Demystifying the DSM: Unspecified Bipolar & Other Types

Dr. B here, with our series on Demystifying the DSM. Now I'm going to sum up the other bipolar type of diagnosis. I don't personally study the DSM, and so it's kind of funny that I'm doing this Demystifying the DSM series. I personally study Dr. Stahl and his symptoms and receptors, and any professionals out there, that's who I recommend that you study from. These videos are more for our clients to understand these diagnosis, and when I'm talking to my clients, I'm very specific about “don't own this”, right? This is just a cluster of symptoms, we can work with this, The Mentally STRONG Method and the cognitive behavioral approach to get your thinking and your choices in line with what you want, and if there is a neurobiology symptoms and receptor, we can treat that with medication. So, I'm going to quickly go through some of these other bipolar types. Cyclothymia is the next one here in the DSM, and it's basically a milder bipolar II. Right, so you don't really meet criteria for hypomania. You don't really meet criteria for major depressive disorder, but you still have these pretty significant fluctuations in mood and I would challenge that maybe that we can do that with therapy. Or is there a borderline personality or some other personality disorder contributing to that fluctuation. So that's one of the differential diagnosis with Cyclothymia. The other thing that we often see is substance use. And substance use can often look like bipolar, but it can also mask true bipolar. So really, when there's substance abuse going on, the number one goal is sobriety, and there's several mental health clinics that won't treat someone's mental illness until they have become sober. I actually will treat the mental illness while I'm trying to encourage sobriety, because I think it would be very difficult if I'm severely depressed to stop using my substance if I can't get treatment for my depression, right? So, there are two schools of thought on that, but substance abuse can always, always, always complicate the diagnosis and often can look like bipolar. Also, you can have a fluctuating mood disorder secondary to a medical condition. The first thing I tell people, especially if they're coming in at 50 years or older with their first significant mood disorder symptoms, I'm really looking hard at, Is there a medical reason for this? Because most mental health conditions start in childhood, teens, 20s, rarely, early 30s. After that, if there's no mental health history and then someone has significant problems, let's look closely at medication that they've been prescribed. Steroids are a big culprit. I've had several people who have post steroid mood disorder that looks like bipolar and sometimes we do have to treat that for a period of time and sometimes it can take six months to a year post steroid use to feel stabilized from that. So, anytime someone is presenting with some other medical conditions, look at the medications that they're on, as well as any kind of neurological or inflammatory conditions can actually present as mood problems. Then we have the bucket of unspecified bipolar, I use this diagnosis frequently because I don't know the client well enough to say for sure If it’s bipolar I or bipolar II. We haven't been able to really pinpoint it yet, and that's there in the DSM and then it goes through trying to show you all these little boxes of additional modifiers on that bipolar: bipolar with psychotic features. Bipolar with melancholic features. Bipolar with catatonic features. And we like to get to that point, but I can tell you typically in the first three to six months, I can't be that specific, and often it doesn't matter to be that specific because mood disorders can change, the presentation can change. 

Dr. Cristi Bundukamara, Ed.D, PMHNP-BC --- A Psychiatric Mental Health Nurse Practitioner and a Doctor of Healthcare Education has experienced unimaginable trials that have caused many feelings such as depress