DIFFERENTIAL DIAGNOSIS OF BIPOLAR DISORDERS

DIFFERENTIAL DIAGNOSIS OF BIPOLAR DISORDERS Differential diagnosis of manic attacks Secondary manias Has an organic pathology In these cases, the diagnosis is based on the patient's ATCD, the clinical examination and additional tests. Organicity must always be considered when manic symptoms appear for the first time at an advanced age (>60 years). Generally, there is a confusional note with somatic signs. The etiologies can be of origin: Neurological: brain tumor (frontal++), syphilitic dementia, epilepsy, multiple sclerosis, head trauma, vascular lesions (aneurysm, hematoma, stroke, etc.) Endocrine: hyperthyroidism, hypo or hyperparathyroidism, Cushing's disease, pheochromocytoma Metabolic disorders: Wilson's disease, chronic renal failure and hemodialysis. System disease: Systemic lupus erythematosus To take a substance *Toxic: amphetamine, cocaine, morphine, alcohol. *Medications: antidepressants, INH, corticosteroid, levodopa, bromocriptine Mental confusion In favor of mental confusion -The absence of ATCD of thymic disorders -Alteration of general condition, temporospatial disorientation -Anguish and perplexity -Visual hallucinations and dream delirium -Somatic signs The BDA: The presence of mood disorders and especially an elated, labile and fluctuating mood is common during BDA. In favor of the BDA: -absence of family and personal ATCD of mood disorders -predominance and anteriority of delirium in relation to mood disorders in BDA -Richness and polymorphism of delirium 11.2. Differential diagnosis of bipolar disorder 11.2.1 Schizoaffective disorder (ASD) Here, the differential diagnosis arises mainly with BD with psychotic characteristics. ASD is characterized by the coexistence of schizophrenic and mood symptoms during bouts and intervals of poor quality with persistence of attenuated psychotic symptoms with poor social functioning, whereas in BD, during the intervals, all mood and psychotic symptoms disappear. with resumption of

premorbid socio-professional functioning. The differential diagnosis is based on the following elements: Family history : in ASD, we more frequently have familial ATCD of schizophrenia Clinical : in ASD, presence of dissociative symptoms during attacks and persistence of attenuated psychotic symptoms between episodes. 11.2.2 Delusional disorder The florid periods of passionate delusions are often accompanied by an exaltation of mood and can be confused with manic attacks. Medico-legal issues : The manic episode is the most common source of medicolegal procedures (AML). This is facilitated by excitement, lability of mood, ideas of grandeur, the transgression of prohibitions, the lifting of social inhibitions. These AMLs are of 3 types: ● financial (bad checks, fraud) ● risky sexual behavior ● and acts of rebellion at work. Addictive behaviors : The risk factors for this complication are: -age of early onset of TB -greater thymic attacks in number and duration -the greater frequency of depressive episodes, episodes with mixed characteristics, and rapid cycles. The risk of suicide, violence and impulsivity is greater Professional problems : rash resignations, layoffs, absenteeism, Marital problems : divorces, separations (by intolerance of the spouse or by rash decision