The careful assessment of reports and diagnosis is required for assessing the patient with psychiatric illness. However, substantial heterogeneity is marked through these assessments. It becomes sometimes difficult to assess the patient with psychiatric illness if heterogeneity and other considerable factors overlap each other. Bipolar disorder is considered to be the most appropriate example of psychiatric illness. The group of affective disorders is known as Bipolar disorders. These are grouped by hypomanic or manic codes and depression.
The bipolar disorders are of two types: bipolar disorder type I that is suspected to the patient that is diagnosed with manic episodes and bipolar disorder type II is for the patients with hypomanic and depressive episodes. The cyclothymic disorder occurs when the patient having depressive and hypomanic disorder does not encounter the standards for depressing episodes. Bipolar type I is easy to diagnose but, bipolar type II disorder is problematic to diagnose accurately from persistent unipolar depression in the patients with symptoms of depression. The identification of impartial biomarkers that represent pathophysiologic procedures that vary between unipolar depression and bipolar depression both provide and inform bipolar diagnosis for the growth of personalized and new treatments.
Bipolar disorder originates with a categorical approach that lies with the psychiatric illness according to modern psychiatric authors. Kraepelin proposed notable changes that state the effect known by beliefs, thinking ability and symptoms related to psychotic illness. He also said that these symptoms can appear at any stage of life. He stated the first category of psychotic disorders as "manic-depressive psychosis", that are referred to as affective disorders like bipolar disorders and the diseases related to this are schizophrenia. However, this bipolar was first used by Leonhard in 1957 and considered two varieties of disorders such as depressive and manic symptoms. He replaced manic depression with the Diagnostic and Statistical Manual for Mental Disorders (DSM).
These types of acute mental illnesses are the experiences of mood changes and depression. It is related to mood changes, reduced sleep, and neurological defects. He also stated the subsets of bipolar disorders in acute mental illness but was not supported by ICD-10. The classification is such as bipolar disorder type I as it is indicated with one episode of mixed or full-blown symptoms such as depressive and manic symptoms. Bipolar Disorder Type II is indicated with many protected depressive episodes and not only one related to the hypomanic episode. Cyclothymic disorder relates to multiple period symptoms with depressive and panic disorders.
Last is Bipolar disorder in common relates to many episodes and symptoms at a rapid rate and meets the diagnostic criteria of Bipolar disorder Type I, bipolar Disorder Type II, Cyclothymic disorder, and bipolar disorder in common. However, according to the International Classification of diseases-10, they consider bipolar disorder type I and type II as common, they do not discriminate between them. According to ICD-10, it requires one of the mood episodes associated with manic from bipolar disorders during diagnosis. Moreover, the criteria of Diagnostic and Statistical Manual for Mental disorders fourth edition related with mixed mood or an episode of hypomania with the reduction of BD diagnosis.
Bipolar disorders are considered very difficult to diagnose accurately at the early stages of a clinical profession. Hirschfeld, Lewis & Vornik in their article presented that 20% of the patients are there that are experiencing and identified with bipolar disorders in the first year of handling in acute mental illness. They said that there is often a delay between the onset of disease and diagnosis of around 5-10 years. However, in the year 2017, Baldessarini, Tonda, Baethge, Lepri, Bratti stated that there is a major challenge for differentiating between type I and type II types of bipolar disorder.
Hence, Goodwin, Jamison & Ghaemi also stated that they are featured by recurrent depressive episodes especially with the patients that have no history of mania or hypomania during depressive episodes. Unipolar depression is said to be the utmost recurrent misdiagnosis associated with bipolar illness in acute mental illness. But, they said that bipolar type II is suffered to patients with mental illness and no episodes of mania. Another reason that the authors stated that is very different from other authors is the prevalence and incidence of bipolar type I and type II with the high rate symptoms of bipolar type I and type II.
The patients suffering from bipolar type II disorder are said that they spend most of their life in a depressed state. Judd et al., 2016 stated gave an example and said that 9 percent of people experiencing manic or hypomanic episodes are bipolar type I patients and 1 percent are bipolar type II patients. Moreover, they stated in their article that patients per bipolar type II seek handling for depressive indications than they practice manic or hypomanic symptoms and hence make treatment and identification difficult.
The mood mixed episodes are there that are experienced by both manic or hypomanic and depressive disorders in mental illness. The rapid alteration is experienced in these patients is considered as increasing at a fast rate. According to Marneros 2017, the idea was challenged on a traditional view with a list of disorders like manic, hypomanic, or depressive episodes. These symptoms are identified from a patient with a history of more difficult episodes and majorly by the clinicians with less experience in this field. The bias is reported by them in the case of absent hypomanic or manic codes and depressive symptoms in patients. Furthermore, the evidence-results in threshold symptoms of the bipolar disorder like three of them, depressive, manic, or hypomanic to the patients with future or full-blown episodes without subthreshold symptoms. This finding by Dios in 2018 emphasized the possessions of subthreshold indications of bipolar disorder on the upcoming disease form.
Equivalent to this, Akiskal et al. in 2015, provided evidence that many patients that have been diagnosed with depressive disorders have been wrongly identified to their subtype disorder. It is because according to them, bipolar type II is with the prevalence rate of 9 percent and manic or hypomanic disorders are with the prevalence rate of 20 percent. Furthermore, Goldberg Harrow & Whiteside in 2019 stated that in the trials conducted for identification and analysis stated that two-third of patients did not respond to first-line antidepressants. More studies suggested the fact that type II disorder is not clear to be diagnosed by physicians and people have become resistant to unipolar disorder.
Misdiagnosis of any of the disorder type has the dangerous consequences with prescription of inappropriate drugs such as anti-depressants, mood-enhancing drugs, for particular disease type with high healthcare costs rate and poor clinical outcomes and processes. Goodwin in the year 2014 said that the diagnosis of bipolar disorder at the early stages is not ideal for patients with mania or hypomania. No clarity is seen in patients with these disorders. His article stated the involvement and discussion of two panels from which one panel stated this fact and the other presented challenges and strategies in diagnosis for bipolar disorder. Panel 2 said that criteria for diagnosis for the patients of the bipolar and unipolar disorder are the same.
Although, misuse of diagnosis is there for both types of mental illness. Members of panel 2 said that subtypes of these disorders do not exist. Type II and Type I are very difficult to distinguish since of depressing episodes and the nonappearance of full-blown mania. The signs of depression are said to be mutual in both the disorders but the rate is higher of hypomanic than manic symptoms. They also stated that diverse mood events are felt added common than beforehand. These episodes cause an obstruction in the detection of symptoms with the view of biasness towards the symptoms of depression with the treatment-seeking disorder. The subthreshold symptoms of unipolar depression were seen in 30-55% of people. They said that these are those patients that have became resistant to the treatment of depression and misdiagnosed with disorders.
The clinical strategies that panel 2 described were that the clinical rating scales should be set to a standard so that they can help in detecting the patients with hypomanic symptoms in people suffering from depression. In DSM-5 the bipolar disorder is said to be diagnosed with mood changes and activities of a person. They said that the criteria for diagnosis have not been standardized yet and it should be done in ICD-11 and DSM-5. The assessment of patients should be done at regular intervals to know the collateral evidence as of carer givers.
The dimensional approaches that they labeled are the spectrum approach in which the events of emotional pathology are evaluated. This includes the detection of syndromes and mood changes related to lifestyle, traits, and depressive symptoms. The reclassification should be proposed for psychotic disorders that include the assessment of a patient with pathophysiological processes rather than phenomenological observations.
Neuroimaging has been selected or diagnosed that can help in the identification of biomarkers that create the difference between unipolar depression from bipolar disorders. The combinations have been made between the patterns of neuroimaging and recognition approaches that identify the structuring and functioning of the neuron structure. However, this is a combined approach with different scale measurements with biological defects that identify new and personalized treatments for all affective disorders.
Reiger et al., 2016 stated that clinical strategies are recommended in DSM-5. Firstly, he stated that disorders have their chapters, and secondly, the diagnostic criteria are set based on mood and activity changes. Earlier, the assessment was such that the patient has to meet the full criteria of both the disorders. According to new criteria, many features have been included or discarded that acknowledge the relation and existence of three types of subtypes in the bipolar disorder of mental illness. Moreover, First in the year 2018, said that these are less number of recommendations and more should be included to analyze the condition of a mentally ill patient. He conducted DSM-5 trials with test-retest reliability that indicated the fact with DSM-5 can advance the accurateness of bipolar disorder diagnosis. Moreover, his research related to psychopathology stated that this defines a continuum of all the depressive features. According to Mitchell, Goodwin, Johnson & Hirschfeld said that efforts underway the psychiatric illnesses in new ICD-11 with those in DSM-5.
Bowden et al., 2017 stated that rating scales like clinician-administered and self-administered have been developed to improve the detection system of patients with a past experience of depressive incidents. The scales include clinical features such as reappearance of mood episodes, hypomania, and personal history. The scales are named as Screening Assessment of Depression Polarity, Bipolar Inventory Symptom scale, Probabilistic approach for Biopolar depression, and Hypomania checklist. At last, it means that hypomania or mania depressed patients should be diagnosed with the mechanisms to improve accuracy. The clinical matters alone can not identify the biomarkers that identify the variance between bipolar and unipolar depression. The identification of such biomarkers should be done to inform depressive episodes even biological targets to get personalized treatment.
More and more studies are emphasizing on the susceptibility of disorders from a genetic perspective. Neuroimaging techniques should be used to detect the mental illness at an acute level through the analysis of connectivity and functionality of neural circuitry to know the defects and provide the patient with the best possible treatment for bipolar disorder. After knowing many limitations from this critical analysis clinical measures should be taken with high considerate in early diagnosis especially for the patient with bipolar disorders. All the approaches are made and approved, but hence till now, no such has been declared as the appropriate method for identification of such illness. The huge scale of trainings, learnings and researches are needed to do the analysis and search out the best pathway for treatment and diagnosis.
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