Bipolar Symptoms

Several recent studies on bipolar symptoms indicate that a substantial number of patients with bipolar depression, especially bipolar II depression, are initially diagnosed with unipolar major depressive disorder.

For example, Ghaemi and colleagues [Note 3] found that bipolar depression was misdiagnosed as unipolar depression in 37% of patients who initially sought treatment with a mental health clinician following their first manic or hypomanic episode. Consequently, antidepressants were used earlier and more commonly than mood-stabilizers in these patients, resulting in new or worsening rapid cycling in 23%. In a survey of members of the Depression and Bipolar Support Alliance (DBSA), Hirschfeld and colleagues [Note 2] found that 60% of respondents with bipolar symptoms had initially been diagnosed with unipolar depression.

Moreover, an average of 10 years elapsed between the onset of mood symptoms and accurate diagnosis of bipolar symptoms. Why is bipolar depression so difficult to diagnose? First, hypomanic and even manic episodes may go unreported by patients. Second, more than 50% of patients with bipolar disorder experience a depressive episode as their first mood episode.[Note 1] Third, although atypical depressive symptoms (eg, hyperphagia, hypersomnia, profound fatigue, and psychomotor retardation) may occur more commonly in bipolar depression, they are not pathognomic bipolar symptoms for depression and can occur in unipolar depression as well. Fourth, the diagnosis of bipolar II disorder, bipolar disorder NOS, and cyclothymia can be difficult to diagnose because the brief and relatively mild excursions into hypomania may be difficult for patients to recall or characterize as abnormal, and therefore difficult for clinicians to elicit.

With these diagnostic pitfalls in mind, there are fortunately several ways of improving diagnostic sensitivity for bipolar symptoms. Two screening instruments for bipolar disorder have recently been devised with reliable psychometric properties: the Mood Disorder Questionnaire (MDQ )[Notes 4,5] and the Bipolar Spectrum Diagnostic Scale (BSDS).[Note 6] Both scales can be provided to patients and family members or friends to increase the diagnostic suspicion of bipolar symptoms.

Manning and colleagues [Note 7] also identified clues for the detection of subtle presentations of bipolar symptoms and mixed states.

Detecting Subtle Bipolar Symptoms [Note 7]

1. Established bipolar family history, or lithium-responsive illness in first-degree relative, or both, or loaded 3-generational family history of mood disorder
2. Pharmacologically induced mania or hypomania
3. History of mixed states
4. Spontaneous episodes of hypomania, even when "adaptive"
5. Premorbid hyperthymia, cyclothymia, irritable, or dysthymic temperament are also signs of bipolar symptoms
6. Periodic depression with abrupt onset and termination or seasonal pattern, especially with psychomotor retardation and hypersomnia
7. Psychotic depression in a teenager or young adult

Detecting Mixed States of Bipolar symptoms [Note 7]

1. Unrelenting dysphoria or irascibility are typical bipolar symptoms
2. Severe agitation
3. Refractory anxiety
4. Unendurable sexual excitement
5. Intractable insomnia
6. Suicidal obsessions
7. "Histrionic" demeanor yet with genuine expressions of intense suffering

In Jane Pauley's new book, Skywriting: A Life Out of the Blue, she writes openly about the life-changing experience of Bipolar disorder. She was eventually hospitalized in the spring of 2001 with the diagnosis of manic depression. With proper treatment, she is now free of the uncontrollable mood swings.

More on Bipolar Symptoms

Notes to this article on Bipolar Symptoms

1. Angst J, Sellaro R. Historical perspectives and natural history of bipolar disorder. Biol Psychiatry. 2000;48:445-457. Abstract
2. Hirschfeld RMA, Lewis L, Vornik LA. Perceptions and impact of bipolar disorder: how far have we really come? Results of the National Depressive and Manic-Depressive Association 2000 survey of individuals with bipolar disorder. J Clin Psychiatry. 2003;64:161-174. Abstract
3. Ghaemi SN, Boiman EE, Goodwin FK. Diagosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry. 2000;61:804-808. Abstract
4. Hirschfeld RMA, Holzer C, Calabrese JR, et al. Validity of the Mood Disorder Questionnaire: a general population study. Am J Psychiatry. 2003;160:178-180. Abstract
5. Hirschfeld RMA, Williams JBW, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000;157:1873-1875. Abstract
6. Miller C, Ghaemi SN, Klugman J, et al. Utility of Mood Disorder Questionnaire and Bipolar Spectrum Diagnostic Scale. Program and abstracts of the American Psychiatric Association 155th Annual Meeting; May 18-23, 2002; Philadelphia, Pennsylvania.
7. Manning JS, Connor PD, Sahai A. The bipolar spectrum: a review of current concepts and implications for the management of depression in primary care. Arch Fam Med. 1998;6:63-71.

Source : Medscape