Assessment of bipolar disorder

Presentation of bipolar disorder is discussed in the Psychotropic guidelines. Additional observable features that may aid in the diagnosis of bipolar disorder in a person with developmental disability are listed in Observable features that may indicate hypomania and mania in a person with developmental disability.

Mixed episodes may be a more common presentation of bipolar disorder in people with developmental disability. Mood is likely to be irritable and labile with cycles of hyperactive or withdrawn behaviours and limited sleep. Advise the person or their carers or support people to keep a daily record of mood and sleep.

Table 1. Observable features that may indicate hypomania and mania in a person with developmental disability
Core symptoms	Observable features
elevated mood	extremely happy and cheerful laughing, singing, whistling inappropriately
irritable mood	anger, easily annoyed labile verbally or physically aggressive
biological manifestations	sleeping less, may not sleep for days losing or gaining weight showing psychomotor agitation
exaggeration or change of pre-existing behaviours	increased volume or rate of speech or vocalisations, talking incessantly, jumping from one topic to another increased tempo of thought, thought disorder, flight of ideas increasing intensity and frequency of usual or new activities (eg eating, drinking coffee, smoking, pacing, walking long distances, rearranging or throwing furniture) changing from one activity to another intrusiveness grandiosity—wanting to do things out of proportion to their skills and abilities not responding to usual requests and redirections dressing colourfully, wearing best clothes to day placement, wearing more jewellery showing disinhibited behaviour (sexual disinhibition, overfamiliarity with strangers, excessive spending, absconding)
loss of baseline level of daily function	decline in self-care, communication
Note: Reference: Fletcher RJ, Barnhill J, Cooper SA, editors. DM-ID 2 A textbook of diagnosis of mental disorders in persons with intellectual disability. Kingston, NY: NADD Press; 2017. [URL]