1. Bipolar Spectrum Diagnosing and Differentiating From Depression Christopher D. Cobbs, M.D. 13 October 2010

2.  Making the Diagnosis of Bipolar Disorder  Differential Diagnosis  Treatment Options

3.  Lifetime Prevalence of Major Depression is 15 – 25%  Lifetime Prevalence of Bipolar Disorder is 1%  Bipolar Disorder has Equivalent Prevalence Between Men and Women  Average Age of Onset for MDD is 40 yo  30 yo for Bipolar Disorder

4.  Combination of Biologic, Genetic and Psychosocial Factors  Multiple Theories  1 st Degree Relatives of Bipolar Proband Have Increased Incidence of Mood Disorder

5.  Must have Manic Episode for a Bipolar Diagnosis  Elevated Mood Must Last 7+ Days  …or Require Hospitalization  Only One Episode of Mania Required…Ever

6.  3-4 of The Symptoms Present:  Inflated Self-Esteem or Grandiosity  Decreased Need for Sleep  More Talkative Than Usual/Pressured Speech  Flight of Ideas/Racing Thoughts  Distractibility  Increase in Goal-Directed Activity  Excessive Involvement in Pleasurable Activities

7.  Recurrent  Mixed  Psychotic Features  Hypomania/Bipolar II Disorder  Rapid Cycling  Catatonic

8.  5+ of the Follow Symptoms Lasting 2+ Weeks  Depressed Mood (May Be Irritable in Kids)  Diminished Interest in Most All Activities  Decreased Appetite/Significant Wt Loss  Insomnia/Hypersomnia  Psychomotor Agitation/Retardation  Fatigue/Loss of Energy  Feelings of Worthlessness/Excessive Guilt  Difficulty Thinking/Concentrating  Recurrent Thoughts of Death/SI

9.  Substance Abuse  Personality Disorder  Anxiety Disorder  Malingering

10.  Psychotherapy (Primarily Depressive Phases)  Pharmacotherapy:  Valproic Acid  Lithium  2 nd Generation Antipsychotics  Other Anti-Epileptic Drugs  1 st Generation Antipsychotics  Antidepressants