Differentials

• Schizophrenia:

  Delusions and hallucinations can occur in both bipolar disorder and schizophrenia.

  In bipolar disorder, these are mood congruent and so tend to be grandiose, whilst in schizophrenia, they tend to be more bizarre and difficult to understand. Where features of schizophrenia and bipolar disorder are present in a roughly equal proportion, the diagnosis of schizoaffective disorder should be considered
• Organic brain disorder:

  Frontal lobe pathologies can result in a loss of social inhibitions, which can also occur in mania or hypomania. Neurological investigation and imaging through CT or MRI can differentiate an organic cause from bipolar disorder
• Drug use:

  The effects of some psychotropic drugs can cause a similar clinical presentation to mania, but this generally resolves as the drug wears off. Some prescribed medications (e.g. steroids) can cause elation.
• Recurrent depression:

  This should be distinguished from bipolar II by exploring any possible episodes of hypomania with thorough history taking
• BPD:

  This condition is characterised by affective instability which can present similarly to rapid cycling bipolar disorder. However, mood changes tend to occur more quickly in EUPD. Other features of mania such as grandiose ideas and a marked increase in energy are generally not seen in EUPD
• Cyclothymia:

  This is a condition related to bipolar disorder which also presents with chronic mood disturbance, with both depressive and hypomanic periods. However, this is differentiated from bipolar II since, in cyclothymia, periods of depressed mood are less severe and do not meet the criteria for a depressive episode.
• Bipolar differentials:

  • Schizophrenia and other psychotic disorders
  • Anxiety disorders/PTSD
  • Circadian rhythm sleep-wake disorders
  • ADHD/conduct disorder
  • Alcohol or drug misuse
  • Physical illness - thyroid disease, Cushing's, head injury, brain tumour, HIV, neurosyphilis
  • Medicine - Antidepressant withdrawal, psychotropic medications, anti-parkinsonian
  • Borderline personality disorder