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There are two reasons for diagnoses: one is for treatment; the other is for insurance reimbursement. This complicates the discussion. I wish it wasn't so, but it is.
For example, when I bill insurance for treating someone with Bipolar Disorder (BD), they have mostly BD1 codes and then they have some generic BD codes. The generic BD codes are more often what we use for insurance reimbursement because they encompass more symptoms. It's easier. So, you might see your doctor's report that lists a diagnosis that's rather general.
But when we are diagnosing for treatment, we seek to be as specific as we can be so that whoever might treat the patient after us will get the most accurate picture possible. With BD, the most likely scenario would be this:
Assuming that it is determined your son is actually cycling (let's say 5 times a week, more or less) along with the manic state with psychosis he was just treated for. Then, the diagnosis would be "BD1 single manic episode with psychotic behavior and daily hypomanic cycling".
The BD1 would be the main diagnosis because it is more severe if left untreated and uncontrolled. In other words, it would signal that the manic state with psychosis is being treated and when it is under control, the more rapid cycling he's experiencing will be looked at to see if the treatment for the manic states is controlling it as well or if further treatment is necessary.
At this time, I don't know of clinicians who are diagnosing both BD1 and BD2 as concurrent independent disorders. Rather, it is treated as I stated above is my experience.
Okay, I wish you the very best!
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