"Sifting Through" Comorbid Symptoms in Bipolar Disorder Treatment

When treating patients with multiple comorbid disorders, it may be difficult for clinicians to determine which symptoms are coming from which conditions, particularly when treating bipolar disorder. At Psych Congress 2022 in New Orleans, Louisiana, Psych Congress Steering Committee Member Julie Carbray, PhD, APRN, clinical professor at the University of Illinois at Chicago, emphasized the importance of working with patients to identify the "character and signature" of how their mood disorders interact with other disorders and helping them "sift apart" symptoms.

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Julie A. Carbray, PhD, PMHNP-BC, PMHCNS-BC, APRN, is a clinical professor of psychiatry and nursing at the University of Illinois at Chicago. Dr Carbray holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago, and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. Dr Carbray was recognized by the UIC community in 2008 by receiving the Karen Gousman Excellence in Nursing Award and the American Psychiatric Nurses Association’s (APNA) Best Practices in Outpatient Mental Health Nursing Award. In 2012, Dr Carbray was awarded the University of Illinois at Chicago’s Inspire award for her long-standing commitment to UIC values and her inspiration of others in her work, and in 2016, Dr Carbray was awarded the Distinguished Service Award by APNA for her service to the profession of psychiatric nursing.

Read the Transcript:

Several guidelines have been published around managing the symptoms of bipolar illness along with comorbid disorders. And as a clinician, as you're sifting through this turf, it's important to categorize what symptoms might be a part of the bipolar disorder and which might be stemming from another comorbid disorder. Sifting that apart, particularly in the areas of anxiety, ADHD, can be important. Rating scales can be used, keeping a mood diary or journal of particular symptoms with the patient is important. And then also, having a timeline as well. For instance, ADHD does not wax and wane, it's fairly stable. But when you have bipolar illness, you expect to see some cycling of mood and you expect to see episodes of illness. Differentiating between ADHD and a bipolar mood state sometimes can be important because we already know what baseline looks like. Working with your patients to understand, again, the character and signature of how their mood dysregulation disorder exists amongst other disorders is really going to help you to address those comorbid disorders when they should surface.