Bipolar Spectrum Diagnosing and Differentiating From Depression

Christopher D. Cobbs, M.D.13 October 2010

Making the Diagnosis of Bipolar Disorder Differential Diagnosis Treatment Options

Lifetime Prevalence of Major Depression is 15 – 25%

Lifetime Prevalence of Bipolar Disorder is 1%

Bipolar Disorder has Equivalent Prevalence Between Men and Women

Average Age of Onset for MDD is 40 yo 30 yo for Bipolar Disorder

Combination of Biologic, Genetic and Psychosocial Factors

Multiple Theories 1st Degree Relatives of Bipolar Proband

Have Increased Incidence of Mood Disorder

Must have Manic Episode for a Bipolar Diagnosis

Elevated Mood Must Last 7+ Days …or Require Hospitalization Only One Episode of Mania Required…

Ever

3-4 of The Symptoms Present: Inflated Self-Esteem or Grandiosity Decreased Need for Sleep More Talkative Than Usual/Pressured

Speech Flight of Ideas/Racing Thoughts Distractibility Increase in Goal-Directed Activity Excessive Involvement in Pleasurable

Activities

Recurrent Mixed Psychotic Features Hypomania/Bipolar II Disorder Rapid Cycling Catatonic

5+ of the Follow Symptoms Lasting 2+ Weeks

Depressed Mood (May Be Irritable in Kids) Diminished Interest in Most All Activities Decreased Appetite/Significant Wt Loss Insomnia/Hypersomnia Psychomotor Agitation/Retardation Fatigue/Loss of Energy Feelings of Worthlessness/Excessive Guilt Difficulty Thinking/Concentrating Recurrent Thoughts of Death/SI

Substance Abuse Personality Disorder Anxiety Disorder Malingering

Psychotherapy (Primarily Depressive Phases)

Pharmacotherapy: Valproic Acid Lithium 2nd Generation Antipsychotics Other Anti-Epileptic Drugs 1st Generation Antipsychotics Antidepressants