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Information about bipolar disorders

How is the diagnosis made?

The diagnosis results from the current psychic complaints and behavioural changes that persons afflicted describe. Already in this phase it has proven helpful to include relatives or friends with their consent. Through this additional information the hitherto course can be better estimated, as well as mood swings, which maybe appear “normal” to themselves, however are conspicuous to their surroundings. This is important since experienced and observed behaviour often differ from each other.

Your therapist can record the course of the illness with the help of a so-called “life chart”. Here, the mood swings are entered in connection with particular life events, drug changes etc. (on paper or in the PC). This permits important conclusions to be drawn regarding the right diagnosis, treatment, prognosis etc.

A physical investigation (blood analysis, computer tomography etc.) is integrated in order to exclude an organic cause such as e.g. a dysfunction of the thyroid gland. The diagnosis of a bipolar mood disorder is a “clinical diagnosis”, i.e. no laboratory values exist which could give information about the (lacking) existence of the disorder.

The diagnosis is then made by means of so-called diagnostic criteria. In Germany, the “International Classification of Psychic Disorders” in its tenth version (ICD-10) is used. The following table provides you with a general overview by means of which criteria the individual phases are diagnosed.
Unfortunately, the diagnosis of a bipolar mood disorder today is still made much too late. This also means that an effective treatment can only be applied subsequently. On average, today ten years pass between the onset of the first episode of the illness and the right diagnosis. One estimates that one half of the persons afflicted are even never treated at all based on a correct diagnosis.

Diagnostic criteria according to ICD-10 or DSM-IV

Type of episode: Manic episode
A. A manifest period of abnormal and permanently elated, exuberant or irascible mood which lasts more than one week.

B. During the period of the mood disorder three (or more) of the following symptoms continue persistently up to a significant degree:

  • Exaggerated self-esteem or grandiosity
  • Decreasing need for sleep (e.g. the person afflicted feels recuperated after only three hours sleep)
  • More talkative than usual or pressure to talk
  • Flight of ideas or subjective experience that the thoughts are racing
  • Absent-mindedness (attention is easily drawn to unimportant or trivial external stimuli)
  • Increase of hormic activities (either social, at work, in school, or sexual or psychomotor disorder)
  • Excessive amusements which have a high potential for unpleasant consequences (e.g. uninhibited shopping frenzy, sexual indiscretion or frivolous business investments).

C. The symptoms do not coincide with the criteria of a mixed episode.

D. The mood disorder is sufficiently serious to bring about a manifest impairment in professional areas of responsibility or unusual social activities or relationships with others or requires a stay in hospital. The intention here is to prevent the person from afflicting harms on him / herself or others.

E. The symptoms are not caused by direct physiological effects of a substance (e.g. drug abuse, drugs or other treatments) or a general drug-induced state of mind (e.g. overfunction of the thyroid gland).

Type of episode: Hypomanic episode

A. A manifest period of permanently elated, exuberant or irascible mood, by all means lasting four days, which is clearly different from the usual non-depressive mood.

B. During the phase of the mood disorder, three (or more) of the following symptoms (four, if the mood is only irascible)up to a certain extent permanently existing:

  • Excessive feeling of self-worth or delusions of grandeur
  • Reduced sleep requirement (e.g. the person afflicted feels relaxed after three hours sleep)
  • More talkative than usual or urge to speak
  • Flight of ideas or subjective experience of racing thoughts
  • Absent-minded (this means attention to unimportant or significant external stimuli)
  • Increase in hormic activities (either socially, professionally or in school, or sexual or psychomotor disturbance)
  • Excessive commitment during amusements, which to a great extent involve unpleasant consequences (e.g. uninhibited shopping frenzy, sexual indiscretions or frivolous business investments).

C. The episode is accompanied by a distinct change of the mode of action which is uncharacteristic for the person as long as it is without symptoms.

D. The mood disorder and the change of demeanour are observed by others.

E. The episode is not serious enough to cause a manifest impairment in social or professional responsibilities or require a stay in hospital and there are no psychotic characteristics.

F. The symptoms are not caused by direct physiological effects of a substance (e.g. drug abuse, drugs or other treatments) or a general drug-induced state of mind (e.g. overfunction of the thyroid gland).

Type of episode: Depressive episode

A. Five (or more) of the following symptoms exist during the same two-week period and signify a change from earlier activities.

  • Depressive mood almost throughout the entire day, almost every day, indicated either through subjective report (feels e.g. sad or empty) or through observation by others (appears e.g. tearful). NB: In children and adolescents an irascible mood can exist.
  • Clearly reduced interest in or joy in all or almost all activities almost the entire day, almost every day (indicated either by own report or observations by others)
  • Erheblicher Gewichtsverlust ohne Diät oder Gewichtszunahme (z. B. eine Veränderung des Körpergewichts um mehr als 5 % in einem Monat) oder Ab- oder Zunahme des Appetits beinahe jeden Tag
  • Sleeplessness or excessive sleep requirement of sleep almost every day.
  • Psychomotor agitation or deceleration almost everyday (observed by others, not only subjective feelings of restlessness or exhaustion)
  • Exhaustion or loss of energy almost every day.
  • Feelings of worthlessness or the manifest or inappropriate guilt (which may be based on a disappointment) almost every day (not only self-reproach or guilt about being ill)
  • Reduced ability to think or concentrate or lack of resolve almost every day (either through subjective report or observation of others)
  • Recurring thoughts of death (inappropriate fear of dying), recurrent suicidal thoughts without a specific plan, or a suicide attempt or a precise plan to commit suicide.

B. The symptoms do not coincide with the criteria for a mixed phase

C. The symptoms cause clinically significant pains or an impairment in social, professional or other important spheres of responsibility.

D. The symptoms are not caused by direct physiological effects of a substance (e.g. drug abuse, drugs or other treatments) or a general drug-induced state of mind (e.g. overfunction of the thyroid gland).

E. The symptoms are induced by bereavements, e.g. the loss of a loved person. The symptoms last longer than two months or are characterized by a manifest functional impairment; morbid occupation with worthlessness, suicidal thoughts, psychotic symptoms or psychomotor slowdown.

 

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