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Get the Right Diagnosis


The following is an Editorial Resource from YourTotalHealth.

Reviewed by:  Steven A. King, M.D.

bipolar Doctors can tell whether you have diabetes by monitoring your blood sugar levels, and they can determine if you have strep throat by doing a throat culture. No such surefire tests exist to check for bipolar disorder. Instead, diagnosis is based on your family history, your personal medical history, your symptoms and when they began. There are several types of bipolar disorder:

  • Bipolar I. At least one episode of severe mania.

  • Bipolar II. At least one hypomanic episode (mild manic symptoms) and one or more episodes of depression.

  • Rapid-cycling bipolar disorder. Four or more episodes of mania, hypomania or depression within one year. This type of bipolar is more common in women.

  • Cyclothymia. Characterized by symptoms that alternate between mild mania and mild to moderate depression, and that persist for at least two years.

  • Bipolar NOS (Not Otherwise Specified). Applies to people who don’t meet all of the criteria for bipolar I or bipolar II, but have some symptoms and respond better to treatments for bipolar disorder than for depression alone.

In determining whether or not you have bipolar disorder, doctors rely primarily on these factors:

  • Family history. Studies show that most—or more than two-thirds—of the people who suffer from bipolar disorder have relatives with some form of depression.

  • Medical history. A physical exam is usually the first step in your diagnosis. Some medical conditions (thyroid problems, for example), use of some medications (such as steroids) and substance abuse can cause symptoms similar to bipolar disorder, or worsen bipolar symptoms in people who have it. Your doctor can order tests to rule out an underlying medical condition.

  • Symptoms. When your symptoms began is the first big clue to whether you have bipolar disorder. Bipolar disorder usually begins before age 35, and people between the ages of 15 and 25 are at the highest risk, according to the National Alliance on Mental Illness. Initial symptoms can appear in early childhood or middle age. “If somebody is having their first depression at age 40, the chances that they’ll have bipolar disorder are much less than 5 percent,” says Michael Thase, M.D., professor of psychiatry at the University of Pennsylvania School of Medicine. “In someone who is 19 and having their first depression, the chances that they are bipolar may be as high as 20 to 30 percent.”

How your symptoms first appeared also may determine whether you’re correctly diagnosed from the beginning.  “If your first episode is a whopping classical mania that lands you in the hospital, you’re typically not misdiagnosed,” says Dr. Thase. “But at least half the time, depression precedes the onset of mania, especially in women and in people who have bipolar II.” In those cases, the first diagnosis is often major depressive disorder, not bipolar disorder. Women are far more likely to be misdiagnosed with depression and men are more likely to be misdiagnosed with schizophrenia. Doctors are increasingly realizing that some people who initially appear to present only depressive symptoms also may have symptoms of mania. This is a condition known as a “mixed state,” which is defined as the simultaneous occurrence of manic and depressive symptoms lasting at least one week. 

In the future, a blood test that determines bipolar may be possible; perhaps based on levels of the immune protein interleukin-6, which are elevated in bipolar patients. Until then, getting an accurate diagnosis for bipolar disorder can be so tricky that in most cases it’s going to require working with a psychiatrist, preferably one who specializes in mood disorders. (See The Smart Patient Guide for more information.) To streamline the diagnostic process, doctors can use screening tests such as the Mood Disorder Questionnaire.

What's Next: Feel Better with Treatment

 

Review Date: May 01, 2009

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Ask Your Doctor

bipolar disorderBefore you go to your doctor’s office, be prepared to ask these questions, according to your situation:

 

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