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.
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