Diagnosing bipolar disorder

Your first port of call with this disorder is usually your GP. The GP can then refer you to a psychiatrist for a more specialist assessment.

If you are in immediate risk of self harm your appointment will be fast-tracked or you will be sent to A&E with a letter from your GP. If at any stage you are concerned about being of risk to yourself or the risk a loved one may be experiencing please contact your GP, Caredoc (Ireland) or A&E (Accident and Emergency) department straight away.

Specialist Assessment

The psychiatrist at your appointment will ask you a few questions to determine if you have bipolar disorder. If you do, they’ll decide what treatments are most suitable.

The psychiatrist will want to know:

1. Your symptoms and when you first experienced them.
2. How you feel leading up to and during an episode of mania or depression
3. If you have thoughts about harming yourself – suicidal thoughts.
4. Your medical background and family history, especially whether any of your relatives have had bipolar disorder. The psychiatrist may want to talk to this person if at all possible but they’ll ask for your agreement before doing so.

Other tests may be carried out depending on your symptoms and you may also need tests to see whether you have a physical problem. If you have bipolar disorder you’ll need to visit your GP regularly for a physical health check.

Treating bipolar disorder

Treatments for bipolar disorder will aim to help reduce the severity and number of episodes of depression and mania in order to help you live as normal a life as possible.

When diagnosed it is important to be able to discuss treatment with your psychiatrist and be fully involved with the decisions surrounding this. But sometimes a person may be unable to make an informed decision about their treatment, especially with more severe symptoms. In this case it is important you discuss advanced directives with your psychiatrist or your GP. An advanced directive is a set of written instructions that state what treatments and help you want (or don’t want) in advance.

Most people with bipolar disorder can receive most of their treatment without having to stay in hospital. However, hospital treatment may be needed if your symptoms are severe, or if you’re being treated under the Mental Health Act (Ireland, see your own legislation for this), as there’s a danger you may self-harm or hurt others.

In some circumstances, you could have treatment in a day hospital and return home at night. Treatment usually takes the form of a combination of different treatments. These can include one or more of the following:

1. Medication: to prevent episodes of mania, hypomania (less severe mania) and depression – these are known as mood stabilisers and are taken every day on a long-term basis.
2. Education: learning to recognise the triggers and signs of an episode of depression or mania
3. Psychological treatment – such as talking therapies, which help you deal with depression and provide advice on how to improve relationships.
4. Lifestyle advice – such as doing regular exercise, planning activities you enjoy that give you a sense of achievement, and advice on improving your diet and getting more sleep. More on this next week.

Medication

Several medications are available to help stabilise mood swings and antidepressants for depressive episodes. Your psychiatrist and GP are best advised to help you here.

These are:

1. lithium carbonate -you need your blood check regularly if on this in order to check dosage levels and kidney and liver function. You should also avoid non-steroidal anti-inflammatory drugs such as ibuprofen.
2. anticonvulsant medicines -sometimes used to treat episodes of mania and they’re also long-term mood stabilisers. You also need regular check ups on this type of medication.
3. antipsychotic medicines -sometimes prescribed to treat episodes of mania or hypomania and also used as a long-term mood stabiliser. Side effects: blurred vision, dry mouth, constipation and weight gain are possible. You’ll need to have regular health checks at least every three months, but possibly more often particularly if you have diabetes.
4. antidepressants.

If your GP or psychiatrist recommends you stop taking medication for bipolar disorder, the dose should be gradually reduced between at least four weeks to three months if you are taking an antipsychotic or lithium. If you have to stop taking lithium for any reason, see your GP about taking an antipsychotic or valproate instead. Never stop taking your medication without first discussing it with your doctor.

Learning to recognise triggers

Learning to recognise the warning signs of an approaching episode of mania or depression can be very helpful. A community mental health worker (psychiatric nurse) may be able to help you identify your early signs of relapse from your history.

This won’t prevent the episode occurring, but it will allow you to get help in time by making some changes to your treatment or by adding an antidepressant or antipsychotic medicine to the mood-stabilising medication you’re already taking. Discuss this further with your GP/Psychiatrist.

Psychological treatment

Some people find psychological treatment helpful when used in conjunction with medication between episodes of mania or depression. This may include:

1. Psychoeducation – to find out more about bipolar disorder.
2. Cognitive behavioural therapy (CBT) – this is most useful when treating depression.
3. Family therapy – encourages everyone within the family or relationship to work together to improve mental health.

A Special Word About Treatment In Pregnancy

The management of bipolar disorder in women who are pregnant, or those who are trying to conceive, is complex and challenging. One of the main problems is the risks of taking medication during pregnancy aren’t always that well understood.

Close working together of mental health staff, GP, the partner, the obstetrician, the midwife and the patient should be encouraged and actively pursued. A plan should be drawn up for managing the treatment as soon as possible.

The following medication isn’t routinely prescribed for pregnant women with bipolar disorder and if you become pregnant while taking medication prescribed to treat bipolar disorder, it’s important that you don’t stop taking it until you’ve discussed it with your doctor first:

1. valproate – there’s a risk to the foetus and the subsequent development of the child
2. carbamazepine – it has limited effectiveness and there’s risk of harm to the foetus
3. lithium – there’s a risk of harm to the foetus, such as cardiac problems
4. lamotrigine – there’s a risk of harm to the foetus
5. paroxetine – there’s a risk of harm to the foetus, such as cardiovascular malformations
6. benzodiazepines – if used long term, there are risks during the pregnancy and immediately after the birth, such as cleft palate and floppy baby syndrome

The above post is only meant for educational purposes only. If you are concerned about anything discussed here or about a loved one please consult with your GP.