![]() Mood-congruent delusions (e.g., grandiosity) and mood-incongruent delusions (e.g., paranoia) are the most common psychotic features. Psychotic features usually appear during manic rather than depressive episodes. PsychosisĪpproximately 50 to 95 percent of people with bipolar disorder experience psychosis. People with borderline personality disorder often have distal trauma (e.g., childhood adversity). The central and defining features of borderline personality disorder are an enduring and pervasive pattern of interpersonal relations that is chaotic and tempestuous, with subjective complaints of emptiness and attachment difficulties. Personality Disordersīorderline personality disorder is not a diagnosis of exclusion for bipolar disorder. Other psychiatric disorders and problems are described in the following sections. major depressive episode with prominent agitation/anxiety.Other psychiatric disorders and considerationsīipolar disorders share symptoms with other psychiatric disorders, including: In addition, laboratory screening for thyroid abnormalities is generally recommended. For example, a physical exam probing for neurological signs or evidence of head trauma may be warrant- ed. ![]() Organic pathology can be reasonably excluded by focusing on biological factors that may be associated with mania. Some non-psychiatric conditions can present with symptoms of mania. Manic responses, on the other hand, do not follow this pattern. Rather, this reaction would simply be considered a drug side-effect. Note that experiencing a hypomanic episode after starting an antidepressant does not indicate a bipolar diagnosis unless the hypomanic state outlasts the physiological effects of the drug. In previous versions of the DSM, mixed or manic/hypomanic episodes while taking an antidepressant did not count toward the diagnosis of bipolar disorder. If a patient manifests mixed or manic features while taking an antidepressant for depression or immediately upon discontinuing it, a diagnosis of bipolar disorder is made (this was a significant change made in the DSM-5). Mixed features is defined as a minimum of three pre-specified depressive symptoms while experiencing hypomania or mania, or three hypomanic symptoms while experiencing a major depressive episode. cyclothymic disorder: features continuous biphasic mood instability for two or more years, but never severe enough to meet criteria for a major depressive episode, mania or hypomania.Ī common clinical scenario in primary care is a manic/hypomanic presentation in a patient on antidepressant monotherapy who has no prior de novo manic or mixed features.People with this type often use health services when they are depressed and often fail to respond sufficiently to conventional antidepressants (a situation that masquerades as treatment-resistant depression). ![]() This is possibly the most common bipolar presentation in primary care.
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