Irritability as a Diagnostic Criterion

Any of us can have Tuberculosis (TB). Any of us can suffer from Bipolar Disorder (BD) No human can claim that he/she is immune to develop TB; No one can claim that they will never suffer from BD!

Cough is certainly a symptom of TB; Mood swings are certainly a symptom of BD

“Every cough” is not necessarily TB; “Every Mood Swing” is not certainly BD!

Mood Swings May simply be normal emotional waves of life; reflect stresses of coping; indicate personality disorder; may be a feature of BD in some..

Significant and Severe; Persistent and Repetitive; Mood Swings only indicate psychopathology

Periods of Severe Mood SwingsSadness to Happiness and vice versa (Unexplained, Exaggerated & Irrational) to be the Hallmark presentation of BD Significant and Severe Mood swings of sadness to anger outbursts and vice versa, described as Affective Instability (AI),need not always indicate BD; but can be a feature of Personality Disorders (PD) like Borderline Personality Disorder (BPD) and Obsessive Compulsive Personality Disorder (OCPD), and also of Disruptive Mood Dysregulation Disorder (DMDD). Affective Instability (Dysregulation)leads to Behavioral dysregulation. Anger outbursts disrupt relationships; periods of sadness burden a person with negative cognitions. Disruptive emotional and behavioral turbulence, especially in a teenager/ young adult…. rebellion, arguments, negativity, guilt, self harm…. periods of emotional chaos…. bewildered parents…. drug abuse and relationship related issues add fuel to the fire…. Need for professional help is more immediate….descriptive expression of “mood swings” may mislead the clinician into a wrong diagnosis of BD…

Affective Instability mood swings of sadness to irritability to sadness - demands thorough enquiry, both in its cross sectional presentation and also historical longitudinal durations, before arriving at the diagnosis; Differentiation of BD from PD has immense prognostic and therapeutic implications as the treatment plans, both in the short term and in the long term, vary hugely…

Diagnostic mistakes are not uncommon in medical practice; hated by all. Even in these days of MRIs and PET Scans, Digital Pathology and Tele Medicine, Provisional Diagnosis and Differential Diagnoses are common parlance in medical practice! Correct Diagnosis on every patient is every day’s moment of truth to every clinician…Psychiatry is the only branch of medicine with no supportive, confirmatory laboratory diagnostic support. With limitations in place, Psychiatrist, like his medical colleagues, always strive to arrive at the correct diagnosis.

“BD II is a Myth”A rather “Rash” statement, I agree. But the “Rashness” is painted to seek attention! Rashness, I submit, is not out of arrogance, nor an expression of authority, but anguish of my clinical experience about over diagnosis and over treatment BD! Truth has its “Nest” as well as its “Sky” My loud thinking, Collective Idea of our Clinical Experience, is to shake ourselves out of our mental easy chairs..... 🙏

Diagnosis is Prognosis; we owe it (correct diagnosis) to our patients
MSR@ABC
    15 July 2019, 02:30 pm