Bipolar affective disorder

Identifying the symptoms: 

Bipolar affective disorder can be difficult to diagnose. Sometimes symptoms can be misdiagnosed as alcohol misuse or drug use; or even schizophrenia or schizoaffective disorders, especially where psychotic symptoms are present.  Periods of mania and depression often alternate, or are separated by periods of normal mood. Mixed states of mania and depression are common.

Referral to a clinician may be made by others due to the patient’s lack of insight. Lesser degrees of mania and hypomania can be missed on a brief consultation, additional information from friends and relatives is vital. 

Defining the diagnosis:

"There are two main diagnostic schemes defining bipolar affective disorder; the International Classification of Diseases of the World Health Organisation (10th edition ICD-10) and the Diagnostic and Statistical Manual (4th edition DSM-IV) of the American Psychiatric Association.  The schemes use mostly equivalent diagnostic categories, with DSM-IV dividing bipolar disorder into bipolar I and bipolar II."1

Visit our questionnaires section for more information about screening tools for bipolar disorder 

Because two different schemes are used to diagnose bipolar affective disorder, there can sometimes be subtle differences in how symptoms are described.  Where possible, we'll try to refer to the relevant diagnostic system when describing bipolar definitions and diagnoses.

Guidelines from the following organisations were used to compile this section:

  1. National Institute for Clinical Excellence (NICE)2
  2. Canadian Network for Mood and Anxiety Treatments (CANMAT)3
  3. British Association for Psychopharmacology (BAP)4
  4. Scottish Intercollegiate Guidelines Network (SIGN)1
  5. American Psychiatric Association (APA)5

References

  1. Scottish Intercollegiate Guidelines Network. Bipolar affective disorder: A national clinical guideline. Scottish Intercollegiate Guidelines Network. 2005; May
  2. National Institute for Clinical Excellence. The management of bipolar disorder in adults, children and adolescents, in primary and secondary care. National Institute for Clinical Excellence. 2006; Jul
  3. Yatham LN et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) guidelines for the management of patients with bipolar disorder: consensus and controversies. Bipolar Disorders. 2005; 7 (3): 5-69.
  4. Goodwin GM. Evidence-based guidelines for treating bipolar disorder: recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology. 2003; 17 (2): 149-173.
  5. Hirschfeld . Practice guideline for the treatment of patients with bipolar disorder, second edition. American Psychiatric Association. 2002; Apr