Diagnosing Bipolar Disorder

Bipolar Disorder is often a difficult syndrome to diagnosis.  Patients are much more likely to seek treatment when suffering from depression than mania, and many times patients may be less than truthful when discussing their “highs”, whether intentionally or unknowingly.  While a psychiatrist may easily see symptoms of bipolar disorder when a patient is treated over a long period of time, misdiagnosis is frequent on the first visit.  Often times, an inexperienced clinician may view a person experiencing mania or hypomania as a very happy, lively, and enthusiastic individual.  Manic patients’ moods can be very infectious. 

Paying close attention to speech and body language is an important diagnostic tool. Patients with depression may speak slowly and quietly with their heads down, have a flat-tone, and show little emotion. Men may appear unshaven. Clothing may be wrinkled, and patients may have an overall downtrodden look. On the other hand, manic patients may talk quickly and loudly, frequently using jokes or puns. Their speech may be incoherent or consist of a “flight of ideas”, jumping from one topic to the next.  Often provoked to anger, the simple suggestion of mania may cause a patient to become irate.  Clinicians must be aware of the emotional unstableness of manic patients because violent outbursts are common.

As manic patients are often unaware of the mental state they are in or have previously been in, getting an accurate history of the patient may be difficult.  While lying may be intentional because a patient is experiencing a “high” and does not want to come down, individuals may not be able to give a truthful account, regardless of their sincerity. Clinicians should try to gather information such as past medical records, criminal incidents, and job history. Inability to maintain a job, especially when performance was satisfactory for a length of time, may be an indicator. Also, sexually transmitted diseases, and maxed-out credit cards may be consequences of a manic episode. Substance abuse, which is common in bipolar disorder, should be taken into consideration as well.