bipolar spectrum diagnosing and differentiating from depression christopher d. cobbs, m.d. 13...
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Bipolar Spectrum Diagnosing and Differentiating From Depression
Christopher D. Cobbs, M.D.13 October 2010
Making the Diagnosis of Bipolar Disorder Differential Diagnosis Treatment Options
Lifetime Prevalence of Major Depression is 15 – 25%
Lifetime Prevalence of Bipolar Disorder is 1%
Bipolar Disorder has Equivalent Prevalence Between Men and Women
Average Age of Onset for MDD is 40 yo 30 yo for Bipolar Disorder
Combination of Biologic, Genetic and Psychosocial Factors
Multiple Theories 1st Degree Relatives of Bipolar Proband
Have Increased Incidence of Mood Disorder
Must have Manic Episode for a Bipolar Diagnosis
Elevated Mood Must Last 7+ Days …or Require Hospitalization Only One Episode of Mania Required…
Ever
3-4 of The Symptoms Present: Inflated Self-Esteem or Grandiosity Decreased Need for Sleep More Talkative Than Usual/Pressured
Speech Flight of Ideas/Racing Thoughts Distractibility Increase in Goal-Directed Activity Excessive Involvement in Pleasurable
Activities
Recurrent Mixed Psychotic Features Hypomania/Bipolar II Disorder Rapid Cycling Catatonic
5+ of the Follow Symptoms Lasting 2+ Weeks
Depressed Mood (May Be Irritable in Kids) Diminished Interest in Most All Activities Decreased Appetite/Significant Wt Loss Insomnia/Hypersomnia Psychomotor Agitation/Retardation Fatigue/Loss of Energy Feelings of Worthlessness/Excessive Guilt Difficulty Thinking/Concentrating Recurrent Thoughts of Death/SI
Substance Abuse Personality Disorder Anxiety Disorder Malingering
Psychotherapy (Primarily Depressive Phases)
Pharmacotherapy: Valproic Acid Lithium 2nd Generation Antipsychotics Other Anti-Epileptic Drugs 1st Generation Antipsychotics Antidepressants