In this article I have attempted to put together some of the potential problems that a psychiatrist may face while diagnosing bipolar disorders.
I would like to start by defining both bipolar 1 and bipolar 2 disorders and the difference between them.
Firstly, by and large, in the condition the term “bipolar” implies that a person has fluctuations in mood which cause serious impairment in their functioning. Popularly the diagram of “crests and troughs” has commonly been used to explain this, where the mood is extremely elevated for some duration of time and subsequently becomes just the opposite, that is, drastically falls in the next couple of days.
Coming to making a diagnosis, the presence of a manic episode or episodes makes it bipolar 1 disorder. It is very essential to remember that diagnosis of bipolar 1 disorder does not require a past history of depressive episodes and that the diagnosis can be made even when the person has the first mood episode.
In contrast, the diagnosis of bipolar 2 disorder requires the definite presence of a hypomanic episode or episodes and one or more than one major depressive episodes, which has to be revealed through a thorough history taking.
The next important issue is to distinguish between a manic and a hypomanic episode. Firstly, a manic episode is characterized by elevated/irritable mood and increased energy along with 3 of the following symptoms which can be easily remembered by the mnemonic DIGFAST:
§ D – Distractibility
§ I – Irritability
§ G – Grandiosity
§ F – Flight of ideas/racing thoughts
§ A – Activity ( increased goal directed activity/ psychomotor agitation)
§ S – Sleep ( decreased need)
§ T – Talkativeness/pressured speech
These symptoms are severe, will last a week unless the person is hospitalized, will cause marked impairment in socially and functionally (for example, the person during one such episode may be put on probation from his job), may result in hospitalization and may also be accompanied by psychotic features( hallucinations, delusions, disorganized thought).
Hypomania is something like mania but the same symptoms are less severe and not enough to cause marked social or functional impairment or require hospitalization. They are meant to last for or more than equal to 4 days and most importantly are not associated with psychotic features.
While trying to distinguish mania from hypomania, what is helpful to make note of, is the degree of functional impairment. A person with hypomania will continue to live and work normally in the community and their functional impairment is often due to the fluctuations in mood and the depressive symptoms.