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Diagnosing Bipolar Disorder

Bipolar Disorder is diagnosed based on a clinical assessment performed by a physician, usually a psychiatrist.  This assessment usually includes an interview with the patient and a review of any previous assessments in their medical records, and can also include an interview with the patient's family members or close friends.  The goal of this assessment is to determine whether the patient meets the clinical criteria for one of the Bipolar Disorders based on the reports that they or their family members and friends provide.  In many cases it is not possible to arrive at a definitive diagnosis of the disorder from a single clinical interview, and in these cases it can be useful to have a period of observation either in hospital or as an out-patient.

There are no laboratory tests or imaging tests (such as CT scans or MRI scans) that can help make a diagnosis of Bipolar Disorder.  However, these sorts of tests are often important in order to rule-out any other general medical conditions that may be contributing to or mimicking the symptoms of Bipolar Disorder.

Differentiating Bipolar Disorder from other Conditions (Differential Diagnosis)

There are various general medical conditions that are known to mimic or cause Bipolar mood episodes (Major Depressive, Hypomanic, Manic or Mixed Episode).  Most of these conditions are associated with various typical physical signs and symptoms, which makes them distinguishable from Bipolar Disorder. See here for a list of such conditions.

Bipolar Disorder is also commonly confused with various other psychiatric conditions that include mood instability and impulsive behaviors among their main symptoms. Follow these links here to read more on how to distinguish Bipolar Disorder from Major Depressive Disorder, Borderline Personality Disorder, and Attention-Deficit/ Hyperactivity Disorder.

Diagnostic Tools (Rating Scales) for Bipolar Disorder

Sometimes, clinicians may use questionnaires to help identify patients with Bipolar Disorder and to document the severity of their patient's symptoms:  

The Mood Disorders Questionnaire (MDQ) is a screening tool that asks individuals various questions to determine whether they may have ever experienced Manic or Hypomanic Episodes in their lifetime.  The purpose of a screening tool is to get a sense of whether certain people may have a particular condition, in this case Bipolar Disorder.  However, such a tool is not used to make the actual diagnosis.  To make the diagnosis, a clinical assessment is required. 

The HCL-32 is a check-list that individuals complete, which can help to distinguish whether they have Major Depressive Disorder versus Bipolar Disorder [ref]. A total score of 14 or more suggests that the person may have Bipolar Disorder.

    The Young Mania Rating Scale (YMRS) is one of the more popular questionnaires to measure manic symptoms in patients.   It is completed by the clinician based on how the patient appears in a clinical interview. 

    There are various questionnaires, both self-rated and clinician-rated, that measure depressive symptoms.  These include the Beck Depression Inventory (BDI-2) (self-rated), the Hamilton Rating Scale for Depression (HAM-D) (clinician-rated), and the Montogomery-Asberg Depression Rating Scale (MADRS) (clinician-rated).  

    To help identify children and adolescents who may have Bipolar Disorder, parents can complete the Child Mania Rating Scale. A score above 20 indicates that there is a reasonable chance that the youth may have Bipolar Disorder.

    A Life Chart is also a very helpful tool; it is a daily log that a person with Bipolar Disorder keeps of their symptoms - including their moods, sleep, energy level, concentration, etc., their medication use, life events, as well as other types of pertinent information.  The Life Chart allows the person to take an objective view of their condition and to learn about any patterns that may characterize their illness.  It also gives the clinician a way of monitoring the progress of the treatment. 

 

Rapid Cycling

Causes