Bipolar Spectrum Disorders
Dennis B. Kottler, MD
Westlake Village, CA
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Recently, there has been a move away from rigid categorizations of mood disorders. This is especially true in the case of bipolar disorder. Bipolarity is now thought of as a SPECTRUM of disorders.
At one end of this spectrum is cyclothymia, characterized by relatively mild mood swings. Next on the spectrum is bipolar II disorder, characterized by hypomania (less than mania in severity) and periodic depressions. Finally there is bipolar I disorder, characterized by true manic or mixed manic states and periodic depressions. Of course, there are probably many gradations between these conditions.
Dr. Ronald Pies, at Tufts University School of Medicine, has developed the "Bipolar Spectrum Diagnostic Scale" to help patients and clinicians better diagnose bipolar states. This diagnostic tool seems especially sensitive to the detection of bipolar II disorder, a condition frequently missed or misdiagnosed by psychiatrists.
The "Bipolar Spectrum Diagnostic Scale" is properly used in a collaborative effort between patient and clinician. The patient reads the entire passage below and then checks one of the four boxes which follow the passage. Next, the patient re-reads the passage and checks the blank after each statement which seems to apply. Finally the scale is scored using the directions given. The scoring interpretation follows. (Note: To complete this scale, either print it out first, or keep track of the checked responses on a sheet of paper).
Some individuals notice that their mood and/or energy levels shift drastically from time to time________. These individuals notice that, at times, their mood and/or energy level is very low, and at other times, very high________. During their "low" phases, these individuals often feel a lack of energy; a need to stay in bed or get extra sleep; and little or no motivation to do things they need to do________. They often put on weight during these periods________. During their low phases, these individuals often feel "blue," sad all the time, or depressed________. Sometimes, during these low phases, they feel hopeless or even suicidal________. Their ability to function at work or socially is impaired________. Typically, these low phases last for a few weeks, but sometimes they last only a few days________. Individuals with this type of pattern may experience a period of "normal" mood in between mood swings, during which their mood and energy level feels "right" and their ability to function is not disturbed________. They might then notice a marked shift or "switch" in the way they feel________. Their energy increases above what is normal for them, and they often get many things done they would not ordinarily be able to do________. Sometimes, during these "high" periods, these individuals feel as if they have too much energy or feel "hyper" ________. Some individuals, during these high periods, may feel irritable, "on edge," or aggressive________. Some individuals, during these high periods, take on too many activities at once________. During these high periods, some individuals may spend money in ways that cause them trouble________. They may be more talkative, outgoing, or sexual during these periods________. Sometimes, their behavior during these high periods seems strange or annoying to others________. Sometimes, these individuals get into difficulty with co-workers or the police, during these high periods________. Sometimes they increase their alcohol or non-prescription drug use during these high periods________.
Now that you have read this passage, please check one of the following four boxes:
[ ] This story fits me very well, or almost perfectly.
[ ] This story fits me fairly well.
[ ] This story fits me to some degree, but not in most respects.
[ ] This story doesn't really describe me at all.
Now please go back and put a check after each sentence that definitely describes you.
- One point is given for each sentence checked.
- Add six points if subject checked "fits me very well"; four points for "fits me fairly well"; two points for "fits me to some degree"; and no points for "doesn't really describe me at all."
- Maximum total score is 25.
(Patient's score ____________)
Scoring interpretation for Bipolar Spectrum Diagnostic Scale:
20 or higher: bipolar spectrum disorder highly likely
12-19: moderate probability of bipolar spectrum disorder
7-11: low probability of bipolar spectrum disorder
<7: bipolar spectrum disorder very unlikely
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