Bipolar Disorder (BD) is typically characterized by recurrent periods of depression, alternating with episodes of elated mood (mania or hypomania). This workshop will focus on providing the practicing psychiatrist with key elements necessary for the correct identification of BD patients. Critical aspects of the clinical history and mental status exam will be discussed, with a particular emphasis on atypical presentations of BD and their differential diagnosis with other conditions, such as major depressive disorder, borderline personality disorder, attention-deficit and hyperactivity disorder (ADHD), and substance-induced mood disorder. The different cognitive errors that may lead to the misdiagnosis of BD will be critically addressed. Clinical vignettes will be utilized to illustrate the diagnostic difficulties involved in the correct identification of BD patients and to engage the audience in interactive discussions and diagnostic exercises. Moreover, recent research studies directed to refining and incrementing the diagnosis of BD will be discussed. Finally, proposed practical algorithms aiming at improving the diagnostic precision of BD will be presented.

**This content was captured for the 2020 APA OnDemand product and may reference information from various sources and terminology from previous editions of the DSM.

Course References

• Angst, J., Gamma, A., Benazzi, F., Ajdacic, V., Eich, D., and Rössler, W. (2003). Diagnostic issues in bipolar disorder. European Neuropsychopharmacology 13, 43–50. 

• Donohue, A.W. (2012). Diagnosing Bipolar Disorder in the Community Setting: Journal of Psychiatric Practice 18, 395–407. 

• Ghaemi, S.N. (2013). Bipolar Spectrum: A Review of the Concept and a Vision for the Future. Psychiatry Investigation 10, 218. 

• Ghouse, A.A., Sanches, M., Zunta-Soares, G., Swann, A.C., and Soares, J.C. (2013). Over diagnosis of bipolar disorder: a critical analysis of the literature. ScienficWorldJournal 2013, 297087. 

• Kernberg, O.F., and Yeomans, F.E. (2013). Borderline personality disorder, bipolar disorder, depression, attention deficit/hyperactivity disorder, and narcissistic personality disorder: practical differential diagnosis. Bullen of the Menninger Clinic 77, 1–22. 

• Monteith, S., Glenn, T., and Bauer, M. (2013). Searching the internet for health information about bipolar disorder: some cautionary issues. Int J Bipolar Disord 1, 22. 

• Pies, R. (2002). The “softer” end of the bipolar spectrum. Journal of Psychiatric Practice® 8, 189–195. 

• Ruggero, C.J., Zimmerman, Chelminski, I., and Young, D. (2010). Borderline personality disorder and the misdiagnosis of bipolar disorder. Journal of Psychiatric Research 44, 405–408.

Learning Objectives

• Determine the challenges involved in the proper diagnosis of bipolar disorder and the therapeutic and prognostic implications of the inaccurate diagnosis
• Analyze the main heuristics and cognitive processes associated with the misdiagnosis of bipolar disorder
• Discuss strategies aiming at improving the diagnostic accuracy of bipolar disorder
• Critically analyze practical examples involving different clinical cases mistakenly diagnosed as bipolar disorder

Target Audience

Psychiatrists, Residents/Fellows

Estimated Time to Complete

Estimated Duration: 75 minutes
Begin Date:  May 1, 2021
End Date: May 1, 2024

How to Earn Credit

Participants who wish to earn AMA PRA Category 1 Credit ™ or a certificate of participation may do so by completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit

The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. 

The APA designates this enduring CME activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty and Planner Disclosures

Program Presenters

• Jair Soares, M.D., Professor & Chairman, McGovern Medical School; Dr. Soares reports the following relationships: Consultant: Alkermes, Compass Pathways, LivaNova, Pfizer, Sanofi Pharmaceuticals, Inc., Sunovion Pharmaceuticals Inc. Grant/Research: Alkermes, Allergan, Compass Pathways
• Marsal Sanches, M.D., Psychiatrist, University of Texas Harris County Psychiatric Center; Reports no financial relationships with commercial interests
• Vineeth John, M.D., Professor, Vice Chair For Education, Director Of Geriatric Psychiatry, McGovern Medical School; Reports no financial relationships with commercial interests
• Sabrina Correa Da Costa, M.D., Psychiatrist, Mayo Clinic; Reports no financial relationships with commercial interests
• Cristian Zeni, M.D., Houston with Psychiatry & Neurology (Child & Adolescent); Reports no financial relationships with commercial interests

Program Planners

• Tristan Gorrindo, M.D., Director of Education, American Psychiatric Association. Reports no financial relationships with commercial interests.
• Katie Putnam, Membership Development Specialist, American Psychiatric Association. Reports no financial relationships with commercial interests.
• Ally Brown, M.S., Senior Instructional Designer, Online Learning, American Psychiatric Association. Reports no financial relationships with commercial interests.

Accessibility for Participants with Disabilities

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. If you have trouble accessing any of APA’s online resources, please contact us at 202-559-3900 for assistance.

Technical Requirements

This internet-based CME activity is best experienced using any of the following:

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari
• Internet Explorer 11+

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version)
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version)
• Internet Connection: 1 Mbps or higher

Minimum Requirements:

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance