Bipolar Expert Answers - How to diagnose Bipolar Disorder

Hello Folks - I have been getting many questions from followers which require an expert to answer. I was able to get the best expert I know in the mental health field to answer your questions. Better yet, she has agreed to answer more questions you may have and I will share those answers in future blogs. You can't beat FREE advice from the best. Dr. Mani Pavuluri is not only a Psychiatrist but also has a Doctorate in Developmental psychopathology. This is not only a rare combination, but when you add her tremendous level of compassion there is no better person for advice. I personally know many of her patients (plus I am one) from many referrals. She was also key person who helped us develop the Colbeth Clinic for Children in Chicago. You can also follow her on  https://www.medcircle.com/profile/1979620 where she blogs regularly.

What are the most common symptoms you have seen which would lead you to a diagnosis of bipolar disorder? 

As a good clinician, we must think of normal, before viewing it as potentially abnormal. Therefore, recognizing the gestalt of what looks like and is bipolar disorder must present with a cluster of symptoms than any one observation. Generally, those affected with bipolar disorder has highs called mania (for at least a week) or lows called depression (for at least two weeks). During the highs, they look abnormally happy and giddy or irritable in mood. They can be so demanding, loud and aggressive with qualitative change from their baseline mood and behavior. They tend to talk non-stop with pressure of speech, almost like a forceful push of water stream through a narrow hole. Their thinking is so rapid and flits from one related topic to another incessantly that it becomes impossible to keep calm. They are revved up with high energy and take on too much to do, with inability to realistically accomplish the humongous undertaking. They cannot sleep at night and report needing less sleep. They become generous or indulge in disinhibited risky activity such as shopping sprees or becoming hypersexual. See, overall, it is about increased speed in several realms. 

Severe mania can dissolve into psychosis that is, totally losing touch with reality with grandiose thinking or inflated self-esteem.  They are called delusions and an example would be that they believe they are God or that they can communicate with God or the Pope, endowed with super powers. 

In case of hypomania, the milder version than mania, the symptoms are clearly observed by others. But the changes are not so extensive that their functioning is altered and may just be present for four or more days. In bipolar disorder, mania or hypomania alternate with depression randomly operate like a “yo-yo.” However, you can still diagnose bipolar disorder without ever suffering from depression.

In children and adolescents, there is more irritability, mania mixed with depression simultaneously, with rapid shift in mood states, and high degree of associated attention deficit hyperactivity disorder.  Sadly, it is very hard to keep track of the episodes in youngsters due to the rapid shifts in mood and chronic (persistent) nature of the illness.

It is easy to miss it as ‘just being highly energetic, intense and boisterous’ or ‘explosive teenage conflict.’ But careful in-depth understanding by consulting a clinician will resolve any doubt. 

We look forward to any questions you may have on bipolar or other mental health topics.