As discussed, many physical ailments can first present with mood symptoms. A good medical history, review of organ systems and physical examination should be part of any workup of bipolar disorder. The physical examination is not typically performed by the psychiatrist (although it could be), but rather by the individual’s primary care physician, an internist, or a hospitalist.
In the case of someone being admitted to a hospital in the midst of a severe mood episode, a physical examination will be performed early in his stay (within the first twenty-four hours). This is on top of a more cursory examination performed in the emergency room (medical clearance).
Information from the examination and medical history is incorporated into the overall diagnostic picture. In an outpatient setting, a recent physical examination and communication with the patient’s primary care physician, if there are active medical issues and medical medications, is a recommended part of the overall evaluation.