Assessment and Intervention: Bipolar Disorder

Heightening and extreme shifts between moods is characteristic of Bipolar Disorder. Patients may exhibit symptoms that are a noticeable change from their usual behavior. Practitioners may initially suspect Major Depression if the patient is experiencing depression after a manic episode. The symptoms may include: Inflated self-esteem or grandiosity, decreased need for sleep, more talkative than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, distractibility, increase in goal-directed activity or psychomotor agitation, and excessive involvement in activities that have high potential for painful consequences.

For members who present with manic and/or depressive symptoms and have not been diagnosed with Bipolar or another behavioral health condition, refer the member to an in-network specialist who can further assess. Providers can follow these steps with their members:

Assess: Use a standard tool to assess the severity of the member’s mood swings.

Diagnose: The member’s diagnosis reflects the clinical documentation.

Refer: If applicable, refer the member to a mental health professional. You may also refer the member to Molina Healthcare’s Case Management services for additional assistance.

ICD 10 Codes:

*ICD 10 codes capture current symptoms, severity, and onset.

Bipolar Disorder, current episode depressed, mild: F31.31

Bipolar Disorder, current episode manic without psychotic features, unspecified: F31.10

Assessing for Bipolar

The Mood Disorder Questionnaire _MDQ is an effective screening instrument for Bipolar Disorder. The tool is not diagnostic, but is indicative of the existence of bipolar disorder. A positive screen must be followed by a clinical assessment to determine diagnosis.

Case Scenario

29-year old married, mother of a young child age 2, presents with a history of recurrent and disabling depression and headaches. For the past week, she "rushes around, laughs a lot and has more anxiety." A past trial with Wellbutrin was poorly tolerated because of sweating episodes, insomnia and agitation. Several weeks ago, she became severely depressed and had difficulty moving, had diminished appetite, had crying spells much of the day and felt suicidal. She is on Prozac 20 mg a day, and describes herself as getting “manicky” on the Prozac. Her depression is worsening despite the Prozac treatment. Family history of Bipolar disorder - father and paternal grandmother.

Assessment/Diagnosis: Diagnosis of major depressive disorder is suspect, given patient's poor response to both antidepressants. Prozac was discontinued because it appeared to be worsening the underlying mood swings. Diagnosis of Bipolar Disorder, single episode, manic can be made given patient's symptoms and family history. (ICD-10 Code: F30.11*, Bipolar disorder, manic episode without psychotic symptoms, mild.)

Plan: Discontinue Prozac. Patient placed on Seroquel 100mg at bedtime. Also referred to supportive psychotherapy.

RAMP.Operations@MolinaHealthCare.Com