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Old 08-28-07, 09:28 PM
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Diagnosing Bipolar Disorder: Ruling Out Other Psychiatric Conditions

Another of the articles ...I get every week.

All of these articles are found on
www.bipolar.about.com



I thought it would be nice to add it up here since it's been updated so recently. And I added the sister article under it for help with being able to tell the differences between BP and Major Depression. I know we have had several people here asking about it. Interesting enough, I discovered after reading it. The study is being done right here in Cleveland at Case Western Reserve where my phychiatrist, and the one who diagnosed me (finally) with my own Bipolar II , is a Professor.


It's also interesting in reading that it's confirmed once again, that me having been diagnosed with ADD first then shortly after Clinical Depression, before the BP...is often typical. And again shows how difficult it is to pin it down, even for very experienced professionals.


Hope it's helpful!




Diagnosing Bipolar Disorder: Ruling Out Other Psychiatric Conditions

Bipolar Basics
by Kimberly Read

Reference:
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text Revision (DSM-IV-TRTM).

Updated: August 21, 2007



Ask almost any individual with bipolar disorder about how they were diagnosed. You will probably hear of a long and difficult journey through many wrong turns and misdiagnoses, numerous dead ends and new doctors. The path will have included abundant changes of direction and differing medications before arriving at the correct diagnosis of bipolar disorder. Why is this so often the case? It's because the list of psychiatric conditions with symptoms similar to those of bipolar disorder is rather long. To further complicate the picture, most of these disorders can also occur with bipolar disorder.



Psychiatric conditions that can manifest symptoms similar to bipolar disorder include:


Attention Deficit Hyperactivity Disorder (ADHD)

Hyperactivity and distractibility are two of the hallmark symptoms of ADHD.
However, they are also quite predominant in bipolar disorder, especially as it relates to children. Recent research seems to indicate that bipolar disorder does occur even in very young children. Many children diagnosed with ADHD are later diagnosed with bipolar disorder as well.


Alcohol/Substance Abuse

It is very common for those with bipolar disorder to struggle with alcohol and substance abuse issues. This is often an attempt, even on an unconscious level, to self-medicate. Additionally, the effects of these drugs (such as hallucinations or the inability to sleep) can be confused with the symptoms of bipolar disorder.


Borderline Personality Disorder

The diagnostic criteria for this disorder include impulsivity, suicidal behavior, reactivity of mood, inappropriate anger, and paranoia. All of these are also associated with bipolar disorder. It is possible for an individual to be diagnosed with both of these disorders.


Delusional Disorder

The hallmark of this disorder is nonbizarre (the situations are possible) delusions. Mood episodes can be a symptom but they are brief in duration and are part of the delusion. If a doctor is not aware of the delusion, the mood may appear to be incongruent to current circumstances and therefore confused as bipolar disorder.


Depression

The one thing that distinguishes unipolar depression from bipolar disorder is mania/hypomania. If a patient with depression swings into an episode of mania, the diagnosis becomes bipolar disorder.


Eating Disorders

It is not uncommon for those with bipolar disorder to experience eating disorders. Moreover, depression, anxiety and irritability often result from eating disorders. Anorexia nervosa is an eating disorder characterized by an extreme fear of gaining weight or getting fat. Those with this disorder often have a body weight of less than 85 percent of that what is considered normal. Bulimia nervosa is typified by periods of binge eating followed by purging (purposely vomiting).


Panic Disorder

This disorder is characterized by recurrent, spontaneous panic attacks. In that these attacks are traumatic, they do create instability of mood which may be confused with the mood episodes of bipolar disorder. Furthermore, panic attacks are also common in those with bipolar disorder.


Schizophrenia

Schizophrenia is a mental disorder that causes intense disturbances in both cognition (thinking) and emotions (feeling). It consists of two classifications of symptoms – positive and negative. Positive symptoms include delusions, hallucinations, disorganized speech and thinking, disorganized behavior, catatonic behavior, and inappropriate moods. Negative symptoms are flattened emotions, lack of speech and a reduction in goal-directed behavior. The symptoms of schizophrenia are easily confused with those of bipolar disorder.


Schizoaffective Disorder

A diagnosis of schizoaffective disorder is given when the symptoms of both schizophrenia and bipolar disorder (predominantly mania) are both present – occurring simultaneously. If the symptoms alternate or are not present throughout an episode, a diagnosis of schizophrenia or bipolar disorder (perhaps with psychotic features) is more likely depending on the dominant symptoms. As you would expect, there is a great deal of confusion and controversy surrounding this disorder.



And here is the follow up article showing the differences between Major Depression and BP. >>>


Diagnosing Bipolar Disorder verses Major Depression
A New Assessment Tool

Sonia was diagnosed with depression and was prescribed an antidepressant by her doctor. Over the next 5 years, Sonia took multiple antidepressants until a spiral into extreme mania led to her hospitalization and subsequent diagnosis of bipolar disorder. In retrospect, Sonia believes that if her doctors had taken the time to dig a little deeper and not be so quick to diagnose, she would not have been misdiagnosed for so long.

You can view a video of Sonia’s story presented by Say How You Feel
http://mfile.akamai.com/13308/wmv/gsk.download.akamai.com\sayhowyoufeelsonial.asx


Many people are first diagnosed with depression or anxiety when, in fact, they actually have bipolar disorder. Research in this area indicates one in two will first be told they have depression and one in four will be told they have anxiety.

(Say How You Feel) "Bipolar depression may be difficult for both patients and doctors to identify because the symptoms are often confused with major depression," said Joseph R. Calabrese, M.D., Professor of Psychiatry, Case Western Reserve University and Director, Mood Disorders Program, University Hospitals of Cleveland. (GlaxoSmithKline, 2006)

At the 159th Annual Scientific Meeting of the American Psychiatric Association (APA) in Toronto, Canada on May 22, 2006, a new study was presented, which was designed to identify predictors of bipolar disorder risk among patients treated for major depression. This research study identified five key items (GSK, 2006):

Co-morbid anxiety
Feelings of people being unfriendly
Family history of bipolar disorder
Recent diagnosis of depression
Legal problems


"It’s important for people who are suffering from depression to talk to their doctors about other experiences and symptoms over their lifetime – especially times when they were feeling really well," said Gary Sachs, MD, Associate Professor of Psychiatry, Harvard Medical School and Director, Bipolar Disorder Clinic and Research Program, Massachusetts General Hospital.

"The predictors identified in this study may help physicians and patients identify depression associated with bipolar disorder rather than unipolar mood disorder" (GSK, 2006). To help patients start a dialog with their physicians, a brief questionnaire was developed and is available at Say How You Feel. Your responses to this survey can be printed to take to your next doctor's appointment.


References
GlaxoSmithKline (GSK). (2006, May 22). Study identifies predictors of bipolar disorder risk.
Say How You Feel. (2006).
Updated: June 16, 2006
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Old 08-28-07, 09:37 PM
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Nice find, Hope! Really helpful information.
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Old 08-28-07, 09:53 PM
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Thanks CF...always happy to help....sometimes it helps shorten the trips to find the "lost" posts....or missed stickies!
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Old 09-04-07, 04:43 AM
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It is a good find sis . . . .lost hyper dyslexics often find them selves in the bipolar section at 3:00am when they have to work the next day. . .oh crap 3:33 am!!!! I do need to go bed Why do I only feel like sleeping when it's time to wake up and go to work? . . .I wonder what the bi-polar insomnia connection is?????? {see I can connect any thing to the main topic. . . .a gift from the disability fairy}
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