Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

1.  What are the main differential diagnosis rule outs and co-morbidities for bipolar disorder and how are they different between adults and children and adolescents?Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

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2.  You are to create a list of your most likely pharmacological AND non-pharmacological treatments for clients with bipolar disorder and provide rationale for what you have chosen.

You can use this pharmacology or nonpharmacology therapies below or different ones.

Examples of pharmacology include Lamotrigine, Lithium, Valproate and carbamazepine.

Non Pharmacology include Cognitive behavioral therapy (CBT), Interpersonal therapy, Psychoanalytically oriented Therapy

Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Use this reading Materials

·         Read Sadock, Sadock, & Ruiz () Ch. 8 – Mood Disorders (not all content is bipolar specific; read for bipolar content)

·         View Bipolar Disorder Review Presentation

·         Review Bipolar Treatment

·         Read Integrative Treatment of Bipolar Disorder: A Review of the Evidence and Recommendations

·         Read Bipolar Disorder In Children and Teens

·         Review the NIH overview of bipolar disorder and the treatment of Bipolar disorder in children and adolescents.  This has a layperson focus in some respects but still has useful information.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

·         Read Co-occurring Mania and ADHD in Youths

·         Read Atkin, et al (2017) Practitioner Review: The effects of atypical antipsychotics and mood stabilizers in pediatric bipolar d/o

·         Read Corrigan (2016) Ch 11 Family Interventions pp. 206-221

Stahl, S. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). Cambridge, UK: Cambridge University Press.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th Ed.). Washington, DC: Author

Stahl, S. (2017). Stahl’s essential psychopharmacology prescriber’s guide (6th Ed.). New York, NY: Cambridge University Press. Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Bipolar affective disorder is a psychiatric condition defined by two extremes of mood, one being that of euphoria and hyperactivity while the other being that of psychomotor retardation, guilt, self-blame, and suicidality. It is found in the DSM-5 in the diagnostic category referred to as ‘Bipolar and Related Disorders’. The fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) places ‘Bipolar and Related Disorders’ between the diagnostic categories of ‘Depressive Disorders’ and ‘Schizophrenia Spectrum and Other Psychotic Disorders’ because it bridges the two (APA, 2013). This paper discusses the differential diagnosis rule outs and comorbidities for the condition that is bipolar disorder in adults, children, and adolescents.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Differential Diagnosis Rule Outs and Comorbidities

According to the DSM-5, the differential diagnoses that must be ruled out for a diagnosis of bipolar disorder include the following (Sadock et al., 2015; APA, 2013; Stahl, 2013):

1. Major depressive disorder

Irritability can be present in MDD just as in BPD. Additionally, MDD may also be characterized by manic and hypomanic symptoms but lasting for a shorter period of time so as not to qualify them for mania or hypomania.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

1. Substance/ medication-induced bipolar disorder

Use of substances that may be responsible for the symptomatology seen in a patient must be ruled out before making a diagnosis of BPD.

• Anxiety disorders such as panic disorder

Taking a careful history and considering symptom triggers is important in ruling out anxiety disorders. For instance, attempts to minimize anxiety may be mistaken for impulsivity and so on.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

1. Other bipolar disorders

Bipolar I disorder must be distinguished from bipolar II disorder through the establishment of whether there had been a past episode of mania.

1. Personality disorders

Labile mood and impulsivity are present in both BPD and personality disorders such as borderline personality disorder.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

1. Attention-deficit hyperactivity disorder (ADHD)

Misdiagnosis of ADHD as bipolar disorder is common in children and adolescents.

• Disorders characterized by irritability

Persistent irritability in a child may be indicative of disruptive mood dysregulation disorder and not BPD.

The comorbidities for BPD include anxiety disorders (like social anxiety disorder), ADHD, conduct disorder (like oppositional defiant disorder), metabolic syndrome, migraine, and alcohol use disorder amongst others (AA, 2013; Stahl, 2013).

Differences Between Adults and Children/ Adolescents

The difference in differential diagnoses and comorbidities between adults and children or adolescents is that some conditions (differential diagnoses and comorbidities) are more likely to be present in children and adolescents. This means they will be the most likely differential diagnosis rule outs and comorbidities in children and adolescents. They include ADHD and disruptive mood dysregulation disorder. Another difference is that substance use disorder like alcohol use disorder will be a more likely differential diagnosis in adults (Moore et al., 2017; Sadock et al., 2015; APA, 2013; Stahl, 2013).Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Pharmacological and Nonpharmacological Treatments

Pharmacological: Amoxapine, aripiprazole (Abilify), armodafinil (Nuvigil), and bupropion (Wellbutrin). All are used for bipolar depression and maintenance. The rationale is that Amoxapine is a tricyclic antidepressant; aripiprazole is a serotonin receptor partial agonist hence can elevate the mood; armodafinil promotes wakefulness in the somnolence of depression; and bupropion inhibits reuptake of norepinephrine and dopamine hence facilitating the enjoyment of pleasurable activities (Stahl, 2017).Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Nonpharmacological: Cognitive behavioral therapy (CBT) and interpersonal therapy. The rationale is that these two facilitate cognitive remodelling or the shaping of thoughts to make them positive and then have them influence positive behavior. The client is made to see the negativity and destructive nature of their thoughts and made to change

Bipolar affective disorder is a psychiatric condition defined by two extremes of mood, one being that of euphoria and hyperactivity while the other being that of psychomotor retardation, guilt, self-blame, and suicidality. It is found in the DSM-5 in the diagnostic category referred to as ‘Bipolar and Related Disorders’. The fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) places ‘Bipolar and Related Disorders’ between the diagnostic categories of ‘Depressive Disorders’ and ‘Schizophrenia Spectrum and Other Psychotic Disorders’ because it bridges the two (APA, 2013). This paper discusses the differential diagnosis rule outs and comorbidities for the condition that is bipolar disorder in adults, children, and adolescents.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Differential Diagnosis Rule Outs and Comorbidities

According to the DSM-5, the differential diagnoses that must be ruled out for a diagnosis of bipolar disorder include the following (Sadock et al., 2015; APA, 2013; Stahl, 2013):Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

1. Major depressive disorder

Irritability can be present in MDD just as in BPD. Additionally, MDD may also be characterized by manic and hypomanic symptoms but lasting for a shorter period of time so as not to qualify them for mania or hypomania.

1. Substance/ medication-induced bipolar disorder

Use of substances that may be responsible for the symptomatology seen in a patient must be ruled out before making a diagnosis of BPD.

• Anxiety disorders such as panic disorder

Taking a careful history and considering symptom triggers is important in ruling out anxiety disorders. For instance, attempts to minimize anxiety may be mistaken for impulsivity and so on.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

1. Other bipolar disorders

Bipolar I disorder must be distinguished from bipolar II disorder through the establishment of whether there had been a past episode of mania.

1. Personality disorders

Labile mood and impulsivity are present in both BPD and personality disorders such as borderline personality disorder.Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

1. Attention-deficit hyperactivity disorder (ADHD)

Misdiagnosis of ADHD as bipolar disorder is common in children and adolescents.

• Disorders characterized by irritability

Persistent irritability in a child may be indicative of disruptive mood dysregulation disorder and not BPD.

The comorbidities for BPD include anxiety disorders (like social anxiety disorder), ADHD, conduct disorder (like oppositional defiant disorder), metabolic syndrome, migraine, and alcohol use disorder amongst others (APA, 2013; Stahl, 2013).

Differences Between Adults and Children/ Adolescents

The difference in differential diagnoses and comorbidities between adults and children or adolescents is that some conditions (differential diagnoses and comorbidities) are more likely to be present in children and adolescents. This means they will be the most likely differential diagnosis rule outs and comorbidities in children and adolescents. They include ADHD and disruptive mood dysregulation disorder. Another difference is that substance use disorder like alcohol use disorder will be a more likely differential diagnosis in adults (Moore et al., 2017; Sadock et al., 2015; APA, 2013; Stahl, 2013). Another difference is that most times BPD commences in adolescence or teenage years between 15-19 years. Also, adults with BPD show less manic symptoms and more depressive symptoms than children and adolescents. Children, on the other hand, show more manic than depressive symptoms (Sadock et al., 2015; APA, 2013; Stahl, 2013).Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Pharmacological and Nonpharmacological Treatments

Pharmacological: The pharmacological agents of first choice in BPD include anticonvulsants or mood stabilizers (such as divalproex sodium, lamotrigine, and carbamazepine), antimanic agents such as lithium, and atypical antipsychotics like aripiprazole and olanzapine. The rationale, for instance, is that mood stabilizers such as lamotrigine reduce manic symptoms by lowering the effects of excitatory neurotransmitters like glutamic acid and aspartate (Stahl, 2017; Stahl, 2013).Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .

Nonpharmacological: Cognitive behavioral therapy (CBT) and interpersonal therapy. The rationale is that these two facilitate cognitive remodelling or the shaping of thoughts to make them positive and then have them influence positive behavior. The client is made to see the negativity and destructive nature of their thoughts and made to change (Sadock et al., 2015).   Differential Diagnosis Rule Outs and Comorbidities for Bipolar Disorder (BPD) .