Do mental health clinicians know what questions to ask, but ignore or discount positive responses from patients and this is the cause of bipolar disorder underdiagnosis? That is, do the advocates of bipolar disorder screening scales believe that self-report screening questionnaires will improve bipolar disorder recognition because the results of these tests are less easily ignored than the responses of a patient to a clinical interview?
Researchers of the performance of bipolar disorder screening scales have not addressed these questions in the Discussion sections of their papers. I would argue that bipolar disorder screening questionnaires are superfluous. Because bipolar disorder screening scales have modest sensitivity, a clinical interview is necessary to reduce false negatives. Because bipolar disorder screening scales have modest positive predictive value, a clinical interview is necessary to reduce false positives.
Thus, a clinical evaluation is always needed regardless of the results of the screening test. Consequently, it is not clear how a screening scale for bipolar disorder would be helpful in a psychiatric setting.
By my reckoning a clinical evaluation is needed regardless of the results of the screening scale; thus, it is unclear what niche these measures should occupy. Bowden CL. Strategies to reduce misdiagnosis of bipolar depression. Psychiatr Serv. The bipolar spectrum: a clinical perspective.
Bipolar Disord. On the nature of depressive and anxious states in a family practice setting: the high prevalence of bipolar II and related disorders in a cohort followed longitudinally. Compr Psychiatry. Diagnosing bipolar disorder and the effect of antidepressants: a naturalistic study. J Clin Psychiatry.
Can J Psychiatry. Hirschfeld RM. Bipolar spectrum disorder: improving its recognition and diagnosis. Recognition and diagnosis of bipolar disorder. Yatham LN. Diagnosis and management of patients with bipolar II disorder. J Affect Disord.
The high prevalence of "soft" bipolar II features in atypical depression. Under the direction of lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, the researchers' findings indicate that patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID, they were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.
Their research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to patients who were not previously diagnosed with bipolar disorder. The study was conducted between May and March Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, "In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder.
Looking at these results another way, nearly 40 percent 20 of 52 of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder. The results of the study also indicate that patients who had been over-diagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders.
Zimmerman and colleagues note that "we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive.
In their previously published study that concluded bipolar disorder was over-diagnosed, they studied patients. Of the patients, reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the patients He notes that some medications, including atypical antipsychotics , can increase the risk for high cholesterol and diabetes, while others, such as lithium , have been linked to thyroid and kidney problems.
Conversely, up to 20 percent of people with bipolar disorder may be mistakenly diagnosed with depression by their primary care doctors, according to a study published in July in the British Journal of Psychiatry. And another study, published in August in the journal Bipolar Disorders , analyzed the delay in diagnosis of people with bipolar disorder and found that 90 of those individuals initially received a diagnosis of depression before being correctly diagnosed.
According to the study, the lag between diagnoses was about nine years. The patients who were originally diagnosed with depression tended to be younger, have more manic symptoms, and have better coping skills, which perhaps helped them function throughout the day and contributed to the delay in getting the correct diagnosis. Bipolar disorder can be hard to diagnose, he says, because people often seek professional help only during their down periods and neglect to mention their up, or manic, periods.
In addition, some younger people with bipolar disorder may have experienced depression but not yet had a manic episode, so a misdiagnosis of depression can sometimes occur simply because a person has not yet experienced mania. In some cases, the mania may not be entirely obvious, adding to the confusion for both the patient and the provider.
As a consequence, Schwartz says, those with bipolar disorder are often misdiagnosed as having depression and may be given inappropriate treatment. In some cases, bipolar disorder may be mistaken for schizophrenia if the patient also has psychotic symptoms, according to NAMI, and someone with schizoaffective disorder can also be wrongfully diagnosed as bipolar.
Attention deficit hyperactivity disorder ADHD and anxiety disorder can also be confused with bipolar disorder.
Without proper treatment to effectively even out the peaks and valleys of manic and depressive episodes, patients face an increased risk of turning to alcohol and drugs to cope with symptoms, according to a paper published in in The Journal of Clinical Psychiatry.
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