Diagnosis, Clinical Features, Differential Diagnosis, and Psychiatric Comorbidities

Bipolar disorders encompass a range of conditions, including bipolar I disorder, bipolar II disorder, cyclothymic disorder, and other specified bipolar disorders. These disorders have a worldwide prevalence of approximately 2.4%. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-5TR proposes a more dimensional understanding of bipolar disorders for use in research settings, aiming to measure psychopathology and consider the continuum between depressive and manic symptoms. While manic and hypomania are the defining characteristics of bipolar disorder, depressive episodes typically emerge first and are the main reason individuals seek treatment. Despite the efforts of manuals and diagnostic criteria, diagnosing bipolar disorder remains challenging for psychiatric clinicians. Differential diagnosis can be difficult due to overlapping symptoms with other psychiatric and general medical conditions, leading to confusion. Studies have shown a high rate of misdiagnosis in bipolar disorder, averaging up to 69% before the correct diagnosis is made. Therefore, clinicians should exercise caution, thoroughly investigate patients’ mood history, and monitor their mood following the most recent episode. The objective of this chapter is to emphasize the essential clinical features and proposes a more dimensional understanding of bipolar disorders.