Conquering Challenges When Working With Bipolar Disorder

The first challenge to conquer when working with patients with bipolar disorder, according to Craig Chepke, MD, DFAPA, medical director at Excel Psychiatric Associates and Psych Congress Steering Committee member, is diagnosing them in the first place. Comorbidities and overlapping symptoms can make identifying bipolar disorder difficult. So what can clinicians do to make sure they don't miss it when their patient comes in? Dr Chepke recommends looking closely at depression symptoms, re-evaluating diagnoses on a regular basis, and considering risk factors as strategies to ensure patients' diagnoses aren't missed. 

Save the date for NP Institute In-Person, March 20-23, 2024, in San Diego, California! For more information, visit the meeting website.

Read the Transcript: 

Psych Congress Network: What are some of the primary challenges that clinicians face when working with patients with bipolar disorder?

Craig Chepke, MD, DFAPA: When working with patients with bipolar disorder, there are a lot of challenges. The first is finding out who they are. The diagnosis of bipolar disorder is very difficult to make for clinicians and even experienced clinicians like myself, I miss this all the time. All of us do. And admitting that and working harder, doubling down and finding those patients. Every patient who comes in complaining of depression, we need to be thinking about bipolar disorder.

The way that I'd like to think about it is this. Now if someone were to be a clinician working in primary care in an ER, some field like that, any patient who came in complaining of chest pain, that clinician would automatically be thinking about, 'okay, what are the risk factors for this being an acute myocardial infarction?' Now, we all know that someone could walk out of one of those types of practice environments with a dozen different diagnoses. It could be caustic chondritis, could be pneumonia, on and on, but they always think about an acute MI, because if they miss that and the patient leaves, that's a horrific outcome for them.

That's how we need to think about every person who comes into our practices with any complaint of depression. Now we're going to diagnose some people with MDD, but some of those people are going to have bipolar disorder, and it's up to us to figure out which one is which.

And that's not just the first visit with them. We don't set a diagnosis at the first treatment visit or the second, and then we keep that forever. We have to be constantly reevaluating it. And unfortunately, unlike checking for a heart attack, we don't have things like EKGs or drawing troponin levels to be able to help us.

But even in those settings, that's not what the clinicians do in ERs and primary care every time. They may just run through a list in their head of, 'okay, what's the person's age, their medical comorbidities, their ethnicity, their medications, their lifestyle,' things like that. And that's what we would need to do is just figure out what are the risk factors for this being bipolar disorder even if we don't think it is off the bat. We need to screen everyone, everyone, everyone, every single time for bipolar disorder if they come in with any complaint of a depressive illness.

Craig Chepke, MD, DFAPA, is a Board-Certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association. Dr Chepke is the medical director of Excel Psychiatric Associates in Huntersville, NC as well as an Adjunct Associate Professor of Psychiatry for Atrium Health. As part of an interdisciplinary treatment team, he employs a person-centered care model to tailor treatments to each individual's needs, integrating traditional pharmacotherapy with psychotherapeutic and physical health and wellness interventions.