[Diagnostics and early recognition of bipolar disorders]

Bipolar disorder (BD) is a relevant psychiatric disorder, which requires early identification and treatment.

What are the guideline-concordant diagnostic and early recognition procedures regarding BD?

The current German S3 guidelines on BD are based on the ICD-10. The multiaxial and dimensional description should include disorder-relevant somatic, psychological and social factors as well as the level of functional impairment. A BD can be diagnosed when at least two affective episodes have occurred, of which at least one must have been hypomanic, manic or mixed. In people considered at increased risk for BD, (subsyndromal) symptoms should be identified via the patient history and screening tools, e.g. the hypomania checklist 32 (HCL-32) and the mood disorder questionnaire (MDQ). The differential diagnosis of BD should exclude unipolar depression, dysthymia, cyclothymia, schizophrenia, schizoaffective disorders and substance-induced or organically related BD. The risk of comorbid psychiatric disorders is increased 8-13-fold in BD. The most common somatic disorders include obesity, cardiovascular diseases, metabolic syndrome, diabetes, musculoskeletal disorders and migraine. Observation of the course by the clinician and the patient (e.g. mood charting) as well as examinations before and during pharmacological treatment should be part of the treatment plan. Early recognition of BD during a so-called prodromal stage is currently not reliably possible. In the case of a clinical suspicion, e.g. due to subsyndromal (hypo)manic symptoms, comorbid conditions should be addressed and symptom-based psychotherapeutic interventions should be considered.

Early recognition and accurate diagnosis of BD, which enables adequate and timely treatment, can improve outcomes.