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A mandatory criterion for making a diagnosis is the presence in the anamnesis of at least two affective episodes, one of which must be either hypomanic or mixed.
However, to verify the diagnosis, the doctor considers more factors, and attention should be paid to differential diagnosis. It is necessary to monitor the etiology of affective episodes, whether they are exogenous (reaction to traumatic events) hypomanic episodes can also be triggered by hyperstimulation: – chemical (developed against the background of taking antidepressants) or non-chemical (sleep deprivation). Ignoring these cases can lead to an overdiagnosis of BAR.
Differential diagnosis should be made with unipolar depression, personality disorders, schizophrenia, substance abuse, infectious, toxic, traumatic psychoses.
It is also necessary to carefully monitor whether substance abuse (cocaine, amphetamine) is a factor in the development of manic states.
Difficulties arise when performing differential diagnosis with schizophrenic spectrum disorders: anergic depressions are often interpreted within the framework of deficient disorders.
Some somatic pathology can manifest itself as affective symptoms, for example, with thyroid disorders, both manic and depressive symptoms can develop. In this regard, it is advisable to conduct a diagnosis of thyroid function in order to exclude the somatic cause of disorders.
To prevent overdiagnosis of BAR, it is advisable to collect anamnestic data more carefully. As a rule, to establish a definitive diagnosis, patients are observed by psychiatrists with other diagnoses: anxiety disorder, unipolar depression, alcohol or other substance abuse, schizoaffective disorder. The average time to establish a diagnosis (according to American researchers) varies, but more than 30 % of the correct diagnosis is made after 10 years or more.
The distribution of initial episodes (the onset of the disease) can vary from 25 to 44 years, while bipolar forms usually debut at an earlier age. At a later age, there is a correlation with an increase in the number of depressive phases.
Phase formation throughout the disease tends to change with age.
The diagnosis is made by a psychiatrist based on the results of patient observation, medical history, information received from relatives, and special tests.
You will not be able to identify bipolar disorder on your own by focusing on certain symptoms.
If your or a loved one's mental well-being is in doubt, contact a psychiatrist. The doctor will collect an anamnesis, ask clarifying questions, talk to relatives, conduct a comprehensive examination, exclude other pathologies with similar symptoms, make a diagnosis and prescribe treatment.
You can get competent psychiatric and psychotherapeutic help in our clinic: https://psychiatr.clinic/
Still, only a psychiatrist diagnoses it.
But a couple of times I encountered very typical situations. A friend is depressed; this is usually not so much visual as you know about them or from them. And after some time-the eyes are burning, the person is on the crest of a wave, gushing with projects, talks about incredible successes and cool happy changes in his life, borrows / scatters decisively some very large sums for himself and his circle…
Faced with the second time, I already understood that the person, it seems, is classically “maniacal”.
It is important to understand:
1) cyclical periods of low and elated mood are often found – as a personal feature, “accentuation of character”, which is called cyclothymia, this is a variant of the norm. If it is typical, it is enough to know about yourself, and the periods of decline are time to think, rethink something, but do not start serious changes at such a moment. Well, remember that it will pass, even if you do nothing. But the rise of the wave should be caught for turning mountains. With bipolar disorder, there is simply a stage of inadequacy, so a person usually regrets the heaped-up afterward. And with cyclothymia – an excellent stage of cheerfulness, “I want” and “I can”.
2) a person with bipolar disorder can live a normal full life, being aware of the approach of painful periods and receiving the necessary treatment during them.
The psychologist's answer is not correct. I'll describe why below.
BAR is usually diagnosed in the presence of a pronounced episode of mania / hypomania. You can also be diagnosed with an episode of depression within the BAR (phase), it is called bipolar, it is different from unipolar, but it is very difficult to distinguish it, so it is much more difficult to make a diagnosis without a manic episode. Also, the BAR is placed in case of an episode of mixed state of mania and depression (mixed state).
Cyclothymia is NOT the norm (F34), we can say that it is an erased form of BAR. In addition, there are also BAR2 and BAR1, according to the DSM classification, they are not separated in ICD-10, but they have differences. BAR1 is placed in the case of a psychotic episode of mania with delusions, BAR2 – in the absence of psychotics (hypomania is a mild form of mania). In a patient with BAR2, in the case of psychotic, severe mania, the diagnosis changes to BAR1.
The treated BAR is by no means “aware when approaching and receiving treatment.” At the same time, it is important to have constant treatment with normotimics (such as lithium, lamotrigine, valproates, carbamazepine, etc., as well as AAP if necessary). In the case of a depressive bias, an antidepressant can be added, but provided that the anti-manic cover is good.
The goal is to stabilize affect in long-distance patients and prevent episodes of mania and depression, rather than treating them as they occur, giving up as soon as they let go.
In general, the BAR is incurable in the vast majority of cases and patients are forced to take pills for life (at least maintenance doses of HT), if they do not want to have affective jumps. A fully appropriate therapy usually takes years to come up, although it can be fast.
I was diagnosed with BAR by a psychiatrist who interviewed me and observed changes in my condition over several months. During the course of the diagnosis, I took tests once in a while with a bunch of questions, all of them simple, like: “would you be able to work as a librarian?”, “do you ever feel that you are being watched in secret?”, ” do you talk out loud to yourself?”.�
After each such test, I was sent a result that was referred to the doctor.�
So it turned out that I had this diagnosis.�
I live normally, I take pills, sometimes I just lie down at home when it gets really hard. Sometimes I leave with a limited amount of money, so as not to lose everything I have during periods of mania.
There is only one problem – close people do not take the diagnosis seriously.
As a person who has a close relative with a diagnosis of bipolar personality disorder, I absolutely agree with Evgeny Yakovlev's answer. The answer is in the title: the behavior of people with bipolar is two-phase in absolutely everything, and not just a change of mood, but a radical transition from an energetic rush to take the city to the deepest depression. This is usually most noticeable in the seasons-an exacerbation in spring and autumn, but even within one day, severe changes can be observed. For example, at lunchtime a person is happy, creative and friendly, and during dinner he is already angry, insults, fights and does not give in to reasonable calls for calm.