on society.

Bipolar disorder cannot yet be diagnosed physiologically by blood tests or brain scans. Currently, diagnosis is based on symptoms, course of illness, and family history. Clinicians rule out other medical conditions, such as a brain tumor, stroke or other neuropsychiatric illnesses that may also cause mood disturbance. The different types of bipolar disorder are diagnosed based on the pattern and severity of manic and depressive episodes.  Doctors usually diagnose brain and behavior disorders using guidelines from the Diagnostic and Statistical Manual of Mental Disorders, or DSM. According to the DSM, there are four basic types of bipolar disorder:

Bipolar I Disorder is mainly defined by manic or mixed episodes that last at least seven days, or by manic symptoms that are so severe that the person needs immediate hospital care. Usually, the person also has depressive episodes, typically lasting at least two weeks. The symptoms of mania or depression must be a major change from the person’s normal behavior.

Bipolar II Disorder is defined by a pattern of depressive episodes shifting back and forth with hypomanic episodes, but no full-blown manic or mixed episodes.

Bipolar Disorder Not Otherwise Specified (BP-NOS) is diagnosed when a person has symptoms of the illness that do not meet diagnostic criteria for either bipolar I or II. The symptoms may not last long enough, or the person may have too few symptoms, to be diagnosed with bipolar I or II. However, the symptoms are clearly out of the person’s normal range of behavior.

Cyclothymic Disorder, or Cyclothymia, is a mild form of bipolar disorder. People who have cyclothymia have episodes of hypomania that shift back and forth with mild depression for at least two years. However, the symptoms do not meet the diagnostic requirements for any other type of bipolar disorder.

Some people may be diagnosed with rapid-cycling bipolar disorder. This is when a person has four or more episodes of major depression, mania, hypomania, or mixed symptoms within a year.

The main difference between bipolar disorder and major clinical depression is the presence of manic episodes. This is why depression alone is not enough to diagnose an individual with bipolar. However, one manic episode (meeting DMS-IV criteria) is sufficient to make a bipolar diagnosis.

It can be difficult to pinpoint bipolar disorder because everyone at some time or another gets very happy or very sad. So how can you distinguish between the normal swings of emotion and bipolar disorder.

Bipolar disorder causes repeated mood swings, or episodes, that can make someone feel very high (mania) or very low (depressive). The cyclic episodes are punctuated by normal moods.

Mania Episode Signs and Symptoms:

Increased energy, activity, restlessness

Euphoric mood

Extreme irritability

Poor concentration

Racing thoughts, fast talking, jumping between ideas

Sleeplessness

Heightened sense of self-importance

Spending sprees

Increased sexual behavior

Abuse of drugs, such as cocaine, alcohol and sleeping medications

Provocative, intrusive or aggressive behavior

Denial that anything is wrong

Depressive Episode Signs:

Sad, anxious or empty-feeling mood

Feelings of hopelessness and pessimism

Feelings of guilt, worthlessness and helplessness

Loss of interest or pleasure in activities once enjoyed, including sex

Decreased energy, fatigue

Difficulty concentrating, remembering or making decisions

Restlessness and irritability

Sleeplessness or sleeping too much

Change in appetite, unintended weight loss or gain

Bodily symptoms not caused by physical illness or injury

Thoughts of death or suicide

While no cure exists for bipolar disorder, it is treatable and manageable with psychotherapy and medications. Mood stabilizing medications are usually the first choice in medication. Lithium is the most commonly prescribed mood stabilizer. Anticonvulsant medications are usually used to treat seizure disorders, and sometimes offer similar mood-stabilizing effects as antipsychotics and antidepressants. Bipolar disorder is much better controlled when treatment is continuous. Mood changes can occur even when someone is being treated and should be reported immediately to a physician; full-blown episodes may be averted by adjusting the treatment.

People with bipolar disorder are more likely to seek help when they are depressed than when experiencing mania or hypomania. Therefore, a careful medical history is needed to assure that bipolar disorder is not mistakenly diagnosed as major depressive disorder, which is also called unipolar depression. Unlike people with bipolar disorder, people who have unipolar depression do not experience mania. Whenever possible, previous records and input from family and friends should also be included in the medical history.

In addition to medication, psychotherapy provides support, guidance and education to people with bipolar disorder and their families. Psychotherapeutic interventions increase mood stability, decrease hospitalizations and improve overall functioning. Common techniques include cognitive behavioral therapy, psychoeducation, and family therapy.

Cognitive impairment in bipolar disorder is coming under increasing scrutiny. It is undeniably the case that cognitive impairment is present in a minority of bipolar patients. At times it may be severe and approach the level of impairment found in schizophrenia (McKenna, 1994). Generally, however, it is more state-like and thus most likely to be present when psychiatric symptoms are in evidence (e.g., dysphoria, anhedonia, anergia in depression, grandiosity, expansiveness, pressured speech, racing thoughts, gross overactivity in mania) (Goldberg, 1999). In other words, it waxes and wanes in concert with the clinical symptoms of bipolar disorder. When present, it may account in part for the poor judgment and decision making that afflicts some patients with bipolar disorder.

The time course of cognitive impairment in bipolar disorder is not well studied. Certainly, some functions appear to tightly co-vary with clinical improvements, including measures of executive function and verbal fluency (McGrath et al., 1997). Some deficits have been shown to be more persistent, though it is unclear if cognitive improvement simply lags behind normalization of mood.

There are several views of cognitive impairment in bipolar disorder. Some investigators have suggested that tasks that demand the most effort or speed are difficult for patients with bipolar disorder. Another set of research findings indicates that patients with bipolar disorder suffer from right hemisphere cortical involvement that affects different types of visual perceptual processing for recognizing objects and determining orientations in space, as well as impacting on lateralized neural systems that regulate mood. None of these models has received consistent support in the scientific literature.

Bipolar disorder usually lasts a lifetime. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of symptoms, but some people may have lingering symptoms. Bipolar disorder tends to worsen if it is not treated. Over time, a person may suffer more frequent and more severe episodes than when the illness first appeared. Also, delays in getting the correct diagnosis and treatment make a person more likely to experience personal, social, and work-related problems.

About 50% of people with bipolar disorder also have a substance abuse problem, particularly alcohol use, Dr. Bearden says. Many people will drink when they are in a manic phase to slow themselves down, and use alcohol to improve their mood when they are depressed.

Reference Page

Mitchell, P. B. (2013). Bipolar disorder. Australian Family Physician, 42(9), 616-9. Retrieved from http://search.proquest.com/docview/1470780042?accountid=458

Goldstein, Benjamin I,M.D., PhD., & Birmaher, B., M.D. (2012). Prevalence, clinical presentation and differential diagnosis of pediatric bipolar disorder. The Israel Journal of Psychiatry and Related Sciences, 49(1), 3-14. Retrieved from http://search.proquest.com/docview/1545979629?accountid=458

http://www.disabled-world.com/health/neurology/depression/bipolar/

http://www.healthline.com/health/bipolar-disorder/common-signs-symptoms#6

Phillips, M. L., & Kupfer, D. J. (2013). Bipolar disorder diagnosis: Challenges and future directions. The Lancet, 381(9878), 1663-71. doi:http://dx.doi.org/10.1016/S0140-6736(13)60989-7

Baldessarini, R. J., Leahy, L., Arcona, S., Gause, D., Zhang, W., & Hennen, J. (2007). Patterns of psychotropic drug prescription for U.S. patients with diagnoses of bipolar disorders. Psychiatric Services, 58(1), 85-91. Retrieved from http://search.proquest.com/docview/213085901?accountid=458