Introduction
Bipolar Disorder is a chronic psychiatric condition characterized by alternating episodes of mania/hypomania and depression. It affects mood, energy, activity levels, and the ability to carry out daily tasks. A comprehensive psychiatric evaluation is essential for accurate diagnosis, understanding symptom patterns, and developing an effective treatment plan.
Purpose of the Evaluation
To confirm the diagnosis of Bipolar Disorder
To differentiate between Bipolar I, Bipolar II, and Cyclothymic Disorder
To assess severity and impact on functioning
To identify co-occurring psychiatric or medical conditions
To guide pharmacological and psychotherapeutic interventions
To evaluate risk factors such as suicidality or psychosis
Key Components of the Evaluation
1. Identifying Information
Patient’s name, age, gender, occupation
Date of evaluation
Referral source (e.g., self, family, primary care)
2. Chief Complaint
Patient’s own words describing symptoms
Example: “I feel like I’m on top of the world one week and can’t get out of bed the next.”
3. History of Present Illness (HPI)
Onset and progression of mood episodes
Duration and frequency of manic and depressive episodes
Triggers and stressors
Impact on relationships, work, and daily functioning
Previous treatments and responses
4. Past Psychiatric History
Prior diagnoses (e.g., depression, anxiety, psychosis)
Hospitalizations
Suicide attempts or self-harm
Substance use history
5. Medical History
Chronic illnesses (e.g., thyroid disorders)
Neurological conditions
Medications and allergies
6. Family History
Bipolar Disorder or other mood disorders in relatives
Substance use or suicide in family
7. Social History
Living situation
Education and employment
Relationships and support systems
Legal issues
Cultural and spiritual background
Mental Status Examination (MSE)
Domain Description
Appearance May be flamboyant or disheveled depending on mood
Behavior Agitated, impulsive, or slowed
Mood Euphoric, irritable, or depressed
Affect Labile, expansive, or flat
Speech Pressured, rapid, or slowed
Thought Process Flight of ideas, tangential, or goal-directed
Thought Content Grandiosity, guilt, suicidal ideation
Perception Hallucinations (in severe mania or depression)
Cognition Impaired attention or memory
Insight Often poor during mania
Judgment Impaired during mood episodes
Risk Assessment
Suicidal or homicidal ideation
Psychotic symptoms
Impulsivity and risky behaviors
Substance use
Noncompliance with treatment
Diagnostic Criteria (DSM-5)
Bipolar I Disorder
At least one manic episode (may be preceded or followed by depressive episodes)
Manic episode lasts at least 1 week or requires hospitalization
Bipolar II Disorder
At least one hypomanic episode and one major depressive episode
No history of full manic episodes
Cyclothymic Disorder
Numerous periods of hypomanic and depressive symptoms for at least 2 years
Symptoms do not meet full criteria for mania or major depression
Formulation
A biopsychosocial summary integrating biological, psychological, and social factors.
Example: “Patient’s manic episodes are triggered by sleep deprivation and exacerbated by poor medication adherence. Family history of mood disorders and recent job loss contribute to instability.”
Treatment Plan
Pharmacological
Mood stabilizers: lithium, valproate, carbamazepine
Atypical antipsychotics: olanzapine, quetiapine, risperidone
Antidepressants (used cautiously to avoid triggering mania)
Psychotherapy
Cognitive Behavioral Therapy (CBT)
Psychoeducation
Interpersonal and Social Rhythm Therapy (IPSRT)
Family-focused therapy
Lifestyle and Support
Sleep hygiene
Stress management
Routine and structure
Support groups
Referrals
Psychiatry for medication management
Psychology for therapy
Social work for housing, employment, or legal support
Documentation Tips
Use objective, descriptive language
Include direct quotes from the patient
Document mood episode patterns and severity
Note medication adherence and side effects
Ensure confidentiality and informed consent
Conclusion
A comprehensive psychiatric evaluation for Bipolar Disorder provides a structured framework for understanding the patient’s mood fluctuations, functional impairments, and treatment needs. Accurate diagnosis and individualized care planning are essential for stabilizing mood, preventing relapse, and improving quality of life.