Bipolar Disorder-Its Diagnostic Dilemma

by Michael_Koger

The occurrence of bipolar disorder may pose several diagnostic issues.

For many decades, psychiatrists have observed the occurrence of bipolar disorder. A lifetime medical condition, it presents with mood swings that range from suicidal depression to manic stages in which the patient has enormous energy [1]. The progress that scientists have made in its diagnosis and management over the last half century is phenomenal.

In the manic phase of the disease, the patient may remain awake for several days and engage in risky sexual behaviors. Specifically, they can resort to promiscuity and place themselves at risk for sexually transmitted diseases and pregnancy. Moreover, they may go on shopping sprees and write checks for large amounts of money [1].

When they go on sprees, they may forge or write checks with insufficient funds, and subsequently there may be legal charges against them [1].

The most severe cases of manic-depressive illness present as a psychotic condition, and in the depression phase, they may believe that they have come to financial ruin. In the manic phase of manic depressive psychosis, the patient may believe that he or she has special powers or abilities. The client may also think that he or she is wealthy or famous [1].

Mimics other Medical Conditions

The difficulty with diagnosis occurs for many reasons.  First, bipolar disorder mimics a variety of physical and mental diseases, and the psychiatrist and other health care team members have to adequately investigate the patient's behavior and interactions in the community [1].  For example, they may appear to have schizophrenia, and this, naturally, can prompt the psychiatrist to utilize medication for that disease rather than lithium, valproic acid, and other agents which work well for bipolar disorder.

Some children with attention-deficit hyperactivity disorder will also have bipolar disorder, and the health care provider obviously needs to be aware of the dual diagnosis in order to avoid therapeutic mismanagement [1].

The evaluation and diagnosis of any physical or mental illness depend largely on the medical and psychiatric history, and when the history is insufficient or inaccurate, there may be problems with proper diagnosis of bipolar disorder or other mental diseases.  This is where the family, employer, and other members of the community have an important role in the provision of information to the social worker, psychologist, psychiatrist, and other team members [1].

Physical ailments can mimic the clinical signs and symptoms of mental disorders, and the psychiatrist has to obtain adequate medical consultation in order to detect the presence of such illnesses as stroke, thyroid disease, infection, brain tumor, or other abnormalities [1].

Racial and Ethnic Minorities

As the United States population becomes more diverse each year, there may be language and cultural differences which can lead to lapse in communication between patient, family, and the health care team.  This is especially true for African-Americans, Hispanics, and other groups [2].  These clients may lack knowledge about mental illness, and they may not trust the health care system.  All of this can impair the diagnostic process.

Furthermore, minorities may lack money, insurance, transportation, or other necessary resources to visit a physician; hence, they may have a medical or psychiatric disorder for many years without awareness of its presence.  Additionally, some whites and non-whites in the United States will not go for health screening because of the stigma that occurs with psychiatric treatment [2].

Conclusion

There are many discrepancies that can take place in the diagnostic evaluation of individuals with mental illness.  Communication and teamwork between patient, family, and the health care team will afford the best prognosis for the client.

References

  1. National Institute of Mental Health.  (2013).  Bipolar disorder.  Retrieved July 23, 2013.
  2. Primm, A., Vasquez, M., Mays, R., et al.  (2010).  The role of public health in addressing racial and ethnic disparities in mental health and mental illness.  Preventing Chronic Disease, 7, A20.
  3. The photo is a San Salvador field station of the U.S. Centers for Disease Control and Prevention.  Reprinted with permission from Centers for Disease Control and Prevention and Judith Faulk.

Disclaimer

The information contained in this article is for educational purposes only and should not be used for diagnosis or to guide treatment without the opinion of a health professional. Any reader who is concerned about his or her health should contact their physician for advice.

Updated: 07/28/2013, Michael_Koger
 
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