Bipolar disorders: course and context

Think in episodes

Bipolar presentations are understood through changes in mood and activity across time, including periods of depression and episodes of elevated or unusually irritable mood. The current encounter may show only one part of that course. Establish the person’s usual pattern and the boundaries of reported episodes.

Explore associated changes in sleep, speech, energy, activities and consequences. Clarify whether there was a recognizable departure from baseline and seek appropriately obtained collateral history when recall of an episode is incomplete.

Classification requires the whole account

ICD-11 distinguishes bipolar type I and type II through the history of different mood episodes. These categories should not be reduced to everyday mood swings or a questionnaire result. A clinician must consider the complete requirements of the classification being used.

Record whether elevated symptoms occurred alongside substance use, medicine exposure or physical illness. The episode’s timing and course help examine alternative explanations. Avoid combining thresholds and labels from different classification systems into an undocumented hybrid.

Discuss consequences and uncertainty

The account should include occupational, social and financial effects as well as the person’s experience. Ask what recovery between episodes looked like. Distinguish facts documented in records from uncertain retrospective descriptions.

In teaching, construct a timeline before debating a diagnostic label. Mark the evidence for each period and the unanswered questions. This website offers educational context and does not recommend mood stabilizers, dose changes or patient-specific treatment.

For your next supervision discussion

Sketch periods of change and usual functioning on a timeline. Identify whether each description comes from the patient, a collateral account or a record, and mark what remains uncertain.