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 subtype s of the disorder sometimes present with different symptoms, and the carefu l diagnostician must be aware of them. These include comorbidity of bipolar disorder and attention-deficit/hyperactivity disorder, comorbidity of bipo lar disorder and substance abuse, and mania secondary to prescription drugs or physical illness, particularly in the elderly. As a result of these fac tors and others, bipolar disorder is significantly underdiagnosed. Accurate and precise diagnosis has a direct impact on the choice of treatment and w ill be easier for those clinicians who are aware of the several subtypes of mania and depression and are familiar with the relevant Expert Consensus G uidelines for treatment.