Bipolar disorder: Diagnostic challenges and treatment considerations

A review of the criteria for the diagnosis of bipolar disorder identifies a number of complicating factors that historically have interfered with the accurate and precise diagnosis of patients. Patients with different subtypes of the disorder sometimes present with different symptoms, and the careful diagnostician must be aware of them. These include comorbidity of bipolar disorder and attention-deficit/hyperactivity disorder, comorbidity of bipolar disorder and substance abuse, and mania secondary to prescription drugs or physical illness, particularly in the elderly. As a result of these factors and others, bipolar disorder is significantly underdiagnosed. Accurate and precise diagnosis has a direct impact on the choice of treatment and will be easier for those clinicians who are aware of the several subtypes of mania and depression and are familiar with the relevant Expert Consensus Guidelines for treatment.