While 10 years ago there was concern that bipolar disorder was being under-diagnosed, there is now growing evidence that the pendulum has swung to the opposite direction of overdiagnosis, particularly for bipolar II disorder. Positive family history of bipolar disorder.Early onset of first depression (Lability of mood (interspersed hypomanic symptoms).Delusions and hallucinations excessive (pathological) guilt.Early morning wakening/diurnal mood variation (worse in morning).Increased sleep (hypersomnia) and/or increased appetite (hyperphagia).Physical slowing (psychomotor retardation).Features more common in bipolar depression than unipolar depression Some patients present with a mixture of depressive and hypo/manic symptoms. Those features more common in bipolar depression are listed in Table 2. We have termed this a ‘probabilistic approach’, thereby emphasising that there are no pathognomonic characteristics of bipolar depression, rather differing likelihoods of the occurrence of particular symptoms. The work of our group at the University of New South Wales, Black Dog Institute 4,5 and others has demonstrated that some symptoms are more likely to occur in bipolar depression, thereby assisting clinicians in considering this possibility in cases where the history of past hypo/manic episodes is uncertain or ambiguous. 3 One aspect of improving recognition of bipolar depressive episodes has been clarifying if there are symptoms more commonly observed in bipolar than unipolar depression. It is critical that the depressive episodes of bipolar disorder are recognised early and treated vigorously, as most suicides occur during depressive episodes. Furthermore, the illness usually first presents with a depressive episode, meaning that some young people with depressive episodes may go on to have hypo/manic episodes in the future. sounds are more harmonious, colours richer than usual.įor most patients with bipolar disorder, more of their lives are spent in depressed mood than in periods of elevation, even for those with bipolar I disorder.
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