Management commentary

Providing a diagnosis and introducing a management plan As Parker points out, the diagnosis of Bipolar II Disorder requires detailed history-taking from more than one informant. The identification of hypomanic episodes is more difficult than for manic ones and these may have been overlooked in previous assessments. It is also crucial to engage patients and their families in explaining the diagnosis, its implication and its treatment. However, it is questionable whether BP II can really be described as a ‘milder form’ or ‘bipolar lite’. At best, one could argue that the prognosis and clinical course of BP II are areas of genuine clinical uncertainty because of poor availability of relevant data. It is regrettable that even large-scale studies addressing its prognosis, treatment and outcome (such as that undertaken by the Stanley Foundation Bipolar Network) have failed to substantially increase our knowledge base about BP II. Some data from this study are, nevertheless, highly relevant in suggesting that the morbidity and disability associated with BP II is at least comparable with that for BP I. For example, Nolen and colleagues (2004) examined the one-year clinical outcome for 258 bipolar disorder patients, of whom 53 had a diagnosis of BP II. They found that the mean overall severity of bipolar disorder was related to the severity of the depressive - and not the manic/hypomanic features.