The fundamental nature of bipolar disorder is flux. The ever-changing signs of bipolar disorder include illness, energy, mood, thought, sleep and routines. Static descriptions come with an illness where there is continuous modification, a wide array of symptoms and varying degrees of complexity. Individuals may stay in one subgroup or jump into another over the course of their illness. The DSM V (Diagnostic and Statistical Manual of Mental Disorders) scheduled for 2011 will likely include various bipolar subgroups.
Types of Bipolar Illness
At present, there are four types of bipolar illness according to the Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR): Bipolar I, Bipolar II, Cyclothymia and Bipolar disorder NOS (Not Otherwise Specified). According to the DSM-IV-TR, a diagnosis of bipolar I disorder needs to have at least one manic or mixed episode. A depressive episode is not mandatory for the diagnosis of bipolar I disorder but it often occurs. Bipolar II is characterized by at least one hypomania episode and at least one depression episode.
Cyclothymic Disorder and NOS
A diagnosis of Cyclothymic disorder needs the presence of many hypomanic episodes, interlinked with depressive episodes that do not satisfy eligibility criteria for major depressive episodes. The main concept involved in diagnosis of Cyclothymic disorder is that there is a low-grade cycling of mood. This cycling gives an impression of a personality trait, but it also links with ability to function.
If an individual seems to be suffering from some kind of bipolar disorder but does not meet the eligibility criteria for one of the other subgroups, they get a diagnosis of bipolar disorder NOS (Not Otherwise Specified).
Questioning
Most of the time, an individual suffering with bipolar disorder seeks help during a depressed episode. It is of the utmost importance that you find out from the patient, their family or close friends if there have been manic or hypomaniac episode to help diagnosis and find treatment for the depression. This will prevent misdiagnosis of depressive disorder and avoids the use of an antidepressant that may trigger a switch to hypomania or mania, or induce fast cycling. The development of screening tools like the Hypomanic Check List Questionnaire (HCL-32) can go a long way in the quite often tough detection of bipolar disorders.
Treatment Lag
According to one study, the behavioral manifestations of bipolar disorder are not clearly understood by patients or taken into account by mental health doctors. Due to this, people may suffer unnecessarily for a number of years before getting proper treatment. Even though there is an increased public awareness regarding bipolar disorder in magazines and health websites, the treatment lag is still not reducing. Programs such as “The Secret Life of the Manic Depressive”, MTV’s “True Life: I'm Bipolar” have been made on the life of people suffering with bipolar disorder; in addition to a wide array of talk shows and public radio shows. Despite this effort, individuals are still commonly misdiagnosed.
Children with Bipolar Disorder
Children suffering with bipolar disorder do not often meet the strict DSM-IV criteria. In pediatric cases, it has been noted that they tend to have fast-cycling or mixed-cycling. Fast cycling comes into existence when the cycles between depression and mania occur rapidly, within the same day or even the same hour. Mixed cycling occurs when the symptoms of both mania and depression occur simultaneously.
Other kind of psychiatric conditions are also diagnosed in bipolar children. According to experts, these other diagnoses may be concurrent issues or they may be misdiagnosed as bipolar disorder. Common comorbid conditions are depression, ADHD, ODD, schizophrenia and Tourette’s syndrome. In addition, some children with a history of abuse or neglect may be diagnosed with bipolar I disorder.
