Correctly Diagnosing Bipolar Disorder

Questionnaires and other screeners are excellent tools in helping to diagnose bipolar disorder, but they cannot be solely relied on for an accurate diagnosis. Ensuring that clinicians take a “deep dive” into patient history is how to confirm the diagnosis, states Jessica Whelan, DNP, Owner and CEO, Holon Inclusive Health System, and Adjunct Faculty, Maryville University, St Louis, MO, and James Jenkins, MD, Emerson Hospital, Concord, MA, in a joint session at the recent Psych Congress Elevate virtual meeting.

“The majority of [patients are] diagnosed with major depressive disorder first, and something that worries me about that is … you may be risking putting them in a manic or hypomanic episode when giving them the wrong treatment, and this can be very dangerous,” Dr. Whelan told virtual attendees.

Diagnostic screening tools, such as the Mood Disorder Questionnaire (MDQ) and the Rapid Mood Screener, are excellent ways to help screen for bipolar disorder. However, Dr Jenkins has “always found the MDQ to be more helpful for screening out bipolar disorder … it has a much higher negative predictive value than a positive predictive value, so oftentimes, when someone screens positive on this it’s a signal and something to take into consideration.”

When discussing the Rapid Mood Screener, Dr Whelan feels that “it’s nice to have a 6-question questionnaire that also offers a good specificity, sensitivity, and predicative value,” with which Dr Jenkins agrees by stating “the Rapid Mood Screener has a little bit more balance, in that its good at both screening out, and also screening in people who will eventually go on to have a diagnosis of bipolar disorder.”

Considerations When Making a Bipolar Disorder Treatment Plan

Both Dr Whelan and Dr Jenkins agree that the screening tools are a great starting point in determining a path to diagnosis but delving into the “episodic nature” of the disease throughout the patient’s life is necessary to confirm a bipolar disorder diagnosis and proceed with the appropriate treatment plan.

Dr Whelan concludes by saying, “we really need to differentiate for our patients who’s got bipolar 1 disorder versus who’s having MDD in that depressive episode, and we need to do our due diligence using our screening tools, and then doing a dig into the history. And that’s what’s really going to help make sure we don’t miscategorize our patients.”

—Heather Flint

Reference

Jenkins J, Whelan J. Bipolar disorder across the spectrum: novel screening tools and treatment options. Presented at: Psych Congress Elevate; June 11–13, 2021; Virtual.