What’s your first priority when a patient presents with mania with depressive symptoms?
I think probably just recognising the depression as part of the mania or the overall picture, and then, after that, risk assessment and safety, particularly looking at suicidality or risk of self-harm.
According to the IMPACT of Bipolar study, almost two thirds of patients report feelings of depression during a manic episode. How do you identify those depressive symptoms when patients present?
It can be actually quite difficult of course, but I suppose it comes down to taking a very good history, focusing on fluctuations in mood, suicidal or self-harming thoughts, and all the other biological symptoms of depression and being clinically very aware of symptoms, such as irritability and underlying dysphoria.
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