Bipolar Disorder

There is not a mental disorder that generates more consternation when it comes to diagnostic assuredness than bipolar disorder, particularly on an initial evaluation. We clinicians are forever searching for better screening questions to more quickly hone in on a diagnosis, and of course, bipolar is no exception. But we shouldn’t act in haste simply to be more expeditious. I often emphasize when I’m training less experienced clinicians that just as Rome wasn’t built in a day, nailing down a [...]

It is all but impossible to conduct results-oriented psychotherapy with a bipolar patient who is not adequately medication managed. Manic symptoms breed poor insight and judgment, and the inability to accommodate and assimilate even the most basic tenets of psychotherapy in a meaningful way. Combine these factors with the DIG FAST symptoms that define the manic spectrum and there’s virtually nothing to be gained. […]

Although considered highly prevalent, bipolar disorder is routinely misdiagnosed. Psychiatric literature is replete with data about over-diagnosis – particularly in pediatric populations – but this disorder is frequently under-recognized also. Here are the major headwinds combating effective identification and treatment: […]

The assessment and diagnosis of bipolar disorder in youth is enormously controversial. Depending on whom you listen to, there is either an epidemic or it’s virtually non-existent in young people. Many diagnoses nowadays are made by primary care physicians with little expertise in psychiatry, less time with each child and intolerant of unruly behavior. And there remains no consensus on how to effectively measure symptom severity. These factors have contributed to a “diagnostic rush to judgment” mode and children are [...]

When’s the last time you’ve cast a critical eye toward the DSM IV criteria for diagnosing Bipolar Disorder? Do the criteria for Bipolar I and Bipolar II assemble a clear, usable diagnostic path for you, or do you find yourself mired in exclusionary clauses, modifiers, specifiers, categorical systems or whatever all of this extraneous stuff is called nowadays.    […]

We know all about the classic symptoms of manic-depressive illness and its unpredictable cycle of intense mood swings – typically fluctuating between mania and depression. Significant to bipolar disorder though, and more often linked to the manic phase of the disorder, are ego issues, arrogance, an entitlement mentality, and inability to calculate consequences and a general lack of awareness. Here’s a case example to illustrate: […]

When treating a bipolar disordered client, do you their take nutritional intake into account? New research presented at the 17th Annual British Association for Counseling and Psychotherapy Research Conference this past May reveals that there is a connection between diet and bipolar disorder, with sugar, caffeine and poor overall eating habits increasing the mood swings of bipolar individuals. The research also indicated that there are noteworthy differences in the eating patterns of these individuals at the onset of bipolar disorder [...]

From a diagnostic perspective, bipolar disorder is complex, highly nuanced and does not lend itself to black-or-white judgments. As a profession, we are in transition to a different diagnostic system known as the “bipolarity index.” This index will focus on a series of manic and non-manic bipolar markers scored on a point system, eschewing the oversimplified yes-or-no categorical system of the DSM. The diagnosis of bipolar disorder in children and adolescents is currently the most hotly debated issue in pediatric [...]

“The road to hell is paved with good intentions,” remember this old saying? Sometimes we spot a serious problem, and with the best of intentions, discover that our solution wreaks as much havoc as the original problem itself. The writers of DSM 5 have identified what they believe to be a very troublesome problem – the seemingly out-of-control overdiagnosis of childhood bipolar disorder which had led to a veritable proliferation of antipsychotic and mood-stabilizer medication use in pediatric populations. I [...]