What We’ve Said

What we’ve said about Collateral information

13 points from 8 episodes, newest first

Also searched as collateral, collateral history

In short

Collateral is the main thing that matters in diagnosing bipolar disorder, and the higher the stakes and the doubt, the more you need it before committing to treatment. When you cannot get it, do not assume the presentation is normal for the person; and remember that in many places you can still call people without disclosing anything.

Why it matters

  1. In bipolar disorder, family history and collateral are the most important things. A patient can come across as cluster B, using primitive defenses, and then a family member or partner describes clear-cut episodes of mania.

    “look for family history and get collateral. Those are the most important things because you'll get a history from a patient and then you'll speak to a family member or partner and you'll hear clear cut episodes of mania”
    9:19How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026
    Also said in 1 more episode
    “The main thing that matters in bipolar is collateral. There were so many times I'd have an interview with a patient, and they would come off as cluster B, and they would be using primitive defense mechanisms”
    3:42Bipolar Misunderstandings, Integrating Biology & Personality, & Broader ConceptualizationsSep 2024

  2. Most diagnosis happens in a two-person reality, which makes it hard to pin down. That is why collateral and records help.

    “when it comes to diagnosis, most of the time we're dealing with a two person reality. Right. And that gets really a lot harder to determine. And that's why it's nice to have collateral, right, on records”
    4:22How to Decide When ADHD Is Actually ADHDNov 2025

  3. An assessment rests on all the medical data you can gather for the case. If the patient will not cooperate, you cannot simply make no decision; you can wait and reassess later.

    “An assessment is just based on all the medical data that you can gather for that case. OK. And so when a patient is not cooperative, then your hands are tied. You can't. simply make no decision. You can try and wait and reassess at a later time”
    38:04Involuntary Treatment & Agency, Thoughts and Feelings | Episode 19Mar 2025

When we get it

  1. The higher the stakes and the more severe the symptoms, the more information you need to gather and the more certainty you need.

    “when the stakes are higher, when the symptoms are higher, yeah, we need to be gathering more information and getting more certainty when the stakes are higher and higher”
    46:08How to Diagnose Bipolar Disorder with Dr. Phelps: Hypomania, Mixed States & the Clues DSM MissesSep 2026

  2. If there is still doubt about bipolar disorder, try hard to wait before committing to a medication approach, and go get collateral from some source.

    “If there is still some doubt, I would try as hard as possible to wait to commit to a pharmacotherapy approach and go get collateral information from some source because of that”
    25:41How to Diagnose Bipolar Disorder with Dr. Phelps: Hypomania, Mixed States & the Clues DSM MissesSep 2026Guest episode

  3. A busy clinician can send the patient home with an HCL-32 PDF to talk over with their people and pick it up at the next visit. As long as you pursue the information before you set out on a treatment course, you are doing your due diligence.

    “You send them home with an HDL32 PDF and say, talk about this with your people, and then we'll take her from there when you come back. As long as you are pursuing the information before you set out on your treatment course, I think you're doing the due diligence”
    46:31How to Diagnose Bipolar Disorder with Dr. Phelps: Hypomania, Mixed States & the Clues DSM MissesSep 2026Guest episode

  4. When something seems off but the diagnosis is unclear, the answer is first time, watching how symptoms progress, and second, collateral.

    “the way you solve that is first off time and seeing them progress and see how those symptoms progress. And second, collateral”
    37:21What is Psychosis? Look at the DSM, Common Mimics, and a Framework for the DifferentialJan 2026

  5. With higher risk, actively request to communicate with family or trusted people so they can help coordinate care, encourage appropriate medication and watch for alarm symptoms and dangerousness.

    “you must actively request to communicate with these people so that it can help coordinate care and encourage people to take medications that are appropriate or not or monitor for alarm symptoms and dangerousness”
    56:25Lindsay Clancy Case: Biggest Misconceptions After the Mistrial Explained by a Forensic PsychiatristSep 2026

When you cannot get it

  1. Without collateral, you cannot assume the person presents this way because it is normal for them. That is possible, but a minority of cases. Compare them to an ordinary, regular person.

    “when you don't have collateral, you cannot imagine that a person has presented because this is normal for them. It's always possible. I would say that that's a minority of the cases. You have to then start comparing them to an ordinary, regular person”
    36:29Bipolar Misunderstandings, Integrating Biology & Personality, & Broader ConceptualizationsSep 2024

  2. If the patient may be hiding symptoms, talk about things that seem unrelated and rely on your mental status exam rather than on what the patient tells you.

    “You want to talk to them about things that seem unrelated and you want to rely on your mental status exam rather than relying on the output statements of the patient around you”
    30:09Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and CulpabilityApr 2025

Privacy and the law

  1. You cannot disclose anything about the patient or their care, but in many places no law forbids you from calling a partner, and saying you can neither confirm nor deny any information about a specific patient.

    “you can't disclose information about her or her care to the boyfriend. But there is, in many places, no law that forbids you from simply calling the boyfriend and saying, hi, I'm Dr. Malzberg. I can neither confirm nor deny any information about a specific patient”
    48:55Involuntary Treatment & Agency, Thoughts and Feelings | Episode 19Mar 2025

  2. Some places have an imminent-harm exemption that allows calling collateral and disclosing protected health information, but it is very state-dependent.

    “there is an exemption for imminent harm to be able to call collateral and disclose protected health information. But again, it's very state-to-state dependent”
    49:56Involuntary Treatment & Agency, Thoughts and Feelings | Episode 19Mar 2025

Pitfalls

  1. Collateral is not always useful. Some people completely fail to notice clear disorganized schizophrenia in a family member they live with.

    “sometimes collateral is not that useful. I've had people just completely not even notice clear disorganized schizophrenia in the family member that they cohabitate with”
    9:38How to Diagnose Bipolar Disorder: The Interview Framework That Beats Screening QuestionsFeb 2026

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.