Page 16 - e-book CPG - Bipolar Disorder
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CLINICAL PRACTICE GUIDELINES MANAGEMENT OF BIPOLAR DISORDER (2ND ED.)
Recurrence of BD means the return of symptoms e.g. mania, hypomania or depression after
a period of wellness (symptom-free period). In a systematic review, factors associated with
Recurrence of BD means the return of symptoms e.g. mania, hypomania or depression after
Recurrence of BD means the return of symptoms e.g. mania, hypomania or depression after
8, level II-2
recurrence of BD were:
a period of wellness (symptom-free period). In a systematic review, factors associated with
a period of wellness (symptom-free period). In a systematic review, factors associated with
early age of onset
8, level II-2
recurrence of BD were: 8, level II-2
recurrence of BD were:
low socio-economic status
early age of onset
early age of onset
family history of BD
low socio-economic status
low socio-economic status
history of child abuse
family history of BD
family history of BD
low maternal warmth
history of child abuse
history of child abuse
low maternal warmth
co-morbid mental health disorders (anxiety disorder, ADHD and substance use
low maternal warmth
co-morbid
disorders) mental health disorders (anxiety disorder, ADHD and substance use
co-morbid mental health disorders (anxiety disorder, ADHD and substance use
disorders)
inter-episode subsyndromal mood symptoms
disorders)
inter-episode subsyndromal mood symptoms
inter-episode subsyndromal mood symptoms
3. SCREENING AND DIAGNOSIS
3. SCREENING AND DIAGNOSIS
3. SCREENING AND DIAGNOSIS
The diagnosis of BD relies on signs and symptoms elicited during clinical interviews with the
The diagnosis of BD relies on signs and symptoms elicited during clinical interviews with the
patient and often with corroborative history from informants. Diagnostic and Statistical Manual
The diagnosis of BD relies on signs and symptoms elicited during clinical interviews with the
patient and often with corroborative history from informants. Diagnostic and Statistical Manual
of Mental Disorders Fifth Edition, text revision (DSM-5-TR) and International Classification of
patient and often with corroborative history from informants. Diagnostic and Statistical Manual
of Mental Disorders Fifth Edition, text revision (DSM-5-TR) and International Classification of
Diseases Eleventh Revision (ICD-11) classification system for psychiatric disorders assist in
of Mental Disorders Fifth Edition, text revision (DSM-5-TR) and International Classification of
Diseases Eleventh Revision (ICD-11) classification system for psychiatric disorders assist in
framing operational definitions i.e. making diagnoses for clinical work and research. Revisions
Diseases Eleventh Revision (ICD-11) classification system for psychiatric disorders assist in
framing operational definitions i.e. making diagnoses for clinical work and research. Revisions
of these classifications ensure they are at pace with the recent advancements in the field. The
framing operational definitions i.e. making diagnoses for clinical work and research. Revisions
of these classifications ensure they are at pace with the recent advancements in the field. The
main changes in the new classification systems are:
of these classifications ensure they are at pace with the recent advancements in the field. The
main changes in the new classification systems are:
both ICD-11 and DSM-5-TR use the term bipolar disorder instead of bipolar affective
main changes in the new classification systems are:
both ICD-11 and DSM-5-TR use the term bipolar disorder instead of bipolar affective
disorder as in ICD-10
both ICD-11 and DSM-5-TR use the term bipolar disorder instead of bipolar affective
disorder as in ICD-10
ICD-11 uses subdivision of bipolar disorder type I and II, in line with DSM-5-TR
disorder as in ICD-10
ICD-11 uses subdivision of bipolar disorder type I and II, in line with DSM-5-TR
definitions of manic and hypomanic syndromes and episodes are almost identical
ICD-11 uses subdivision of bipolar disorder type I and II, in line with DSM-5-TR
definitions of manic and hypomanic syndromes and episodes are almost identical
between ICD-11 and DSM-5-TR
between ICD-11 and DSM-5-TR
definitions of manic and hypomanic syndromes and episodes are almost identical
Refer to Appendix 3 for Diagnostic Criteria of Bipolar Disorder Based on the Diagnostic
between ICD-11 and DSM-5-TR
Refer to Appendix 3 for Diagnostic Criteria of Bipolar Disorder Based on the Diagnostic
and Statistical Manual of Mental Disorders Fifth Edition, Text Revision (DSM-5-TR) and
and Statistical Manual of Mental Disorders Fifth Edition, Text Revision (DSM-5-TR) and
Refer to Appendix 3 for Diagnostic Criteria of Bipolar Disorder Based on the Diagnostic
International Classification of Diseases Eleventh Revision (ICD-11).
and Statistical Manual of Mental Disorders Fifth Edition, Text Revision (DSM-5-TR) and
International Classification of Diseases Eleventh Revision (ICD-11).
International Classification of Diseases Eleventh Revision (ICD-11).
Recommendation 1
Recommendation 1
Bipolar Disorder should be diagnosed based on the Diagnostic and Statistical Manual of
Bipolar Disorder should be diagnosed based on the Diagnostic and Statistical Manual of
Recommendation 1
Mental Disorders Fifth Edition, Text Revision or International Classification of Diseases
Mental Disorders Fifth Edition, Text Revision or International Classification of Diseases
Bipolar Disorder should be diagnosed based on the Diagnostic and Statistical Manual of
Eleventh Revision.
Mental Disorders Fifth Edition, Text Revision or International Classification of Diseases
Eleventh Revision.
Eleventh Revision.
3.1. Screening Tools
3.1. Screening Tools
3.1. Screening Tools
BD commonly presents as unipolar depression on the first presentation. There is a prevalence
BD commonly presents as unipolar depression on the first presentation. There is a prevalence
of 17% of undiagnosed BD in primary care, amounting to over 3 in every 20 patients.
9, level II-2
of 17% of undiagnosed BD in primary care, amounting to over 3 in every 20 patients. 9, level II-2
BD commonly presents as unipolar depression on the first presentation. There is a prevalence
This may lead to a misdiagnosis or delayed diagnosis of BD up to 10 years, which in turn may
This may lead to a misdiagnosis or delayed diagnosis of BD up to 10 years, which in turn may
of 17% of undiagnosed BD in primary care, amounting to over 3 in every 20 patients.
9, level II-2
result in an increased risk of treatment-emergent mania/hypomania and suicide.
10-12
10-12
result in an increased risk of treatment-emergent mania/hypomania and suicide.
This may lead to a misdiagnosis or delayed diagnosis of BD up to 10 years, which in turn may
Screening tools for BD may assist healthcare practitioners in identifying those with underlying
Screening tools for BD may assist healthcare practitioners in identifying those with underlying
result in an increased risk of treatment-emergent mania/hypomania and suicide.
10-12
BD. Furthermore, identifying those who are at risk of BD allows for preventive strategies and
BD. Furthermore, identifying those who are at risk of BD allows for preventive strategies and
Screening tools for BD may assist healthcare practitioners in identifying those with underlying
early interventions.
early interventions.
BD. Furthermore, identifying those who are at risk of BD allows for preventive strategies and
early interventions.
The following tools are available for the screening of BD:
The following tools are available for the screening of BD:
Mood disorder questionnaire (MDQ)
13
Mood disorder questionnaire (MDQ)
13
The following tools are available for the screening of BD:
Hypomania checklist (HCL-32)
14
Hypomania checklist (HCL-32) 13
14
Mood disorder questionnaire (MDQ)
Bipolar spectrum diagnostic scale (BSDS)
Bipolar spectrum diagnostic scale (BSDS) 15 15
14
Hypomania checklist (HCL-32)
Rapid mood screener (RMS) 16 16 15
Rapid mood screener (RMS)
Bipolar spectrum diagnostic scale (BSDS)
Refer Appendix 4 for List of Screening Tools in Bipolar Disorder.
Refer Appendix 4 for List of Screening Tools in Bipolar Disorder.
16
Rapid mood screener (RMS)
Refer Appendix 4 for List of Screening Tools in Bipolar Disorder.
2 2
2 2
