Question

Compare and contrast the characteristics of bipolar and major depressive disorder. What would a therapist need to know about the client in order to ensure that he or she was correctly diagnosed?

Answer 1

Bipolar disorder, also known as bipolar affective disorder, manic-depressive disorder, or manic depression, is a mental illness classified by psychiatry as a mood disorder. Individuals with bipolar disorder experience episodes of an elevated or agitated mood known as mania alternating with episodes of depression.
Mania can occur with different levels of severity. At milder levels of mania, known as hypomania, individuals appear energetic, excitable, and may be highly productive. As mania becomes more severe, individuals begin to behave erratically and impulsively, often making poor decisions due to unrealistic ideas about the future, and may have great difficulty with sleep. At the most severe level, individuals can experience very distorted beliefs about the world known as psychosis.
Individuals who experience manic episodes also commonly experience depressive episodes; some experience a mixed state in which features of both mania and depression are present at the same time. Manic and depressive episodes last from a few days to several months.
About 4% of people suffer from bipolar disorder. Prevalence is similar in men and women and, broadly, across different cultures and ethnic groups. Genetic factors contribute substantially to the likelihood of developing bipolar disorder, and environmental factors are also implicated. Bipolar disorder is often treated with mood stabilizing medications and psychotherapy. In serious cases, in which there is a risk of harm to oneself or others, involuntary commitment may be used. These cases generally involve severe manic episodes with dangerous behavior or depressive episodes with suicidal ideation. There are widespread problems with social stigma, stereotypes, and prejudice against individuals with a diagnosis of bipolar disorder. People with bipolar disorder exhibiting psychotic symptoms can sometimes be misdiagnosed as having schizophrenia.
The current term bipolar disorder is of fairly recent origin and refers to the cycling between high and low episodes (poles). The term "manic–depressive illness" or psychosis was coined by German psychiatrist Emil Kraepelin in the late nineteenth century, originally referring to all kinds of mood disorder. German psychiatrist Karl Leonhard split the classification in 1957, employing the terms unipolar disorder (major depressive disorder) and bipolar disorder.

Diagnose:

Diagnosis is based on the self-reported experiences of an individual as well as abnormalities in behavior reported by family members, friends or co-workers, followed by secondary signs observed by a psychiatrist, nurse, social worker, clinical psychologist or other clinician in a clinical assessment. There are lists of criteria for someone to be so diagnosed. These depend on both the presence and duration of certain signs and symptoms. Assessment is usually done on an outpatient basis; admission to an inpatient facility is considered if there is a risk to oneself or others. The most widely used criteria for diagnosing bipolar disorder are from the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, the current version being DSM-IV-TR, and the World Health Organization's International Statistical Classification of Diseases and Related Health Problems, currently the ICD-10. The latter criteria are typically used in Europe and other regions while the DSM criteria are used in the USA and other regions, as well as prevailing in research studies. The DSM-V, to be published in 2013, will likely include further and more accurate sub-typing.[55]
An initial assessment may include a physical exam by a physician. Although there are no biological tests which confirm bipolar disorder, tests may be carried out to exclude medical illnesses such as hypo- or hyperthyroidism, metabolic disturbance, a systemic infection or chronic disease, and syphilis or HIV infection. An EEG may be used to exclude epilepsy, and a CT scan of the head to exclude brain lesions. Investigations are not generally repeated for relapse unless there is a specific medical indication.
Several rating scales for the screening and evaluation of bipolar disorder exist, such as the Bipolar spectrum diagnostic scale.[56] The use of evaluation scales can not substitute a full clinical interview but they serve to systematize the recollection of symptoms.[56] On the other hand instruments for the screening of bipolar disorder have low sensitivity[clarification needed] and limited diagnostic validity