Psyched Episode 3 b): Diagnosis of Bipolar Disorder (Depression) with Dr. Ariel Shafro

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Aug 11, 2017

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INSIGHT

Bipolar Mood States

Bipolar patients spend more time depressed than manic.
A 15-year study showed euthymia for about half the time and more time depressed (52% in Bipolar II, 31% in Bipolar I).

INSIGHT

Diagnosing Bipolar Depression

Bipolar depression shares the same diagnostic criteria as unipolar depression.
Use the same SIGECAPS screening and require five of nine criteria, including low mood or anhedonia.

ADVICE

Assessing Mania Subtly

Start by asking about anxiety, then mood, and lastly, euphoric mania.
This approach avoids patients prematurely dismissing the possibility of mania.

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Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the diagnosis of bipolar disorder in ther depressive episodes, and a phenomenon termed "episodes with mixed features", with guest Dr. Ariel Shafro, a staff psychiatrist at Trillium Health Partners.

Bipolar disorder is an illness characterized by manic and depressive episodes; patients in fact spend more time in a depressed state than a manic state. The criteria for diagnosing a bipolar depression is the same as unipolar depression (or major depressive disorder).

When patients present with a depressive episode, it is important to consider bipolar disorder as a possible differential diagnosis. In addition, we discuss certain features that can point to an increased likelihood of bipolarity in a patient presenting with depression: this includes a strong family of bipolar disorder; previous subthreshold mania and cyclothymic features;atypical depression, psychomotor retardation (and/or catatonia), and psychotic features; and atypical reaction to antidepressants.

Lastly, we talk about the phenomenon of "episodes with mixed features", where people can present with simultaneous symptoms of depression and mania. We discuss the relevance of recognizing such episodes, including increased vigilance for features of bipolarity and considerations for treatments that have effect in both unipolar and bipolar depression.

The learning objectives for this episode are as follows. By the end of this episode, the listener will be able to:

Describe criteria for bipolar depression (it's the same as unipolar depression!)
List features suggestive of bipolarity in a presentation of depression
Know the DSM-V criteria of and recognize episodes with mixed features
Describe the relevance of diagnosing episodes with mixed features

Guest Staff Psychiatrist: Dr. Ariel Shafro (Trillium Health Partners, Mississauga)

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