Thursday, January 29, 2015

Bipolar Disorder ~ Receiving A Differential Diagnosis

Differential diagnosis maze...


Maybe you've had the experience of making an appointment with your primary care physician to discuss some unexplained symptoms only to be told that you might have one of three different diseases or conditions. Many people receive a differential diagnosis when either they or a loved one presents at a hospital emergency department. The truth is many diseases and disorders have similar symptoms, so it is prudent for health care providers to present the differential diagnoses.

However, this process can get murky when the diagnosis process takes years and maybe is not definitive until the end (consider chronic traumatic encephalopathy CTE). This can happen with physical as well as mental disorders and creates an additional burden for the person who is trying to live with the symptoms. The burden can also impact family members who are trying to care for or emotionally support the patient.

What if the differential diagnosis is bipolar disorder?


Often when the general public reads or hears about bipolar disorder it has to do with a celebrity who has been recently diagnosed or who now feels comfortable speaking publicly about living their life with bipolar disorder. Recently U.S. News & World Report published a health article Bipolar Disorder: What You Need to Know.  It is an interesting article that highlights how and why many patients can wait years to have a clear diagnosis of bipolar disorder. The article offers insight from Terence Ketter, chief of the Bipolar Disorders Clinic at Stanford School of Medicine:

"Diagnosis can further be complicated by having other chronic conditions. Sixty percent of patients with bipolar disorder also have substance abuse problems, Ketter says, making it difficult to determine if someone’s fluctuating moods are due to drugs or alcohol or something else. Attention deficit hyperactivity disorder is also common in patients with bipolar disorder, as are anxiety and personality disorders, further exacerbating ease of diagnosis."


Assessment can take time and there are multiple bipolar disorder subtypes: including bipolar I, bipolar II, mixed bipolar disorder, and cyclothymia. Assessments can take time.

Cottonwood Assessment Program (CAP)


A number of years ago Cottonwood Tucson's multidisciplinary staff designed the Cottonwood Assessment Program (CAP). CAP is intended to meet the needs of the following:

  • Cases of complex differentiated diagnosis. 
  • Individuals with addictions or mental health issues who are not progressing in therapy.
  • Individuals who, following an intervention, may be willing to come for a thorough evaluation, without the intention of committing to a full inpatient stay. 
  • Individuals needing a powerful, yet gentle supportive process to break through denial of substance abuse, behavioral addictions and/or mental health issues. 
  • Individuals wanting a second opinion to previous diagnosis. 

The process also includes participation in educational presentations, psychoeducational groups, lectures including mindfulness and life skills, 12-step meetings, including Caduceus, Lawyer's 12-Step and "Birds of a Feather" (professional pilot's recovery) groups. If indicated, the individual may participate in Tai Chi, yoga and other Eastern approaches at our addiction rehab. Throughout the process, members of the team meet to discuss and integrate their findings. At the end of the four (4) days, a roundtable meeting is held with the patient to discuss strengths, findings and treatment recommendations. This meeting is set up so that referents or significant others can participate either in person, or by teleconference. A comprehensive report is the final component to the CAP process.

You can view and/or print our CAP brochure.

Going forward...


Tomorrow we will bring you additional information about bipolar disorder, including how some new organizations are working toward starting the conversation and ending the stigma that is often attached to many mental disorders, particularly bipolar disorder. Stay tuned...

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