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Bipolar Spectrum Diagnosing and Differentiating From Depression Christopher D. Cobbs, M.D. 13 October 2010 Making the Diagnosis of Bipolar Disorder Differential Diagnosis Treatment Options 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 Combination of Biologic, Genetic and Psychosocial Factors Multiple Theories 1st Degree Relatives of Bipolar Proband Have Increased Incidence of Mood Disorder Must have Manic Episode for a Bipolar Diagnosis Elevated Mood Must Last 7+ Days …or Require Hospitalization Only One Episode of Mania Required…Ever 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 Recurrent Mixed Psychotic Features Hypomania/Bipolar II Disorder Rapid Cycling Catatonic 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 Substance Abuse Personality Disorder Anxiety Disorder Malingering Psychotherapy (Primarily Depressive Phases) Pharmacotherapy: Valproic Acid Lithium 2nd Generation Antipsychotics Other Anti-Epileptic Drugs 1st Generation Antipsychotics Antidepressants