How many times is ADHD mistakenly diagnosed as bipolar?
(= b. p.) bipolar disorders; lat. bi- two, gr. πολος (polos) Axis point], [KLI], are among the most serious mental disorders with a comparatively high mortality, serious accompanying and consequential stress, complex therapy requirements and an unfavorable prognosis. They encompass a number of diagnoses from the affective group of forms, the central characteristic of which is the chronically recurrent course with alternating manic or hypomanic and depressive as well as mixed episodes or states, which in turn are interrupted by symptom-free (euthymic) intervals of different lengths. The symptoms fluctuate between extreme conditions in the areas of drive, activity and mood ("cheering up high - saddened to death"). The phenomenology of the depressive episodes corresponds to that of the unipolar major depression. Manic states (mania), on the other hand, are characterized by extremely exaggerated drive, restlessness, reduced need for sleep, euphoric or irritable mood and cogn. Hyperactivity, often associated with ideas of size and a reduced perception of reality. Manics are often perceived from the outside as particularly creative and charismatic personalities. During mania tend to b. Pat. To impulsive, uncontrolled and reckless actions in terms of their consequential risks (borrowing, setting up a company, spending large amounts of money in the "consumer frenzy") and pronounced risk behavior (road traffic, sexuality, sport), which can be associated with massive health, financial, legal and social risks . In this phase, those affected focus their entire capacity on best. Partial aspects of their life, while at the same time they massively neglect their role tasks and obligations in other areas of life (family, work). UnderHypomania one understands a less pronounced form of mania with clearly elevated mood, increased drive and increased performance above the normal level. During hypomanic phases, self-control as well as self-criticism and self-control are often reduced, but self-image and risk awareness are exaggerated. A mixed episode is characterized by the simultaneous or rapidly changing occurrence of manic / hypomanic and depressive symptoms (e.g. increased drive and dysphoria). In the subj. Perception of the patient, the depressive phases are consistently experienced as aversive, but the manic or hypomanic states are mostly even experienced as pleasant. During mania / hypomania, those affected fear above all the switch into depression, which is experienced as particularly blatant. In theCyclothymia it is a chronically fluctuating affective disorder, in which numerous periods with hypomanic and depressive symptoms occur separately from one another, which the diagn. Do not fully meet the criteria of hypomania in terms of number, severity, intensity and duration.
etiology: The etiopathogenesis of b. S. is still largely unclear. A multifactorial genesis in the interplay of biopsychosocial influencing factors (disease models) and personality characteristics is probably responsible for the development. Since b. If disorders show the highest concordance rates in twin studies in addition to schizophrenia, a relatively high genetic share in the etiology is assumed. The characteristic periodicity and the particular vulnerability to disturbances of the everyday and sleep-wake rhythm speak for a prominent role in biological. Basic disorders in the pathogenesis. The following were unspecific risk factors for a chronic course and an unfavorable prognosis. Factors determined: female gender, premorbid serious critical life events and unfavorable personality traits as well as insufficient coping resources (coping), early onset age, mixed episodes, rapid cycling (rapid phase change, at least four times a year), psychotic symptoms, high episode frequency, psych. or somatic comorbidity, substance use, poor compliance, inadequate pharmacotherapeutic response.
classification: In the DSM-5, the Bipolar Spectrum Disorders differentiated from the depression and classified between the Schizophrenia speculum disorder and other psychoses on the one hand and depressive disorders on the other (classification of mental disorders; see Appendix I). The DSM-5 differs like the DSM-IV and ICD-10 Bipolar I disorder (F31.1), the Bipolar II disorder (F31.8) and the Cyclothymic disorder (F34.0). The Bipolar II disorder will not be longer than weakened form of bipolar I disorder considered, since those affected suffer long-term from recurring depressive episodes and from persistent mood lability with the resulting psychosocial functional impairments. According to DSM-5, it is used to diagnose a Bipolar I disorder It is necessary that the criteria for at least one manic episode in the anamnesis are met: Definable period abnormal and persistent elevated, expansive or irritable mood and continuously increased targeted activity and energy of at least one week, which lasts almost for most of the day are available on all days (criterion A). There must be at least three symptoms from criterion B: Excessive self-esteem and great ideas, reduced need for sleep, increased talkativeness and the urge to talk, flight of ideas and racing thoughts, increased distractibility, increased purposeful activity or psychomotor restlessness, excessive preoccupation with activities with a high probability of unpleasant consequences result in (excessive shopping, sexual adventures, nonsensical investments). In the DSM-5 the diagn. Coded based on the last current episode. Additionally it can be based on severity (light, medium, heavy), psychotic characteristics and remission status (part, full) coded as well as a supplementary description of the characteristics without a code (e.g. with fear, mixed characteristics, Rapid cycling) can be made. The presence of a depressive episode is for the diagnosis assignment of the Bipolar I disorder not absolutely necessary, although the vast majority of patients with manic episodes also experience depressive episodes at some point in the process. For the diagnosis of a Bipolar II disorder In contrast, it is necessary that the criteria of at least one hypomanic episode and the criteria of at least one major depressive episode (MDE) are met. The characteristics of the Hypomania largely correspond to the manic symptoms, but without being so severe that they cause significant social or occupational functional impairments or require hospitalization. The episode one Major depression should last at least two weeks, the hypomanic period at least four days. During the affective episode should have the required number of symptoms most of the day for most of the day. If a fully syndromic manic episode has occurred in the past, the diagnosis is Bipolar I. given. In the cyclothymic disorder numerous periods with hypomanic symptoms must occur over a period of at least two years that do not meet the full criteria of a hypomanic episode, as well as numerous periods with depressive symptoms that do not meet the full criteria of an MDE. During this two-year period, the hypomanic and depressive periods must be present for at least half of the time and the person must not be symptom-free for longer than two months. The diagnosis is only made if the criteria for fully syndromic hypomanic, manic, or depressive episodes were never met in the past. ICD-10 and DSM-5 differ only slightly in the specific symptom criteria for manic, hypomanic and depressive episodes. There is, however, a significant deviation in the classification of the syndromes: I. Ggs. To the DSM-5, the ICD-10 uses the Bez. Bipolar Affective Disorder (F31) and does not make an explicit distinction between bipolar I and bipolar II diagnoses, but rather according to the act. Presence of a hypomanic (F31.0) or manic (F31.1) or depressive episode (F31.3) as well as after occurrence manic or depressive episodes with psychotic symptoms (F31.2; F31.5) and according to severity. The ICD-10 also uses the diagnostic category of Bipolar affective psychosis (F31.5, F31.6, F31.7), which was abandoned in the DSM.
Prevalence: The lifetime prevalence of Bipolar I disorder according to the results of current epidemiological studies representative of the population, is around 3%. Bipolar spectrum diseases at about 5%. Possibly the true prevalence of b. S. underestimated, because they are disproportionately often not recognized, but are misdiagnosed as unipolar depression or ADHD, for example. B. S. usually begin in adolescence or early adulthood. 75% of the patients suffer their first episode by the age of 25. I. Ggs. To most other psych. Disorders the gender relationship is balanced. At b. There are high comorbidities, especially with substance disorders (addiction and substance-related disorders) and impulse control disorders (e.g. pathological gambling), anxiety disorders and post-traumatic stress disorders. In population surveys from the USA and Europe, the comorbidity with substance abuse or dependence was increased up to six times. B. Patients use different legal and illegal drugs. In the manic phase, it is predominantly not counterregulatory sedative, but additional stimulating substances that are consumed. B. S. have particularly high recurrence rates, whereby the individual course can look very different. In the majority of patients, only a few episodes occur in the course of their life, but in every tenth patient the number of episodes is over 10. In the long-term course b. affective S., manic episodes occur significantly less often and are on average shorter than depressive phases. Up to 20% of bipolar I patients, especially women (80%), suffer from the particularly serious type of rapid cycling, which is characterized by a rapid change from manic / hypomanic and depressive phases and an extremely high number of episodes . The risk of developing such a high phase frequency increases with the duration of the disturbance. In many patients, residual symptoms persist, which in turn are associated with an increased risk of recurrence and permanent impairment of the social function level. Thief. S. has particularly serious psychosocial impairments (periods of incapacity for work, loss of professional and earning capacity, loss of partner, family rifts and social isolation or exclusion), secondary damage (accidental injuries, organismic damage due to substance abuse, irreversible psychological impairments) and the consequences of illness (jurist. Consequences, financial problems up to personal bankruptcy), which in turn can have a negative effect on the course of the fault. According to WHO data, B. S. are among the ten diseases with the highest rate of permanent disability worldwide. These disruptive consequences, which can be coded according to ICF, make up about 80% of the enormous health-economic burdens. The risk of suicide b. Pat. Is twice (suicide attempt) to three times (completed suicide) higher than in unipolar depressives and five to six times higher than in the general population, especially in comorbidities with substance use disorders.
Diagnosis: The diagnosis of a b. S. is particularly difficult for various reasons: (1) The diagnosis must always be made longitudinally. According to DSM-5, some are diagnosed. Rules to be observed: If there is at least one manic or hypomanic episode in the life story, the diagnosis is mandatory bipolar given, even if the depressive phases dominate currently or for most of the life. Hypomanic or depressive phases can precede or follow the manic episode. The diagnosis is corrected in the direction of the more serious disorder, if z. B. with existing cyclothymia a fully syndromic episode of the depressive, hypomanic or manic type occurs. The bipolar II diagnosis is also changed to bipolar I as soon as at least one manic episode with full criteria is detected. (2) The symptoms of mania or hypomania can be caused by the consumption of certain psychotropic substances (e.g. stimulants) or other med. Disease factors are simulated. In this case, a substance- or drug-induced b. S. be diagnosed. Conversely, a b. S. may be overlooked by substance users, as the symptoms are wrongly attributed to the substance's effect. (3) The manic symptoms show certain syndromic overlaps, for example with the ADHD disorder, and are therefore often underdiagnosed or misdiagnosed in childhood and adolescence. (4) The numerous different gradient patterns (rapid, ultra rapid, mixed) and the symptomatological "many faces" of b. S. complicate a clear diagnosis and differential diagnosis. In addition to classificational diagnostics (diagnostics, categorical), the clin. Practice further valid diagn. Information required for indication, therapy planning, progress and success control. Usually this dimensional diagnostics to determine the severity and severity of b. Symptomatology, a multimodal approach (diagnostics, multimodal; combination of various survey instruments using several data sources) is urgently recommended, as the affected patients - especially with regard to mania - tend to distort perceptions and evaluations (trivialization, romanticization). A number of German-language dimensional survey methods for self-assessment and external assessment are available for the various purposes, the use of which should not be limited to self-assessment scales. The Bech Rafaelsen Mania Scale (BRMAS) or the Young Mania Rating Scale (YMRS), for the depressive symptoms the common depression scales (Beck Depression Inventory (BDI-II), General Depression Scale ADS). Also stands with the General Depression and Mania Scale (ADMS) an instrument for the combined recording of manic-depressive symptoms is available. For the long-term measurement of the course of manic-depressive episodes, the so-called. Life chart method (retrospective and prospective), i.e. graphical progress documentation on the time axis, with which various degrees of severity and many disease parameters can be recorded and which are now also available as electronic versions. Short-term changes should be recorded with mood diaries. Since at b. S. a particularly pronounced comorbidity with different other psych. There are disorders that can be of decisive importance for the course and prognosis and thus for the therapy planning of the primary disorder, a corresponding broadband diagnosis should be carried out using structured clinical interviews. bipolar disorder, psychotherapy, bipolar disorder, psychopharmacotherapy.
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