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| Diagnosis Current diagnostic criteria for bipolar disorder Flux is the fundamental nature of bipolar disorder. Both within and between individuals with the illness, energy, mood, thought, sleep and activity are among the continually changing biological markers of the disorder. The diagnostic subtypes of bipolar disorder are thus static descriptions--snapshots, perhaps--of an illness in change. Individuals may stay in one subtype or change into another over the course of their illness. The DSM V, to be published in 2011, will likely include further subtyping (Akiskal and Ghaemi, 2006). There are currently four types of bipolar illness. The DSM-IV-TR details four categories of bipolar disorder, Bipolar I, Bipolar II, Cyclothymia and Bipolar Disorder NOS (Not Otherwise Specified). According to the DSM-IV-TR, a diagnosis of bipolar I disorder requires one or more manic or mixed episodes. A depressive episode is not required for a diagnosis of BP I disorder, although the overwhelming majority of people with BP I suffer from them as well. Bipolar II, the more common but by no means less severe type of the disorder, is characterized by episodes of hypomania and disabling depression. A diagnosis of bipolar II disorder requires at least one hypomanic episode. This is used mainly to differentiate it from unipolar depression. Although a patient may be depressed, it is very important to find out from the patient or patient's family or friends if hypomania has ever been present using careful questioning. This, again, avoids the antidepressant problem. Recent screening tools such as the Hypomanic Check List Questionnaire (HCL-32) have been developed to assist the sometimes difficult detection of Bipolar II disorders. A diagnosis of cyclothymic disorder requires the presence of numerous hypomanic episodes, intermingled with depressive episodes that do not meet full criteria for major depressive episodes. The main idea here is that there is a low grade cycling of mood which appears to the observer as a personality trait, but interferes with functioning. If an individual clearly seems to be suffering from some type of bipolar disorder but does not meet the criteria for one of the subtypes above, he or she receives a diagnosis of Bipolar Disorder NOS (Not Otherwise Specified). The criteria for "major depression" may apply to unipolar or bipolar depression. Misdiagnosis and the treatment lag The behavioral manifestations of bipolar disorder are often not recognized by mental health professionals, so people may suffer unnecessarily for many years (over 10 years, according to research conducted by bipolar disorders expert Nassir Ghaemi M.D.) before receiving proper treatment. That treatment lag is apparently not decreasing, even though there is now increased public awareness of the illness in popular magazines and health websites. Recent TV specials, for example MTV's "True Life: I'm Bipolar", talk shows and public radio shows have focused on mental illnesses thereby further raising public awareness. Despite this increased focus, individuals are still commonly misdiagnosed. (See the 2005 American Journal of Managed Care.) Avoiding misdiagnosis and the current diagnostic criteria There are many problems with symptom accuracy, relevance and reliability in making a diagnosis of bipolar disorder in the DSM-IV-TR. These problems all too often lead to misdiagnosis. In fact, University of California at San Diego's Hagop Akiskal M.D. believes that the way the bipolar disorders in the DSM are conceptualized and presented routinely leads many primary care doctors and mental health professionals to misdiagnose bipolar patients with unipolar depression, when a careful history from patient, family and/or friends would yield the correct diagnosis. If misdiagnosed with depression, patients are usually prescribed antidepressants and the person with bipolar depression can become agitated, angry, hostile, suicidal and even homicidal (these are all symptoms of hypomania, mania and mixed states). |