Bipolar disorder subject to delayed diagnosis and misdiagnosis

Difficulties surrounding the diagnosis of bipolar disorder and possible ways in which the situation can be improved are the subject of a recent report by Australian researchers.Research conducted in Australia and the US has shown that there is often a significant delay before correct diagnosis of bipolar disorder, with many people being misdiagnosed several times before receiving the correct diagnosis.Bipolar disorder lacks a definitive diagnostic system; differences in DSM-IV and ICD-10 criteria mean that a patient may be diagnosed as bipolar under one system but not under the other. In addition, both systems require a full episode of mania or hypomania to have occurred to allow a diagnosis of bipolar disorder, yet for many patients the illness begins with a depressive episode.Research has shown that early intervention in bipolar disorder results in a more favourable outcome and that appropriate diagnosis and treatment may also be protective against associated functional impairment. The researchers stated that despite difficulties with current diagnostic systems good clinical practice requires that when a patient presents with a depressive episode the clinician should have a strong index of suspicion that the episode may be part of bipolar disorder.Simple screening instruments such as the Mood Disorder Questionnaire may be useful in suggesting an appropriate diagnosis of bipolar disorder and an awareness of the multiple factors that may obscure diagnosis may also be of use. However, in many cases the presenting symptoms of the illness are not those that are required to diagnose or define bipolar disorder, creating a confusing picture for patients and physicians.Diagnosis is also made more difficult by the presence of co-morbidity or by the subject's age; for example, different phenomenology in children and adolescents may create difficulties.Another problem is the potential for structured and clinical interviews to yield differing information. Histrionic patients may report symptoms not seen by the clinician to be clinically salient, potentially resulting in over-diagnosis, while other individuals may deny or minimise symptoms that are evident to third parties.The concept of a bipolar spectrum, whereby patients have symptoms that lie in a grey area between unipolar depression and bipolar disorder, further complicates the diagnosis of bipolar disorder. The potential for mixed symptoms is also problematic, with mixed states having particularly high rates of co-morbidity with anxiety, personality disorders and the use of antidepressants and substance misuse.The researchers concluded that a diagnosis of bipolar disorder can be assisted by asking all patients presenting with depression about symptoms of mania or hypomania, recognising mixed states, and identifying the features that distinguish bipolar from unipolar depression.Reference...