Bipolar Disorder Assessment

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Bipolar disorder (previously called manic depression) is a condition in which a person has extreme changes in mood and activity levels - recurrent periods of being unusually happy or irritable (known as ‘mania’ or ‘hypomania’), and (usually) also periods of being unusually sad (‘depression’).

IMPORTANT: The mood swings in Bipolar disorder are way beyond what would be considered normal for a particular individual, and are out of keeping with the person’s personality.

Causes

Research suggests that bipolar disorder runs in families, and genes can influence whether someone develops the illness. We also know that the brain systems involved in controlling our moods work differently in people with bipolar disorder.

Factors such as life stress, lack of sleep and recreational drugs can trigger episodes of abnormal mood.

Simplified Assessment

Bipolar disorder is a complex illness which can vary a great deal in nature and severity between people.

In addition to the general psychiatric assessment and mental state examination outlined earlier in the guide, look for the following features if you suspect Bipolar disorder:

Mania and hypomania

In an acute manic or hypomanic episode, the person will experience several of the following symptoms, lasting for at least one week, and severely enough to interfere with their work or home life.

  • Elevated or irritable mood
  • Decreased need for sleep
  • Increased activity and energy, increased or rapid speech
  • Loss of normal social inhibitions such as sexual indiscretion
  • Impulsive or reckless behaviours such as excessive spending, making important decisions without planning
  • Being easily distracted
  • Unrealistically inflated self-esteem

Mania is at the one extreme end. Some people with mania develop psychosis.  These beliefs will match the mood of the person e.g. that they have superhuman powers. 'Hypomania’ is a milder form of mania and there are no symptoms of psychosis.

Depression

Symptoms are the same as for depression (see section). See the separate section on depression assessment.

Typical MSE - Mania & Depression

Typical MSE - Mania

A + B

Restless, disinhibited, bright or bizarre clothing, self-neglect

Speech

Loud, rapid, lots of ideas

Mood

Elated or Irritable

Thought

Grandiose ideas of wealth, importance, religious powers etc.

Perception

If severe may have hallucinations – usually voices. (Visual suggests DELIRIUM)

Cognition

Impaired concentration (Confusion suggests DELIRIUM)

Insight

Impaired, often none at all

 

Typical MSE – Depression

See depression section

Risk

In mania, risks include harm through reckless behaviour e.g. driving too fast, excessive alcohol, promiscuity. There is risk of harm by others in response to social disinhibition. In severe mania, self-neglect and exhaustion may occur. Mood can change quickly and suicide is a risk even during a manic episode. Depression carries risks as described in that section.