Key Challenges in Accurately Diagnosing Bipolar Disorder

In this video from on-site at NP Institute 2024 in Boston, Massachusetts, Rakesh Jain, MD, MPH, psychiatrist at Mental Wellness in Austin, Texas, tackles the complex challenge of diagnosing and differentiating bipolar disorder from other mental health conditions. Dr Jain emphasizes the importance of a thorough patient history, screening tools, and the critical role of DSM-5 guidelines. By delving into family and longitudinal history and understanding the full spectrum of symptoms, clinicians can navigate the murky waters of diagnosis with greater clarity and confidence.

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Read the Transcript:

Psych Congress Network: What are some of the key challenges with accurately diagnosing and differentiating bipolar disorder from other mental health conditions? How can these challenges be addressed?

Rakesh Jain, MD: That's a really good question because one of the most vexing things in modern-day psychiatry is this question about differentiating bipolar disorder from other conditions. Maybe I'll pick 2, the top 2, that are confusing and perhaps shed some light on how we can clarify a murky clinical situation.

The first is, how do I differentiate bipolar depression from unipolar depression? I know it's easier said than done, but perhaps the thing to remember is the following: The symptoms of bipolar depression and the symptoms of unipolar depression look identical. Therefore, the main task you and I have is to look for a hypomanic or manic episode in the patient's history. Obviously, asking a patient, "Have you had a hypomanic episode?" is not going to work. The best thing to do is to use your scales and screeners as a starting point, and then collect family history, and most importantly, collect longitudinal history.

Always keeping in mind, DSM-5 is the North Star. Use that information, and when you do that, you do get to the right diagnosis.

The other one that you want to keep in mind is ADHD as a differential. Also a complex task. The best way to accomplish this goal is to think of them as 2 separate entities and not to let distractibility be the only symptom you're looking for. You want to look for the full cluster of symptoms from either disorder and one more time: collect longitudinal history and use DSM as your north star. You do that, success is on its way for you and your patient.

Rakesh Jain, MD, MPH, attended medical school at the University of Calcutta in India. He then attended graduate school at the University of Texas School of Public Health in Houston, where he was awarded a “National Institute/Center for Disease Control Competitive Traineeship”. He graduated from the School of Public Health in 1987 with a Masters of Public Health (MPH) degree. Dr Jain served a 3-year residency in Psychiatry at the Department of Psychiatry and Behavioral Sciences at the University of Texas Medical School at Houston. In addition, Dr Jain completed a postdoctoral fellowship in Research Psychiatry at the University of Texas Mental Sciences Institute, in Houston. He was awarded the “National Research Service Award” for the support of this postdoctoral fellowship.