The differential diagnoses for manic states essentially include other psychotic conditions (e.g. schizophrenia, drug-induced psychosis) and, rarely, a primary organic state. While cross-sectional dissection of the phenomenology can be helpful, there is wisdom in also weighting the longitudinal course. Thus, those with manic states are more likely to describe complete restoration of function between episodes (of mania and/or depression), while this is less likely for those with schizophrenia. Definitive distinction is not always possible, and a diagnosis of 'schizoaffective' disorder may then be appropriate. In severe mania, an 'organic' picture may be suggested, and require exclusion of a dementia or delirium.

The differential diagnosis of hypomanic states is often quite difficult. Questioned about having 'highs', a number of depressed people will present a remission to a euthymic state as a 'high'. Highly creative people may affirm many hypomanic descriptors when possessed by the muse (e.g. less need for sleep, feeling creative and overconfident, being enthused and energized), as may those with a distinctly extroverted or cyclothymic personality when stimulated. Some patients with a cluster B personality style (especially of the borderline type) may also describe mood states that approximate to hypomania. Regrettably, current criteria sets appear to result in a percentage of patients with a primary personality disorder or even a (healthy) cyclothymic personality style being diagnosed as having a hypomanic (or bipolar II) disorder, risking inappropriate treatment.(41) Clarification is probably best assisted by interview of a corroborative witness to determine if hypomanic behaviours are observable.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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