Question

1.Consider the assessment and diagnosis of major depressive disorder and bipolar disorder in adults (two of the most common psychiatric disorder seen in acute and outpatient settings)

a. Discuss how treatment for the two disorder is different and why it is different. What are some examples of specific pharmacological and non-pharmacological interventions?

b. When performing a psychiatric evaluation why is it critical to have access to an immediate family or close friend to confirm information?

Answer 1

1. To determine whether a person has MDD or Bipolar Disorder (or any mental disorder in general), a physical check up should be first conducted to identify if there are any medical causes, a psychiatrist and a psychologist can carry out an assessment to see how the thoughts and feelings etc are, mood changes can be recorded daily (aka - mood charting) and last but not the least, the DSM criteria should be referred.  

MAJOR DEPRESSIVE DISORDER - diagnostic assessment - MDD is one of the most common mental illnesses that is found among the people. To make a formal diagnosis of any disorder, usually the DSM-IV-TR or the DSM 5 criteria is used. Diagnosis of a MDD, according to DSM - there are 5 (or more) symptoms whose presence can be seen during a 2 week period and these symptoms represent a change from the previous year functioning. Of these 5, one of the symptoms should at least be (1) depressed mood or (2) loss of interest or pleasure. Also these symptoms should not be because of any medical condition. (Please refer to DSM criteria for details of the 5 symptoms).

BIPOLAR DISORDER - According to DSM 5, there are two main types of BD - BD I and BD II. Based on the severity level and the nature of the symptoms, one can identify which BD it is.

Bipolar I - at least one manic episode in life, many people also experience many depressive episodes throughout their life.

Bipolar II - there will be at least one hypomanic episode which is a less severe form of mania. Also, there will be the presence of at least one major depressive episode.

a. Treatment for the two disorders are different because the symptoms are different in both the cases. In MDD, there are no episodes of mania and hence medication for MDD does not include mood stabilizers. But in BD, there are episodes of both mania and major depression and so, both mood stabilizers and anti-depressants are required.

Examples of pharmacological treatment for MDD - SSRIs (Prozac, Paxil)/ Trycyclic antidepressant (Tofranil), MAOIs (Parnate, Nardil etc).

Pharmacological treatment for BD - Mood stabilizers (Lithobid)/, Antipsychotic (Risperdal) etc

Non pharmacological interventions for both the disorders would involve - psychotherapy like CBT, DBT etc. Home remedies like focussing on maintaining a healthy diet, workout plan and overall having a routine. Family focussed therapy, relaxation and mind fullness based therapy etc.

b. It is always important to cross verify the diagnostic information with a close family member because sometimes the patient, themselves live in a state of denial or are unaware of the severity of their own conditions. Also, sometimes, in rare cases,patients might try to hide, or give false information which might be matter of great concern and because of which the treatment would not be effective. Moreover, the family member will be able to provide a history of the mental illness, the behavioral patterns, the details of the episodes etc in a non-biased way.