A tragic case of a depressed mother19 Nov 2014
I really don’t want to take psychiatric medication25 Nov 2014
This article is primarily written for health professionals/mental health professionals who have some knowledge of psychiatric disorders.
What is the Bipolar Spectrum?
There are vasts amounts of research and literature around the Bipolar Spectrum concept, large amounts of it theoretical and academic. Even when studying for my psychiatry exams I found it a very confusing topic.
In a nutshell, the Bipolar Spectrum is the spectrum between two polar ends of Major depressive disorder and Bipolar disorder. The concept of having either a Bipolar disorder I or II or a Major Depressive disorder is no longer black and white, and there is a vast amount of grey in between.
Why is it relevant to non-psychiatrists?
Psychologists/Occupational therapists and GPs, often see patients more frequently than psychiatrists, and therefore are in a good position to pick up some of the signs. Usually, these patients have had a previous diagnosis of a major depressive disorder/anxiety disorder or borderline personality disorder. These patients are commonly undiagnosed and can struggle for years before receiving the correct treatment.
When you think someone has a BP spectrum diagnosis, it may be useful to discuss it with their treating psychiatrist or doctor since they may not be on the correct treatment.
What are the signs of Bipolar Spectrum disorder?
There are many criteria out there the one that I like the best is WHIPLASHED1
W – Worse or wired when taking antidepressants
H – Hypomania, hyper thymic temperament, and mood swings in history
I – Irritable hostile or mixed features
P – Psychomotor retardation
L – Loaded Family history: bipolar illness, affectivity and mood swings
A – Abrupt onset and /or termination of depressive episodes less than three months
S – Seasonal or postpartum depression
H – Hyperphagia and Hypersomnia
E – Early age of onset
D – Delusions, Hallucinations and Psychotic features
What do I need to know about pharmacological and psychological management of Bipolar spectrum disorders?
The majority of patients in this spectrum have received trial after trial of antidepressant generally with a poor response. Patients should be assessed by a psychiatrist and treatment with a mood stabiliser should be considered.
Additionally psychological therapy can be focussed on mood regulation,healthy sleep and eating habits, interpersonal skills, development regular schedule, psychoeducation for the patient and family with regards the diagnosis and overall taking charge of the illness. And providing structure in patients’ lives.
There are some risks associated with antidepressants in patients with Bipolar disorder or Bipolar spectrum disorders, this is a complicated topic which if you are interested in here is a very useful website which I use for all things Bipolar related2. (Look at Principle C)
Tools to help screen patients
There are many screening tools to screen for Bipolar II/ Bipolarity. This tool is one which I am using most frequently2.
- Pies R. WHIPLASHED:A mnemonic for recognizing bipolar depression. Psychiatric Times. 2007;24:10.