The Best Bipolar Diagnostic Interview From The Best Bipolar Expert

A practical guide to conducting a semi-structured diagnostic interview for bipolar disorder while ruling out common clinical mimics.

Bipolar disorder diagnostic interview: a practical, semi-structured approach. We cover how to pull narrative threads, map depression and sleep changes, and rule out mimics like substances, PTSD, and borderline traits without checklist thinking. 💡Anti-depressant Course: psycho.farm/psychofarm-course 📖 PsychoFarm's Treating Depression Book: a.co/d/3M0uFui ================ Follow PsychoFarm: 🔴SUBSCRIBE ► youtube.com/c/Psychofarm?sub_confirmation=1 🧠Mental Health Resources: psycho.farm/services-4 ➡ Substack: psychofarm.substack.com/ ➡Apple Podcasts: podcasts.apple.com/us/podcast/psychofarm-podcast/id176654449… ➡Spotify: open.spotify.com/show/5kqD1sD0EtWNYopWT5MbGs ================ Bipolar disorder diagnostic interview: a practical, semi-structured approach to getting the diagnosis right. If you’ve ever had a patient “screen positive on everything” or “no to everything,” this episode is about building a better interview, not hunting for one magic question. Why this is hard Psychiatry doesn’t have a blood test for bipolar disorder. Your questions are the exam, and what you hear depends on wording, context, and the patient’s baseline risk. Start before mood episodes We walk through a high-yield intake sequence: * Medical history and non-psychiatric meds (including steroids and other culprits) * Medication timeline (including antidepressants and possible antidepressant-induced mania) * Substance timeline (intoxication vs real sobriety periods, stimulants, “supplements,” and misattribution) Depression first, then bipolar Before you chase hypomania, map the course of major depressive episodes: first onset, recurrence, duration, time fully well, and whether there’s chronic low mood with distinct “worse” episodes. This often raises or lowers suspicion in a way checklists can’t. Hypomania screening that actually works We share phrasing that focuses on “not your normal self,” decreased sleep with preserved activity, and mood changes across 48–72 hours, then immediately pivots to narrative: tell me what happened, walk me through the day, what changed in functioning? We also cover sleep patterns that can be more typical than “no sleep,” like early awakening with feeling fully rested after just 2–3 hours. When needed, we tighten the picture by exploring speech, racing thoughts, irritability/euphoria, and impulsive behavior (spending, sex, fights, risky decisions), always compared to baseline. Mimics you must rule out Substances and meds, PTSD hypervigilance with severe insomnia, borderline traits and mood lability without episodes, psychosis-related agitation, paradoxical insomnia, and “ADHD” labels applied to mood-driven concentration problems. Tools that help, without replacing judgment We discuss common instruments (MDQ, Rapid Mood Screener, BSDS, Hypomania Checklist) as prompts, not substitutes for clinical judgment, and why collateral and family history can change everything.