The Diagnosis and Treatment of Bipolar Disorder
Who is qualified to diagnose and treat bipolar disorder?
In general, the need for medication when diagnosed with bipolar disorder is far greater than with depression. Bipolar disorder is much more complicated to treat medically and therefore this should be your primary concern when seeking a qualified clinician.
Many clinicians of various educational backgrounds are qualified to diagnose and treat bipolar disorder to varying degrees. The choice of practitioner type in part will depend on the severity of symptoms, the need for therapy, medication, or a combination of these factors.
Your internist or family practice doctor can diagnose and treat bipolar disorder to a limited degree, as can a nurse practitioner. Typically they will refer you to a mental health specialist, however, because a more in-depth evaluation is warranted. Most insurance plans have participants who can provide mental health services, although sometimes the choices available on a given plan are limited.
Geographical location also may dictate choice of practitioner, as there are shortages of certain clinicians (e.g., child and adolescent psychiatrists) in some areas of the United States. Also, because of the typical need for medication in bipolar disorder (in contrast to unipolar depression), a psychiatrist should be part of the treatment team.
Mental health specialists who can evaluate for and take part in the treatment of bipolar disorder include:
• Social workers
• Psychologists
• Psychiatric nurse specialists or APRNs (advanced practice registered nurses)
• Psychiatrists
In seeking a mental health specialist, it is important to choose someone with proper credentials and training. Anyone can call himself or herself a psychotherapist without having specialized training or a degree. It is appropriate to ask the therapist about his or her training and background in the assessment and treatment of bipolar disorder. Credentials for the above-noted mental health specialists follow.
Social workers provide a full range of mental health services, including assessment, diagnosis, and treatment. Most social workers work in conjunction with a physician, either a primary care practitioner or a psychiatrist who can prescribe medication. They have completed undergraduate work in social work or other fields, followed by postgraduate education to obtain a master’s of social work (MSW) or a doctorate degree.
An MSW is required in order to practice as a clinical social worker or to provide therapy. Most states require practicing social workers to be licensed, certified, or registered. Postgraduate education is two years, with courses in social welfare, psychology, family systems, child development, diagnosis, and child and elder abuse/neglect. During the two years of coursework, social work students participate in internships concordant with their interest. Following completion of the master’s program, direct clinical supervision is usually required for a period of time, the hours of which may vary from state to state, prior to obtaining a license.
Psychologists have completed undergraduate work followed by several years of postgraduate studies in order to receive a doctorate degree (PhD or PsyD) in psychology. Graduate psychology education includes study of a variety of subjects, notably statistics, social psychology, developmental psychology, personality theory, psychological testing (paper and pencil tests to help assess personality characteristics, intelligence, learning difficulties, and evidence of psychopathology), psychotherapeutic techniques, history and philosophy of psychology, and psychopharmacology and physiological psychology. Following the coursework, a year is spent in a mental health setting providing psychotherapeutic care and psychological testing under the supervision of a senior psychologist.
Psychologists must demonstrate a minimum number of hours (usually around 1,500) before they are eligible to sit for state psychology licensure exams. In Louisiana and Arizona, psychologists have earned limited prescribing privileges and work under the supervision of a psychiatrist.
These two states require psychologists to complete a clinical psychopharmacology program in addition to their other postgraduate work. This may be an option for patients if there is a scarcity of psychiatrists available to prescribe medication.
Psychiatric nurse specialists have completed undergraduate work, typically in nursing, and obtain postgraduate education in nursing at the master’s or doctorate level. Master’s programs are two years, with coursework consisting of study in physiology, pathophysiology, psychopathology, pharmacology, psychosocial and psychotherapeutic treatment modalities, advanced nursing, and diagnosis. The training includes clinical work under supervision. Licensing and scope of practice varies from state to state.
Psychiatrists are medical doctors with specialized training in psychiatry. They have completed undergraduate work followed by four years of medical school. Medical education is grounded in basic sciences of anatomy, physiology, pharmacology, microbiology, histology, immunology, and pathology, followed by two years of clinical rotations through specialties that include medicine, surgery, pediatrics, obstetrics and gynecology, family practice, and psychiatry (as well as other elective clerkships). During this time medical students must pass two examinations toward licensure.
After graduation from medical school physicians have a year of internship that includes at least four months in a primary care specialty such as medicine or pediatrics and two months of neurology. Following internship, physicians must take and pass a third exam toward licensure in order to be eligible for licensure (and subsequently practice) in any state. Psychiatrists-in-training have three more years of specialty training in residency, the successful completion of which makes them eligible for board certification.
Following residency, many psychiatrists pursue further training in a fellowship that can last an additional two years. Such fellowships include child and adolescent psychiatry, geriatric psychiatry, consultation-liaison psychiatry, addiction psychiatry, forensic psychiatry, and research. To become board certified, psychiatrists take both a written and an oral examination. Certain psychiatry specialties also have a board certification process. Board certification is not a requirement to practice and may not be obtained immediately upon completion of residency, although many hospitals and insurance companies do require physicians to be board certified within a specified number of years in order to treat patients.
In addition to seeking a private practitioner for mental health services, you have different choices of facilities and programs where you may obtain evaluation and treatment, in which various mental health specialists’ work, including community mental health centers, hospital psychiatry departments and outpatient clinics, university-affiliated programs, social service agencies, and employee assistance programs.
