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Dr. Michael
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience:  Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
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Dear Doctor I would like to know (in laymans terms) how

Resolved Question:

Dear Doctor

I would like to know (in laymans terms) how one goes about diagnosing bipolar disorder?

Can a psychiatrist diagnose bipolar disorder in one one hour session with a patient?

Regards
Sumarie
Submitted: 2 years ago.
Category: Mental Health
Expert:  Dr. Michael replied 2 years ago.
Hello. I believe I can be of help to you with this issue.

The key criterion for diagnosing bipolar disorder is clear evidence of a manic, hypo manic or "mixed" (manic-depressive) episode. Evidence of depression isn't required because it is assumed the person has had, or will have a depressive episode. Period of pure mania or manic episodes, occurring on their own are very rare, so the diagnosis hinges on the presence of a manic episode.

The disorder is MIS-diagnosed quite often, particularly Bipolar II disorder, in which hypo manic episodes occur. This is because the problem of anger/irritability can be a primary symptom, not grossly elevated mood (significant euphoria, 'high' or elevated mood). The symptoms of bipolar overlap significantly with another, unrelated problem called Borderline Personality Disorder, for example, or a mild, mood cycling disorder called Cyclothymic Disorder. In addition, it is sometime misdiagnosed when Attention Deficit, Hyperactivity Disorder is present, especially in adolescents. So it can be diagnosed in a single session, depending on how clear-cut and dramatic the manic symptoms are, as described by the patient. On the other hand, milder variants of the disorder are actually quite hard to diagnose and the person should (in my opinion) be seen over the course of several months for separate assessments, at separate times. This would be important because if the clinician misses the diagnosis altogether, the person might not get treated correctly. For patient with true bipolar disorder, missing the diagnosis and concluding they only have recurrent depression is a problem because a prescription of higher dose antidepressants alone can cause the eruption of manic symptoms and make the condition worse. The person should have been put on a mood stabilizer first. If a person receives a diagnosis of bipolar disorder, I would usually want a second opinion. That second opinion should NOT include records from the first diagnosing psychiatrist, but should be done in the absence of access to such an opinion. A clinical psychologist can provide standardized psychological testing and assessment that can be helpful as a second opinion. Again, the patient should be coached to not bias the psychologist or psychiatrist by explaining why they want a second opinion, or share the first diagnosis. It should be a blind evaluation.

What do you think?
Customer: replied 2 years ago.

Dear Doctor

 

Thank you for your quick response.

 

Just to give you some context:

I have had an extremely stressful 6 months, in a nutshell:

  • I have a very senior position and with that comes a lot of stress
  • I was engaged to be married and when it came to the crux (i.e.paying the deposit for the wedding venue), my fiance back tracked. I walked away from the relastionship
  • I sold my house and the buyer was exceptionally difficult
  • The department (at the company) that I am working in, may be closing down (50%/50% chance)
  • I am in a process of litigation with my stepsister over a money issue

I have NEVER used drugs, I train (gym) 3 times a week (currently training for a triathlon end March), may have one glass of wine every second week. I am a predicable, consistent, kind person and very responsible.

 

I went through a "bad patch" 2 weeks ago = felt that everything is just too much for me and yes, I did have thoughts of suicide.

 

I went to a phyciatrist after my GP suggested I see one.

 

I explained the context of my life to her. In addition, I told her I feel irritable, restless,anxious and that I feel I am having difficulty to "bounce back" = see the bigger picture and know I will get through this time etc.

 

She then prescibed medication (after an hour session). I asked her what it was for and she answered "moodiness". I emailed her this morning to ask her to give me more information - I want to know what the medication is for. She answered me, via email, that the medication is for bipolar disorder. I feel it is extremely insentitive of her to email me to share such a diagnosis with me and, needless to say, I am extremely offended that she can come to such a radical conclusion after one hour.

 

Can the likelyhood of bipolar be tested with blood tests?

 

A friend of mine said she felt the same emotions a year ago - it was hormonal changes and after she changed contraception, she was fine.

 

I am 39years old and it may be hormonal changes and loads of stress.

 

Maybe I am just in denail, but I refuse to accept that I have a personality disorder.

 

I will take you advise and go for a second opinion.

 

Please note: English is not my first language, so please excuse any spelling errors.

 

Kind Regards

Sumarie

Expert:  Dr. Michael replied 2 years ago.
There is absolutely no blood test available for detecting risk or likelihood of bipolar disorder. Indeed, mood swings and difficulties with emotion regulation can be due to hormonal changes, switch to another birth control pill with a different 'formula' etc.

Personality disorder? Anyone suggest you have one (now or in the past)? Your post and the details you share don't seem to reflect some of the personality disorder ideation one often sees (e.g., borderline personality). You can Google this topic and read more about it. I doubt you have borderline personality disorder.

Please do get a second opinion and possibly, a third. Diagnoses in psychiatry wax and wane in popularity and when popular, they get overdiagnosed e.g., schizophrenia, Tourette's Syndrome, ADHD, Bipolar, Borderline Personalty, are all good historical examples. Bipolar is a pretty serious, significant diagnosis so it is worth a second opinion. You might do perfectly well with a really good clinical or counseling psychologist in psychotherapy, to help sort out your stress, pick up some coping/stress management skills etc.

Good luck to you.

Please click on the green Accept button at the bottom of the screen. Thanks.
Dr. Michael, Psychologist
Category: Mental Health
Satisfied Customers: 2177
Experience: Licensed Ph.D. Clinical Health Psychology with 30 years of experience in private practive and as a clinical psychology university professor.
Dr. Michael and other Mental Health Specialists are ready to help you
Customer: replied 2 years ago.

Dear Doctor

 

 

Sorry, I thought bipolar is a personality disorder. No one ever said I have a personality disorder.

 

Thank you for your reassurance= that I may only need some coaching i.t.o coping skills and stress management .

 

I really appreciate your feedback and giving me perspective.

 

Kind Regards

Sumarie

 

 

Expert:  Dr. Michael replied 2 years ago.
No bipolar disorder falls under the diagnostic group of Mood Disorders, as you now know. You are obviously a much brighter-than-average person and are quite accomplished. I think with some consultation and support you could very well be just fine.

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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
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  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
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