Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
No specific blood tests or instrumental tests will tell the health care professional that a person definitely has bipolar disorder. The diagnosis is made on the basis of all the signs, symptoms
and history. Psychiatric doctors use guidelines from the Diagnostic and Statistical Manual of Mental Disorders (DSM) to establish the diagnosis of bipolar disorder and other psychiatric conditions.
If a person experiences at least four of the symptoms of mania and depression for a period of at least two weeks, that person may have bipolar disorder or another form of mood disorder.
The person may have a long history of feeling depressed and then finally have a first manic episode. This clinches the diagnosis. However, any potentially treatable medical condition that could account for severe mood swings should be ruled out first.
A complete physical examination is performed to check for enlarged glands, poor nerve function, or any other signs of a medical condition.
A detailed interview will focus on the signs of bipolar disorder such as periods of racing thoughts, risky behavior, and inflated self-esteem followed by periods of depression.
Certain tests may be ordered to rule out medical conditions that could cause mood swings, especially when the first manic episode occurs after the age of 40. Tests will probably be ordered to check the balance of electrolytes and sugar in the blood, hormone function, blood cell counts, and drug and alcohol levels. These tests all are blood or urine tests.
Rarely, an EEG (electroencephalogram), a study of the electrical impulses in the brain, may be ordered if the person is thought to have a seizure disorder. Electrodes are placed all over the scalp and secured by an adhesive. The electrodes are hooked up to a machine that traces brain signals. This is seldom performed in the emergency department.
A spinal tap (lumbar puncture) may be ordered to get a sample of spinal fluid. This will be done if signs suggest a brain infection, such as meningitis or encephalitis. Such an infection is generally only considered a possibility if the behavior change happened relatively recently or if a fever or other signs of infection are present. The laboratory will study the fluid and be able to tell if an infection is present.
Treatment is based on the results of these tests. If test results are all normal, the diagnosis is most likely a psychiatric disorder, such as bipolar disorder.