Clinician’s Guide to Bipolar Disorder: Integrating by David J. Miklowitz
By David J. Miklowitz
Winner (First Place)--American magazine of Nursing booklet of the yr Award, Psychiatric and psychological health and wellbeing Nursing Category
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Additional info for Clinician’s Guide to Bipolar Disorder: Integrating Pharmacology and Psychotherapy
There is a family history of bipolar depression and major depression. There is a family history of drug abuse, impulsivity, and depression. Manic/hypomanic episodes are characterized by classic symptoms. Mood swings are rarely characterized by decreased sleep, increased energy, elation, or grandiosity. Compared to those of bipolar disorder, the mood swings of borderline personality disorder tend to be more responsive to environmental triggers. Classic manic symptoms such as psychomotor activation associated with euphoric mood and decreased need for sleep are not typically seen in borderline patients.
If a colleague says she is treating “a depressed patient who I’m now thinking may be bipolar,” the issue may be that conventional treatments for depression have not worked well. A referral that asks “whether this is bipolar or a personality disorder” may mean that patient has been difficult to treat, confrontational, or inconsistent in drug adherence. As with any patient, the clinician should consider whether anyone else is already treating this patient and make contact with that provider. Patients who self-refer—and often those referred by another doctor— may have never notified the existing therapist or psychopharmacologist that they are seeking a second opinion (see also the Chapter 11 discussion of split treatment).
If the interviewer then “circles back” to the depressed mood or loss of interests question, patients may well endorse it the second time. As a general framework for assessing whether a patient has had one or more past episodes of depression or (hypo)mania, we suggest the following: Describe to the patient a template for that type of episode first, a brief statement describing what a depressive or manic/hypomanic episode generally looks like. Then, follow it up with “Has there been a period of time like this?