Differentials
Mood disorder due to general medical condition
SIGNS / SYMPTOMS
May be clinically indistinguishable; however, people often have atypical mood symptoms.
Symptoms and signs specific for the underlying medical condition (e.g., stroke, thyroid disease, and multiple sclerosis) may be present.
INVESTIGATIONS
Specific testing based on suspected underlying condition. May include CT head, MRI brain, and thyroid function testing.
Substance-induced mood disorder
SIGNS / SYMPTOMS
May be clinically indistinguishable.
The mood disorder is judged to be temporally associated with exposure to the causative substance. Withdrawal states from some substances can last for up to 4 weeks.
INVESTIGATIONS
Initial period of observation required.
Laboratory findings, including blood alcohol level and toxicology screens.
Major depressive disorder
SIGNS / SYMPTOMS
Criteria include depressed mood most of the day, as self-reported or observed by others, or diminished interest or pleasure in all or almost all activities. These core symptoms are associated with at least four of the following: significant weight loss when not dieting, weight gain, or decrease or increase in appetite; insomnia or hypersomnia; psychomotor agitation or retardation; fatigue or loss of energy; feelings of worthlessness or excessive or inappropriate guilt; diminished ability to think or concentrate; recurrent thoughts of death, recurrent suicidal ideation without a specific plan.[1]
However, patients have never had a manic, hypomanic, or mixed episode.
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Persistent depressive disorder
SIGNS / SYMPTOMS
A form of depression characterised by a chronic course (persistent for 2 years or longer).
Symptoms of persistent depressive disorder include 2 or more of the following: poor appetite/overeating, insomnia/hypersomnia, low energy/fatigue, low self-esteem, poor concentration, feelings of hopelessness.
However, patients have never had a manic, hypomanic, or mixed episode.[1]
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Cyclothymic disorder
SIGNS / SYMPTOMS
Cyclothymic disorder is characterised by a minimum duration of 2 years marked by numerous periods of hypomanic symptoms that do not meet criteria for a manic episode, and numerous periods with depressive symptoms that do not meet criteria for a major depressive episode. During the 2-year period, the person has not been without mood symptoms for >2 months at a time.[1]
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Psychotic disorders
SIGNS / SYMPTOMS
Psychotic disorders such as schizophrenia, schizoaffective disorder, and delusional disorder are characterised by periods of psychotic symptoms that occur in the absence of prominent mood symptoms.
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Personality disorders
SIGNS / SYMPTOMS
A personality disorder is an enduring pattern of inner experiences and behaviours that deviate from cultural expectations and is marked by persistent disturbances in cognition, affectivity, interpersonal functioning, and impulse control.
The pattern is maladaptive, inflexible, pervasive, stable, and of long duration, in contrast with the episodic nature of bipolar disorder.
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Obsessive-compulsive disorder
SIGNS / SYMPTOMS
Characterised by persistent or repetitive thoughts (obsessions) and/or behaviours (compulsions). Obsessions are defined as recurrent or persistent thoughts, urges, or images that are experienced as intrusive and unwanted and which usually result in marked anxiety or distress, which the person tries to ignore, suppress, or neutralise with some other thought or action. Compulsions are defined as repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly, which are aimed at preventing or reducing anxiety or distress, or preventing a dreaded event or situation; however, compulsions are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive.[1]
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
ADHD
SIGNS / SYMPTOMS
Symptoms of inattention, hyperactivity-impulsivity must be present in 2 or more settings (e.g., at work and at home) with clear evidence of clinically significant impairment in social, academic, or occupational functioning.
The ADHD symptoms must not occur exclusively during a manic, hypomanic, or depressive episode, or any other mental disorder.
Problems with attention, hyperactivity, and/or impulsiveness noted to have emerged before age 7 years may persist into adulthood and confound the diagnosis of bipolar disorder.
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Generalised anxiety disorder
SIGNS / SYMPTOMS
Generalised anxiety disorder (GAD) is defined as at least 6 months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress or impairment. The worry is not confined to features of another mental health disorder, a result of substance misuse, or relating only to a physical health condition. The worry is hard to control.
At least three of the following symptoms are present most of the time: restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance.[1]
Careful history taking is required to differentiate bipolar disorder from anxiety disorders, given that anxious ruminations may be mistaken for racing thoughts, and efforts to minimise anxious feelings may be taken as impulsive behaviour.[1]
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Panic disorder
SIGNS / SYMPTOMS
Panic disorder is characterised by recurring unexpected panic attacks over a 1-month period. People with panic disorder are persistently concerned about having another panic attack, and/or about the consequences of this (e.g., having a heart attack or losing control). People with panic disorder may also change their behaviour in an attempt to avoid having more panic attacks (e.g., avoiding situations that may trigger the panic sensations; engaging in various safety-related behaviours).[1]
Careful history taking is required to differentiate bipolar disorder from anxiety disorders, given that anxious ruminations may be mistaken for racing thoughts, and efforts to minimise anxious feelings may be taken as impulsive behaviour.[1]
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
Post-traumatic stress disorder (PTSD)
SIGNS / SYMPTOMS
PTSD may develop following exposure to 1 or more traumatic events involving actual or threatened death, serious injury, or sexual violence. PTSD is characterised by 4 types of symptoms: intrusions, avoidance, negative alterations in mood and cognition, and hyper-arousal or hyper-reactivity. These symptoms must persist for more than 1 month and cause functional impairment for a diagnosis to be made.[1]
INVESTIGATIONS
Clinical diagnosis using DSM-5-TR or ICD-11 criteria.
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