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Thursday's Bipolar Abstract:
Clinical predictors of
unrecognized bipolar I and II disorders
Outi Mantere, Kirsi
Suominen, Petri Arvilommi, Hanna Valtonen,
Sami Leppämäki, and Erkki Isometsä
From the Department of
Mental Health and Alcohol Research, National Public Health Institute,
Helsinki; Department of Psychiatry, Jorvi Hospital, Helsinki University
Central Hospital, Espoo; and Department of Psychiatry, Helsinki
University Central Hospital, Helsinki, Finland
Objective: Bipolar disorder
(BD) is correctly diagnosed in only 40–50% of patients. No previous
study has investigated the characteristics of bipolar patients in
psychiatric care with or without clinical diagnoses of BD. We
investigated the demographic and clinical predictors of the absence of a
clinical diagnosis of BD I and II among psychiatric patients.
Methods:
In the Jorvi Bipolar Study, 1,630 psychiatric in- and outpatients were
screened with the Mood Disorder Questionnaire. Suspected cases were
diagnosed with the Structured Clinical Interview for DSM-IV Axis I
Disorders-Patient version (SCID-I/P) for BD. Patients with no preceding
clinical diagnosis of BD, despite previous manic, hypomanic or mixed
phases and treatment in psychiatric care, were classified as
undiagnosed. The clinical characteristics of unrecognized BD I patients
(23 of 90 BD I patients) and BD II patients (47 of 93 BD II patients)
were compared to those of patients who had been correctly diagnosed.
Results:
No previous hospitalizations [odds ratio (OR) = 10.6, p = 0.001] or
psychotic symptoms (OR = 4.4, p = 0.045), and the presence of rapid
cycling (OR = 11.6, p = 0.001) predicted lack of BD I diagnosis. No
psychotic symptoms (OR = 3.3, p = 0.01), female gender (OR = 3.0, p =
0.03), and shorter time in treatment (OR = 1.1, p = 0.03) predicted the
lack of a BD II diagnosis.
Conclusions: Correct diagnosis of BD I is related to
the severe phases of illness leading to hospitalizations. In BD II, the
illness factors may not be as important as time elapsed in treatment, a
factor that often leads to a delay in diagnosis or none at all.
Excessive reliance on typical and cross-sectional presentations of
illness likely explain the non-recognition of BD. The challenge for
correctly diagnosing bipolar patients is in outpatient settings.
Source: Bipolar
Disorders
2008; 10 (2): 238-244
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Other
bipolar Links:
Juvenile Bipolar
Research Foundation
Child and Adolescent
Bipolar Foundation
Depression and
Bipolar
Support Alliance
NIMH Child and
Adolescent Mental Health
International Society for Bipolar Disorders
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