PHYSICIAN VOICES

Diagnosing Bipolar Disorder

When I diagnose a person with bipolar disorder, it means I've determined that there is a chemical imbalance in his or her brain that causes unusual shifts in mood, energy, activity levels, and daily functioning. In someone with bipolar disorder, mood shifts may happen without any triggering event that could cause happiness or depression.

Making a psychiatric diagnosis is different than getting diagnosed with a physical disease like diabetes or asthma. We can't do a blood test or take an X-ray or MRI to make the diagnosis-we need to talk to the patient and learn about his or her situation. If the patient shows specific symptoms of bipolar disorder, we can make a diagnosis. But it's not a black and white process.

I start by spending about an hour with the patient, where I'll ask a variety of questions about his behaviors, his moods, and his daily functioning. "Collateral information," or information from friends and family, is also important, because the patient may not realize that anything has changed about his behavior. He may not realize that anything unusual is happening.

I ask the patient to give me a general description of his or her mood. The answer to that question will help me decide the other questions that will follow.

If a patient leads me to believe that he's experiencing an elevated mood, I'll ask him to further describe his mood and behavioral changes. Signs of mania include overly long periods of feeling happy or outgoing-almost like a "high." Someone experiencing mania may also show extreme irritability. After establishing his mood, I inquire about his sleeping patterns, like how many hours of sleep he gets per night. If he says he only sleeps about two hours per night, I'll then inquire what his energy level is like. If he feels very energetic even after sleeping only two hours per night, then that's a sign that he may be in a manic phase.

I'll also ask him if people often tell him he's speaking too quickly; sometimes, I can tell the answer to this question just from listening to a patient talk. A common symptom of the manic phase of bipolar is experiencing racing thoughts that turn into fast-paced speech. People in mania may also feel they have unusually high levels of creativity as well as confidence. I'll ask patients if they feel extra powerful, if they think they have special powers, or if they think they can control outcomes of various world events. Grandiose illusions are significant symptoms of the manic phase of bipolar disorder, as are feelings of impulsivity. Often, people experiencing mania can be very impulsive, which means they do things without considering the consequences of their actions. I'll inquire about their sexual activity and drug and alcohol use.  These questions help me explore whether they are making risky decisions that are characteristic of manic phases.

Patients on the other end of the bipolar spectrum may be experiencing a severe depressive episode. I'll ask them to describe their mood. Signs of depressive episodes are extended periods of feeling sad or hopeless, and loss of interest in activities that they used to enjoy. I'll ask patients about behavior changes they've noticed. People in depressive stages may feel extremely tired; have problems concentrating, remembering things, and making decisions; feel restless or irritable; and/or may feel so depressed that they've considered hurting themselves or others. If they give me reason to believe they're experiencing a depressive episode, we'll move on to figuring out the best treatment.

Treatment for bipolar can be successful if all the best tools are in place. With the right medication and the right treatment program, symptoms of bipolar disorder can be controlled, and most people can live normal lives.

Dr. Eric Chavez is the associate medical director for Skyland Trail, a nonprofit mental health treatment organization in Atlanta.