Assessment Questions for Bipolar Disorder with Trauma History and Marijuana Use
Core Bipolar Disorder Symptom Assessment
Ask about distinct mood episodes with specific temporal patterns to differentiate true bipolar disorder from chronic irritability or trauma-related symptoms. 1, 2
Essential Questions About Manic/Hypomanic Episodes
"Have you had distinct periods lasting at least 4-7 days when you felt unusually 'high,' euphoric, or on top of the world—clearly different from your normal mood?" This targets the hallmark feature of mania that distinguishes it from situational reactions. 2, 3
"During these periods, did you need much less sleep than usual but still felt rested or full of energy (sleeping only 2-4 hours)?" Decreased need for sleep is the single most differentiating feature between bipolar disorder and other conditions like ADHD or trauma-related hyperarousal. 1, 2, 3
"Have you experienced periods of racing thoughts, talking much faster than usual, or feeling like your thoughts were jumping from topic to topic?" These cognitive symptoms help distinguish manic episodes from anxiety or PTSD-related symptoms. 3
"During these high periods, did you engage in risky behaviors like excessive spending, sexual indiscretions, reckless driving, or other impulsive actions that were out of character for you?" This assesses functional impairment and goal-directed activity changes. 2
"Did you feel grandiose or have inflated self-esteem during these periods—like you had special powers, talents, or connections?" Grandiosity must be differentiated from normal childhood confidence or trauma-related hypervigilance. 2, 3
Essential Questions About Depressive Episodes
"Have you had periods lasting at least 2 weeks when you felt depressed, empty, or hopeless nearly every day?" This establishes the depressive pole and duration criteria. 2
"During depressive periods, did you experience excessive sleeping (hypersomnia), extreme fatigue, or feeling physically slowed down?" Psychomotor retardation and hypersomnia increase suspicion for bipolar depression rather than unipolar depression. 2, 4
"Have you experienced suicidal thoughts, plans, or attempts?" Bipolar disorder has exceptionally high rates of suicide attempts, requiring thorough assessment. 1, 3
Temporal Pattern Questions
"Can you describe when these mood changes started, how long they lasted, and whether there were clear periods of normal mood in between?" Use a life chart approach to map longitudinal patterns and distinguish episodic illness from chronic temperamental traits. 2, 3
"Have you experienced four or more distinct mood episodes within a single year?" This identifies rapid cycling, which complicates treatment and prognosis. 2
Trauma History Assessment
Trauma symptoms can mimic or co-occur with bipolar disorder, requiring careful differentiation of reactive versus spontaneous mood changes. 1, 3
Specific Trauma-Related Questions
"What traumatic experiences have you had, and when did they occur relative to when your mood symptoms started?" This establishes temporal relationships between trauma exposure and mood symptom onset. 3
"Do your mood changes happen spontaneously, or are they triggered by specific reminders of your trauma?" PTSD-related irritability is typically reactive to trauma reminders, whereas manic irritability occurs spontaneously as part of a mood episode. 3
"Do you experience flashbacks, nightmares, or intrusive memories of traumatic events?" This differentiates PTSD from bipolar disorder, though both can coexist. 1, 3
"Have you experienced periods of feeling detached from yourself or your surroundings, or gaps in your memory?" Dissociative symptoms suggest trauma-related pathology that requires specific treatment approaches. 1
Marijuana Use Assessment
Cannabis use is common in bipolar disorder and may worsen outcomes, but the temporal relationship between use and symptoms is critical for treatment planning. 5, 6, 4
Detailed Substance Use Questions
"When did you first start using marijuana, and how does this timing relate to when your mood symptoms began?" The sequence of onsets affects prognosis—cannabis use disorder preceding bipolar disorder may have different implications than the reverse. 4
"How frequently do you use marijuana (daily, weekly, occasionally), and what quantities do you typically use?" Current use patterns inform immediate treatment decisions. 5, 6
"What are your reasons for using marijuana—to feel good when you're already in a good mood, to calm down when agitated, to help with sleep, or to cope with depression?" Research shows individuals with bipolar disorder use cannabis when experiencing positive affect rather than to self-medicate negative symptoms. 5
"Have you noticed that marijuana use affects your mood, energy, sleep, or thinking in the hours or days afterward?" Cannabis use is associated with subsequent increases in both manic and depressive symptoms. 5
"Have you used other substances including alcohol, stimulants, hallucinogens, or prescription medications not as prescribed?" Comprehensive substance use history is essential, as polydrug use complicates diagnosis and treatment. 3, 4
"Have you ever experienced mood elevation, increased energy, or racing thoughts after starting an antidepressant medication?" Antidepressant-induced mania strongly suggests underlying bipolar disorder and is classified as substance-induced per DSM criteria. 2, 3
Treatment Response History
Past treatment responses provide critical diagnostic and prognostic information. 7, 3
"What psychiatric medications have you tried previously, at what doses, for how long, and what were the results?" Previous positive response to specific medications (like lurasidone or lithium) strongly predicts future response. 7
"Have you ever been hospitalized for psychiatric reasons, and if so, what were the circumstances?" Hospitalization history indicates severity and helps establish diagnosis. 3
"Have you ever stopped taking prescribed medications, and what happened when you did?" Medication noncompliance is a major contributor to relapse, with over 90% of noncompliant adolescents relapsing. 1
Family Psychiatric History
Bipolar disorder has strong genetic loading, making family history a critical diagnostic element. 2, 3
"Do any blood relatives have bipolar disorder, depression, schizophrenia, substance use disorders, or suicide attempts/completions?" First-degree relatives of individuals with bipolar disorder have a four- to sixfold increased risk. 3
"Have any family members had unusual reactions to antidepressants, such as becoming agitated or 'hyper'?" This may indicate familial bipolar vulnerability. 3
Functional Impairment Assessment
True bipolar episodes cause impairment across multiple life domains, not just in isolated settings. 2, 3
"How have your mood symptoms affected your school/work performance, relationships with family and friends, and ability to take care of yourself?" Impairment across multiple settings distinguishes bipolar disorder from situational reactions. 2
"Have you needed special educational services, an individualized education plan (IEP), or accommodations at school or work?" Educational and occupational functioning are significantly affected by bipolar disorder. 1
Comorbidity Screening
High rates of comorbid conditions complicate diagnosis and require comprehensive assessment. 1, 3
"Do you have difficulty concentrating, staying organized, or completing tasks even when your mood is stable?" This screens for ADHD, which has high comorbidity with bipolar disorder. 3
"Do you experience persistent worry, panic attacks, or avoidance of situations due to anxiety?" Anxiety disorders commonly co-occur and require treatment. 1, 3
"Have you had any medical problems, particularly thyroid issues, seizures, or neurological conditions?" Medical conditions can mimic or exacerbate mood symptoms. 3
Safety and Risk Assessment
Bipolar disorder carries exceptionally high suicide risk requiring immediate assessment. 1, 3
"Are you currently having thoughts of harming yourself or ending your life? Do you have a plan? Do you have access to means?" Direct assessment of current suicidal ideation, intent, and access to lethal means is mandatory. 3
"Have you ever attempted suicide or engaged in self-harm behaviors?" Past attempts dramatically increase future risk. 3
"Do you have thoughts of harming others, or have you acted aggressively toward others?" Assess for violence risk, particularly during manic episodes. 3
Collateral Information
Patients often lack insight during manic episodes, making collateral information essential for accurate diagnosis. 3
- Obtain information from family members, previous treatment providers, school records, and pharmacy records to verify reported history and identify episodes the patient may not recall or recognize. Family members can describe behavioral changes and episodic patterns more objectively than patients. 3