How reliable do you find it to make the diagnosis of bipolar disorder based on a patient report of prior symptoms or questionnaire and not the actual observation of hypo/mania on the exam?  

Of course, direct observation is the most reliable way to diagnose a patient with bipolar disorder. Self-report can be less reliable especially if the described symptom of hypomania/mania is in the distant past. I find that patients are least likely to describe past periods of paranoia, intense irri...

I agree that direct observation is always nice, but we certainly don't want to wait for a manic episode to determine the correct diagnosis. I find that by asking lots of detailed questions, most people who have experienced and manic episode can report enough history to correctly. Identify the episod...