The challenge of diagnosis
An accurate diagnosis of Bipolar I or Bipolar II Disorder can only be done by clinicians who are trained and experienced in recognizing and diagnosing psychiatric conditions, as well as general medical conditions that may cause a mood disorder which looks like but is not, in fact, bipolar I or II disorder. An accurate clinical history is essential to making a sound diagnosis. Whenever possible this history should be obtained not only from the patient but also from a relative or a close friend who has known the patient well for at least three years years.
The most significant challenge problem in obtaining an accurate history is that many people do not recognize or do not report manic (severe) or hypomanic (less severe) episodes. In fact, patients often do not seek treatment when they feel manic or hypomanic, and tend to seek treatment only when they feel depressed. Unfortunately, a depressive episode by itself cannot help distinguish between Bipolar I or II and major depressive disorders. It is therefore crucial to carefully examine the patient's history of symptoms, since misdiagnosis can have serious consequences: the wrong medication may be prescribed, the prognosis may be under- or overestimated, and the patient will suffer.
The three most common diagnostic errors are:
- mistaking recurrent major depressive episodes for normal reactions to life’s difficulties,
- failing to detect manic or hypomanic episodes, and
- judging the patient to have schizophrenia instead of bipolar disorder with psychotic features during manic, mixed manic, or major depressive episodes.
Finally, it is not at all uncommon for patients with bipolar disorder to abuse alcohol, abuse stimulants (amphetamines, cocaine), or take other substances in an attempt to lessen or control the most unpleasant symptoms. For many individuals, these substances make matters worse and can precipitate specific episodes of either mania or depression.