Key Challenges in Accurately Diagnosing Bipolar Disorder Transcript

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Psych Congress Network: What are some of the key challenges with accurately diagnosing and differentiating bipolar disorder from other mental health conditions? How can these challenges be addressed?

Rakesh Jain, MD: That's a really good question because one of the most vexing things in modern-day psychiatry is this question about differentiating bipolar disorder from other conditions. Maybe I'll pick 2, the top 2, that are confusing and perhaps shed some light on how we can clarify a murky clinical situation.

The first is, how do I differentiate bipolar depression from unipolar depression? I know it's easier said than done, but perhaps the thing to remember is the following: The symptoms of bipolar depression and the symptoms of unipolar depression look identical. Therefore, the main task you and I have is to look for a hypomanic or manic episode in the patient's history. Obviously, asking a patient, "Have you had a hypomanic episode?" is not going to work. The best thing to do is to use your scales and screeners as a starting point, and then collect family history, and most importantly, collect longitudinal history.

Always keeping in mind, DSM-5 is the North Star. Use that information, and when you do that, you do get to the right diagnosis.

The other one that you want to keep in mind is ADHD as a differential. Also a complex task. The best way to accomplish this goal is to think of them as 2 separate entities and not to let distractibility be the only symptom you're looking for. You want to look for the full cluster of symptoms from either disorder and one more time: collect longitudinal history and use DSM as your north star. You do that, success is on its way for you and your patient.