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Diagnosis of Bipolar Disorder Not Always Clear

 

The two most common functional psychoses are schizophrenia and bipolar disorder.  The distinction between the two is often not easy to make and psychiatrists in different parts of the world at different times have drawn the boundaries in different ways.  In essence, however, bipolar disorder is an episodic and recurrent disorder in which the psychotic symptoms are associated with severe alterations in mood—at times elated, agitated episodes of mania, at other times depression, with physical and mental slowing, despair, guilt feelings and low self-esteem.

 

Schizophrenia, while it may relapse at irregular intervals, is more likely to have a continuous, fluctuating course.  Although schizophrenia can be associated with depression, elation or agitation at times, it is often free of these features and the person’s mood is likely, instead, to be blunted, lacking in spontaneity or incongruous.  Very illogical thinking is common in schizophrenia. 

 

Auditory hallucinations may occur in either bipolar disorder or schizophrenia. In the manic phase of bipolar disorder, the hallucinations may be congratulatory or paranoid but in the depressive phase they are likely to be critical, abusive or guilt-inducing. In schizophrenia, they are more likely to be neutral – commenting on the person’s thoughts and actions or conversing one with another. 

 

Delusions, also, can occur in both conditions. In mania, they may be grandiose or ecstatic, leading the person to feel he or she has achieved, or will achieve, magnificent things, or has a special connection to God or the universe. In depression they often focus on death, disease or guilt. In schizophrenia they may give the person the sense that he or she is being controlled by outside forces or that his or her thoughts are being tampered with by outside forces or are being broadcast aloud.  

 

Mania may be severe or mild.
In the manic phase of the illness the person is likely to be energetic and need little sleep. He or she may be

 

• exhilarated, or even ecstatic
• talkative and argumentative
• enthused about any number of plans, many of them unrealistic

 

The person may be impatient, impulsive, and resist any attempts to dissuade him or her from irrational plans or from dangerous or harmful behavior.

 

In this phase of the disorder, the person may have grandiose or paranoid delusions and experience hallucinations that reinforce these delusions. When the episode is milder, the person’s judgment is less severely impaired and no hallucinations or delusions are present, the episode is referred to as “hypomania.”

 

Variations in depression may also exist.
In the depressed phase of the disorder the person is likely to be

 

• slowed down
• lacking in energy
• unwilling to get out of bed or leave the house

 

Sleep may be excessive or disturbed. The person often wakes feeling un-rested. He or she may ruminate about negative events in his or her life, feel helpless and hopeless, have low self-esteem, and think, plan or attempt suicide.

 

The depressive episode may be free of psychotic symptoms but, when delusions are present, they often focus on death, disease, or guilt about some imagined offence, and hallucinations are likely to be critical or abusive in nature.

 

Confusion surrounds bipolar disorder diagnosis.

Confusion has arisen regarding the diagnosis of bipolar disorder in recent years due to the practice among child psychiatrists in the U.S of diagnosing aggressive and irritable children with volatile emotions as suffering from “bipolar disorder.”

 

The vast majority of these children never go on to develop bipolar disorder, with the manic-depressive features described above, in adulthood. However, the practice has led to an expansion of the rate of diagnosis of bipolar disorder to 40 times the previous prevalence.

 

The American Psychiatric Association plans to rectify this error and reduce the confusion with the publication, in 2013, of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The revised manual will require emotionally volatile children of this type to be diagnosed as suffering from “temper dysregulation disorder with dysphoria.” With this change, it will again become clear that “bipolar disorder” follows the description above.

 

Resources are available for coping with bipolar disorder.

More information about bipolar disorder may be found in The Bipolar Disorder Survival Guide by David Miklowitz, Ph.D. (Guilford Press, 2002).

 

Dr. Miklowitz is a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior in Los Angeles, California. He is renowned in the field of bipolar disorder research and the Survival Guide is recommended reading.

 

Contact Us to discuss residential treatment for bipolar disorder. Colorado Recovery also offers intensive outpatient treatment for bipolar disorder.

 

 

 

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