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Bipolar Diagnosis

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Do other illnesses mimic symptoms of bipolar disorder?

Mood swings and impulsive behavior can sometimes reflect psychiatric problems other than bipolar disorder, including:

  • Substance use disorders
  • Borderline personality disorder
  • Conduct disorders
  • Impulse control disorders
  • Developmental disorders
  • Attention deficit-hyperactivity disorder
  • Certain anxiety disorders such as posttraumatic stress disorder. 

Psychosis (delusions and hallucinations) can occur not only in bipolar disorder but other conditions such as schizophrenia or schizoaffective disorder. In addition, people with bipolar disorder often have additional psychiatric problems such as anxiety disorders (including panic disorder, generalized anxiety disorder (GAD), and social anxiety disorder), substance use disorders, or personality disorders that may complicate an illness presentation and require independent treatment. 

Some non psychiatric illnesses, such as thyroid disease, lupus, HIV and other infections, and syphilis, may have signs and symptoms that mimic those of bipolar disorder. This can pose further challenges in making a diagnosis and determining the treatment.

Other problems often resemble mania but reflect causes other than bipolar disorder. An example is mood or behavior changes caused by steroid medications like prednisone (used to treat inflammatory diseases such as rheumatoid arthritis and asthma, musculoskeletal injuries, or other medical problems).  .

 

What should I do before I see the doctor about bipolar disorder?

Before meeting with your doctor to clarify a diagnosis, it’s helpful to write down the symptoms you notice that may reflect depression, hypomania, or mania. Particular attention should focus not just on mood but also changes in sleep, energy, thinking, speech, and behavior.  It is also useful to get an in-depth family history from relatives before meeting with your doctor. A family history can be very helpful in supporting a suspected diagnosis and prescribing appropriate treatments.

In addition, consider bringing your spouse (or other family member) or a close friend with you to the doctor’s visit. Oftentimes, a family member or friend may be more aware of a person’s unusual behaviors and be able to describe these in detail to the doctor. Before your visit, think about and record the following:

  • Your mental and physical health concerns
  • Symptoms you’ve noticed
  • Unusual behaviors you’ve had
  • Past illnesses
  • Your family history of mental illness (bipolar disorder, depression, mania, seasonal affective disorder or SAD, or others)
  • Medications you are taking now and in the past (bring all medications to your doctor’s appointment)
  • Natural dietary supplements you are taking (bring your supplements to your doctor's appointment)
  • Your lifestyle habits (exercise, diet, smoking, alcohol consumption, recreational drug use)
  • Your sleep habits
  • Causes of stress in your life (marriage, work, relationships)
  • Questions you may have about bipolar disorder

What tests will the doctor use to make a bipolar diagnosis?

Your doctor may have you fill out a mood questionnaire or checklist to help guide the clinical interview when he or she assesses mood symptoms.  In addition, your doctor may order blood and urine tests to rule out other causes of your symptoms. In a toxicology screening, blood, urine, or hair are examined for the presence of drugs. Blood tests also include a check of thyroid stimulating hormone (TSH) level, since depression is sometimes linked to thyroid function.

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