Psyched Episode 3 a): Diagnosis of Bipolar Disorder (Mania) with Dr. Mark Sinyor

Jul 7, 2017

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ADVICE

Interviewing Manic Patients

Ask simple, close-ended questions when interviewing a suspected manic patient.
This helps manage their potential flight of ideas and impulsivity.

INSIGHT

Neurotoxicity of Mania

Manic episodes may be neurotoxic, emphasizing the need for prompt treatment.
This goes beyond immediate safety concerns and considers long-term implications.

ADVICE

Managing Emotional Contagion

Be aware that a manic patient's intense emotions can be infectious.
Maintain professional boundaries and avoid mimicking their mood.

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Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners.

This episode covers the diagnosis of Bipolar Disorder (Type 1 and 2), with insights from guest Dr. Mark Sinyor, Staff Psychiatrist at Sunnybrook Health Sciences Centre.

Bipolar disorder is characterized by depressive and manic episodes. This episode focuses on the diagnostic criteria and assessment in mania, and presents a fictional case of a patient with a first manic episode. We discuss the epidemiology of bipolar disorder, and a plain-English description of manic episodes. We then explore the DSM-5 diagnostic criteria for manic episodes using the mnemonic GSTPAID. Relating the criteria back to the case, we will talk with Dr. Sinyor about practical methods and tips for assessing a person who presents with manic symptoms. Some common mental status exam terms and findings in mania will be explained. We then discuss common differential diagnoses for bipolar disorder, including schizoaffective disorder, schizophrenia, borderline personality disorder, and substance intoxication/substance-induced mania.

Lastly, we will differentiate between mania and hypomania, and Bipolar Disorder Type 1 and Type 2. Through the examination of the concept of “bipolar spectrum”, we will discuss some challenges and limitations of the DSM-5 and the current understanding of Bipolar Disorder.
The Learning Objectives for this episode are as follows. By the end of this episode, the listener will be able to:

Cite the prevalence and incidence rates of bipolar affective disorder
Describe the natural history of bipolar disorder including its cyclical nature, and relative ratio of times in mania vs depression
Know the DSM-V criteria for mania, hypomania
Suggested mnemonic GSTPAID
Perform an effective diagnostic interview for manic symptoms
Perform a differential diagnosis for bipolar disorder including borderline personality disorder and psychotic disorders

Guest Staff Psychiatrist: Dr. Mark Sinyor (Sunnybrook Health Sciences Centre, Toronto)

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