In order to properly diagnose bipolar disorder in a patient, a mental health professional will review evidence concerning several areas of the person’s history, behavior, and lifestyle. These in-depth medical interviews will, of course, start with the patient and may extend to family or friends if the doctor feels that helpful information about the patient’s behavior could be gleaned from third parties.
Any discussion between the doctor and patient will be preceded by a thorough medical examination to identify and rule out other physical causes of the bipolar symptoms. After a medical history is taken, the doctor will review any current medical problems and note any current prescription medications. The doctor may order lab tests to check for thyroid problems or to detect any illicit drugs or alcohol in the patient’s system. If the blood test reveals presence of illicit drugs or alcohol, the doctor will need to determine if the drugs are actually causing the patient to appear to have bipolar disorder. The doctor will also want to rule out stroke or the presence of a brain tumor.
The initial diagnostic interview between doctor and patient will likely focus on the frequency and intensity of the patient’s recent mood swings. The doctor will also use this opportunity to observe the patient’s current behavior and mood. It is important to note that bipolar patients are more likely to seek help when in a depressive episode, rather than a manic one. Therefore, it is especially important that the doctor rule out major depressive disorder before making a bipolar diagnosis. Previous medical records and information from family and friends are often needed to ensure a proper diagnosis.
Because there is evidence that bipolar disorder has a genetic component, the provider will be particularly interested in any history of mental illness in the patient’s family, especially if family members have a history of bipolar disorder. Medical research on bipolar disorder is presently focused on identifying the genes that may increase a patient’s chance of developing the disease. Children with a parent or sibling who has bipolar disorder are four to six times more likely to develop bipolar disorder than children who have no family history of the disease.
The Bipolar Disorder Phenome Database, funded in part by the NIMH, makes it possible for scientists to link visible signs of bipolar disorder with genes that may influence them. To date, research suggests that most people with bipolar disorder have missed worked because of the disease, had co-occurring disorders such as substance abuse or panic attacks, and had been treated or hospitalized for bipolar disorder in the past. Researchers have discovered that family traits for bipolar disorder include a history of psychiatric hospitalization, co-occurring obsessive-compulsive disorder (OCD), same age at onset, and the same number and frequency of episodes.
Although much of the current medical research on bipolar disorder suggests a genetic component, the role of environment in the emergence of the disease may be equally important. Research has shown that the twin sibling of a bipolar patient, who shares identical genes, will not necessarily face the same diagnosis.