HealthCareMagic is now Ask A Doctor - 24x7 | https://www.askadoctor24x7.com

question-icon

How Is Bipolar Disorder Diagnosed?

default
Posted on Sat, 24 May 2014
Question: Is one mania enough to diagnose bipolar?
doctor
Answered by Dr. Shafi Ullah Khan (4 hours later)
Brief Answer:
DIagnosis criteria mentioned

Detailed Answer:
Thank you for asking!
Bipolar disorder, or manic-depressive illness (MDI), is one of the most common, severe, and persistent mental illnesses. It constitutes one pole of a spectrum of mood disorders that includes bipolar I (BPI), bipolar II (BPII), cyclothymia (oscillating high and low moods), and major depression. The pathophysiology of bipolar disorder has not been determined, but studies indicate that it has a substantial genetic component.

The diagnosis of BPI requires the following:
A manic episode of at least 1 week’s duration that leads to hospitalization or other significant impairment in occupational or social functioning
The episode cannot be caused by another medical illness or by substance abuse

Manic episodes also must include at least 3 of the following symptoms:
Grandiosity
Diminished need for sleep
Excessive talking or pressured speech
Racing thoughts or flight of ideas
Clear evidence of distractibility
Increased level of goal-focused activity at home, at work, or sexually
Excessive pleasurable activities, often with painful consequences

Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4 days’ duration, along with at least 3 of the following symptoms:
Grandiosity or inflated self-esteem
Diminished need for sleep
Pressured speech
Racing thoughts or flight of ideas
Clear evidence of distractibility
Psychomotor agitation at home, at work, or sexually
Engaging in activities with a high potential for painful consequences
For major depressive episodes, the person experiences 5 or more of the following symptoms for the same 2 weeks, with at least 1 of the symptoms being either of the first 2 listed:

Depressed mood
Markedly diminished pleasure or interest in nearly all activities
Significant weight loss or gain or significant loss or increase in appetite
Hypersomnia or insomnia
Psychomotor retardation or agitation
Loss of energy or fatigue
Decreased concentration ability or marked indecisiveness
Preoccupation with death or suicide; patient has a plan or has attempted suicide
The symptoms cause significant impairment and distress
The mood is not the result of substance abuse or a medical condition
Mixed episodes are characterized by the following:

Persons must meet the criteria for both mania and major depression; the depressive event is required to be present for 1 week only
The mood disturbance results in marked disruption in social or vocation function
The mood is not the result of substance abuse or a medical condition
Evaluation should address the following:

Appearance
Affect/mood
Thought content
Perceptions
Suicide/self-destruction
Homicide/violence/aggression
Judgment/insight
Cognition
Physical health
Complications (eg, suicide, homicide, and addictions)

Laboratory studies that may be helpful include the following:

Complete blood count (CBC) with differential
Erythrocyte sedimentation rate (ESR)
Fasting glucose level
Serum electrolyte concentrations
Serum calcium concentration
Serum protein levels
Thyroid tests
Serum creatinine and blood urea nitrogen (BUN) levels
Substance and alcohol screening
Other laboratory tests: Urine copper levels, antinuclear antibody (ANA) testing, HIV testing, or Venereal Disease Research Laboratory (VDRL) testing
Other diagnostic modalities that may be helpful include the following:

Magnetic resonance imaging
Electrocardiography
Electroencephalography

Management
Treatment of bipolar disorder is directly related to the phase of the episode and the severity of that phase. It may involve inpatient care, outpatient care, or partial hospitalization or day treatment. Indications for inpatient treatment include the following:

Danger to self
Danger to others
Total inability to function
Total loss of control
Medical conditions that warrant medication monitoring
Pharmacologic agents approved by the FDA for use in treating bipolar disorder are as follows:

Valproate (manic)
Carbamazepine, extended-release (manic, mixed)
Lamotrigine (maintenance; risk of aseptic meningitis[2] )
Lithium (manic, maintenance)
Aripiprazole (manic, mixed, maintenance)
Ziprasidone (manic, mixed)
Risperidone (manic, mixed)
Asenapine (manic, mixed)
Quetiapine (manic, depression)
Chlorpromazine (manic)
Olanzapine (manic, mixed, maintenance)
Olanzapine-fluoxetine (depression)
Electroconvulsive therapy (ECT) has proved to be highly effective in the treatment of acute mania. Other measures that may be considered include the following:

Diet: Unless the patient is on monoamine oxidase inhibitors (MAOIs), no special diet is required; no significant changes should be made in salt intake; adjunctive use of omega-3 may improve bipolar depressive symptoms, though not bipolar mania
Regular exercise
Prevention (medication and psychoeducation)
I hope it helps. Get to a psychiatrist for further management. Don't forget to close the discussion please.
Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
default
Follow up: Dr. Shafi Ullah Khan (6 hours later)
i became unconscious due to severe dehydration exercise induced. Doctors requested that i stay in hospital for more time to make sure i am recovered. I did not stay in the hospital. During the stay in the hospital all checks were normal and i went out the next day not listening to Doctors' advice.

Two days later i had a full blown mania and i am doubting that the mania is due to nutrient imbalance and not due to mental illness. Is it possible that mania may develop due to physiological reasons such as shock from the treatment for severe dehydration rather than a mental illness.

I went to check several psychiatrists some said i am bipolar other said i am not and that the mania developed due to severe dehydration. How can i be sure?
doctor
Answered by Dr. Shafi Ullah Khan (23 minutes later)
Brief Answer:
Then you are not, odds are least likely

Detailed Answer:
Thank you for asking!
That ambiguity is due to you don't fill the criteria for BP disorder. Re read the criteria for diagnosis. That is pretty strict. getting an anxiety panic attack from a dehydration issues is more a psychological issue. mania is too thicker label for such scenario. I think the later proposition of diagnosis is good. Every pathology to simple correctable electrolytes disturbance and dehydration can explain that.
But the final diagnosis needs to established after a comple psychiatric evaluation. If the work up was all that normal as you mentioned , you already dont qualify the criteria so you are not bipolar. just some psychiatric rehab is all you need.
Cheers up and stop getting overwhelmed.
Take care
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Shafi Ullah Khan

General & Family Physician

Practicing since :2012

Answered : 3613 Questions

premium_optimized

The User accepted the expert's answer

Share on

Get personalised answers from verified doctor in minutes across 80+ specialties

159 Doctors Online

By proceeding, I accept the Terms and Conditions

HCM Blog Instant Access to Doctors
HCM Blog Questions Answered
HCM Blog Satisfaction
How Is Bipolar Disorder Diagnosed?

Brief Answer: DIagnosis criteria mentioned Detailed Answer: Thank you for asking! Bipolar disorder, or manic-depressive illness (MDI), is one of the most common, severe, and persistent mental illnesses. It constitutes one pole of a spectrum of mood disorders that includes bipolar I (BPI), bipolar II (BPII), cyclothymia (oscillating high and low moods), and major depression. The pathophysiology of bipolar disorder has not been determined, but studies indicate that it has a substantial genetic component. The diagnosis of BPI requires the following: A manic episode of at least 1 week’s duration that leads to hospitalization or other significant impairment in occupational or social functioning The episode cannot be caused by another medical illness or by substance abuse Manic episodes also must include at least 3 of the following symptoms: Grandiosity Diminished need for sleep Excessive talking or pressured speech Racing thoughts or flight of ideas Clear evidence of distractibility Increased level of goal-focused activity at home, at work, or sexually Excessive pleasurable activities, often with painful consequences Hypomanic episodes are characterized by an elevated, expansive, or irritable mood of at least 4 days’ duration, along with at least 3 of the following symptoms: Grandiosity or inflated self-esteem Diminished need for sleep Pressured speech Racing thoughts or flight of ideas Clear evidence of distractibility Psychomotor agitation at home, at work, or sexually Engaging in activities with a high potential for painful consequences For major depressive episodes, the person experiences 5 or more of the following symptoms for the same 2 weeks, with at least 1 of the symptoms being either of the first 2 listed: Depressed mood Markedly diminished pleasure or interest in nearly all activities Significant weight loss or gain or significant loss or increase in appetite Hypersomnia or insomnia Psychomotor retardation or agitation Loss of energy or fatigue Decreased concentration ability or marked indecisiveness Preoccupation with death or suicide; patient has a plan or has attempted suicide The symptoms cause significant impairment and distress The mood is not the result of substance abuse or a medical condition Mixed episodes are characterized by the following: Persons must meet the criteria for both mania and major depression; the depressive event is required to be present for 1 week only The mood disturbance results in marked disruption in social or vocation function The mood is not the result of substance abuse or a medical condition Evaluation should address the following: Appearance Affect/mood Thought content Perceptions Suicide/self-destruction Homicide/violence/aggression Judgment/insight Cognition Physical health Complications (eg, suicide, homicide, and addictions) Laboratory studies that may be helpful include the following: Complete blood count (CBC) with differential Erythrocyte sedimentation rate (ESR) Fasting glucose level Serum electrolyte concentrations Serum calcium concentration Serum protein levels Thyroid tests Serum creatinine and blood urea nitrogen (BUN) levels Substance and alcohol screening Other laboratory tests: Urine copper levels, antinuclear antibody (ANA) testing, HIV testing, or Venereal Disease Research Laboratory (VDRL) testing Other diagnostic modalities that may be helpful include the following: Magnetic resonance imaging Electrocardiography Electroencephalography Management Treatment of bipolar disorder is directly related to the phase of the episode and the severity of that phase. It may involve inpatient care, outpatient care, or partial hospitalization or day treatment. Indications for inpatient treatment include the following: Danger to self Danger to others Total inability to function Total loss of control Medical conditions that warrant medication monitoring Pharmacologic agents approved by the FDA for use in treating bipolar disorder are as follows: Valproate (manic) Carbamazepine, extended-release (manic, mixed) Lamotrigine (maintenance; risk of aseptic meningitis[2] ) Lithium (manic, maintenance) Aripiprazole (manic, mixed, maintenance) Ziprasidone (manic, mixed) Risperidone (manic, mixed) Asenapine (manic, mixed) Quetiapine (manic, depression) Chlorpromazine (manic) Olanzapine (manic, mixed, maintenance) Olanzapine-fluoxetine (depression) Electroconvulsive therapy (ECT) has proved to be highly effective in the treatment of acute mania. Other measures that may be considered include the following: Diet: Unless the patient is on monoamine oxidase inhibitors (MAOIs), no special diet is required; no significant changes should be made in salt intake; adjunctive use of omega-3 may improve bipolar depressive symptoms, though not bipolar mania Regular exercise Prevention (medication and psychoeducation) I hope it helps. Get to a psychiatrist for further management. Don't forget to close the discussion please. Regards