Accurate diagnosis is the first step to successfully treating bipolar disorder. Unfortunately, getting that diagnosis is not always easy. The symptoms of the disease are shared with a number of other conditions, so that it is easily confused with, for instance, schizophrenia or ADHD (attention-deficit hyperactivity disorder). It is not something that can be detected by a simple examination such as a blood test; a diagnosis has to be made on the basis of a number of typical behaviors and attributes.

While bipolar disorder is a mental health issue, the first step in a diagnosis will usually be a physical examination. This aims to assess whether the symptoms stem from a physical cause such as head trauma, epilepsy or thyroid problems. Only once those potential causes have been ruled out can the physician confidently proceed to consider a bipolar disorder diagnosis.

The patient’s medical history will also be reviewed in order to assess whether there are any episodes which make any particular diagnosis more or less likely. This will involve a review of the patient’s psychiatric history, as the mood swings that are typical of bipolar disorder might also be present in patients suffering from other conditions (ADHD, schizophrenia, or even alcoholism).

Family medical history should also be covered, since there is evidence that both schizophrenia and bipolar disorder run in families. The presence of either condition in other family members predisposes a person to the condition. However it is important to note that a schizophrenic relative might predispose the patient to either schizophrenia or bipolar disorder, so the medical practitioner will still need to probe the patient’s symptoms and behaviors to arrive at an accurate diagnosis of which of these two disorders is present.

However the face to face interview will be the most important pat of the diagnosis process. Previous notes are not enough; for instance a doctor may have recorded ‘patient is depressed’ but has not stated how deep the depression was, how long it lasted, or whether it was due to some other factor in the patient’s life.

The doctor will be concerned to find out not just what symptoms the patient displays, but also which symptoms tend to accompany each other, and how long the symptoms typically last. The doctor will also need to probe in order to find evidence of further symptoms that the patient may have overlooked, possibly talking about recent episodes of depression or manic states and exploring how severely the symptoms affected the patient’s life.

A diagnosis may involve more than one visit to the doctor’s office, as the patient may be in a manic state at one point, and in a depressive state on their next visit. They would be displaying different symptoms on each visit. Most people with bipolar disorder have long periods of ‘normal’ functioning, during which they may be able to discuss the symptoms of their manic and depressive phases, but do not display any of the symptoms.

If a doctor misdiagnosed depression, for instance, on the basis of a single visit, a standard antidepressant might be prescribed, such as Prozac. That could make bipolar disorder worse, since it could tip the patient over into mania. What the bipolar disorder patient needs is not a ‘high’, but a mood stabilizer, such as lithium.

While many family doctors are able to help their patients suffering from bipolar disorder,it is worth finding a doctor who specialists in mood disorders (the American Psychiatric Association can help find such a doctor locally if your general practitioner is unable to refer you). Getting an accurate diagnosis is the first step to successful treatment, so it makes sense to ensure your diagnosis is the right one.

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