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Psychiatry Files - Bipolar

Rob Orman, MD and Shawn Hersevoort, MD, MPH
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Bipolar disorders are broadly broken into three groups: bipolar 1, bipolar 2, and cyclothymia. Each is characterized by varying degrees of vascilation between the poles of mania and depression.  Bipolar 1 is characterized by episodes of mania, Bipolar 2 by hypomania, cyclothymia by greater than average variation in energy levels and mood.  Lithium is the medication of choice for bipolar 1 and, in Dr. Hersevoort’s opinion, can be initiated and managed by primary care physicians.


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Mohan T., mr -

Grandiosity (the G in DIGFAST) is missing from the list of symptoms for Bipolar disorders.

Heidi J., MD -

And so it is! Thank-you for letting us know - it's been corrected on the written summary.

Ian L., Dr -

My experience in Bipolar1 in a primary care is to use an atypical antipsychotic with Lithium for a short time -Olanzapine is recommended by guidelines .
It's faster with calming manic energy and agitation .
Psychotherapy both for calming and support ought be often in the first weeks .

Heidi J., MD -

Good points - Thanks Ian!

John K., MD -

Three robust Huzzahs for Dr Hersevort! I have been concerned about the over-diagnosis of Bipolar 1. Many that come to me with the dx but seem to fit more in the Borderline Personality Disorder category. I love the clarifying questions. This will help me to engage in my favorite procedure, the medication-ectomy

Heidi J., MD -

Fantastic! Glad it's helpful, John :) Dr. Hersevoort is fantastic indeed!

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My Gut Biome Told Me So Full episode audio for MD edition 174:19 min - 82 MB - M4AHippo Primary Care RAP May 2017 Summary 301 KB - PDF