High Levels of Misdiagnosis For Bipolar Disorder Can Impede Treatment

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One of the most sensitive aspects of mental health care is identifying if a psychiatric problem is present. You would think diagnosing patients would become routine, but healthcare professionals are constantly forced into the tricky situation of trying to assess a person’s mental health based only on what the patient describes.

There are many researchers looking for more objective ways of evaluating mental health, but those are largely years away from being implemented into regular health care.

This situation creates numerous complications in the diagnosis process, which can ultimately lead to improper care and treatment based on incorrect assumptions. One of the biggest complications is how similar disorders can appear when you are only relying on subjective statements, which may explain why a new study suggests bipolar disorder is often misdiagnosed as depression.

With the wrong diagnosis, patients are unable to receive the treatment necessary to begin recovery or management of bipolar disorder.

The study, led by Sergey Mosolov from the Moscow Research Institute of Psychiatry, found that over 40 percent of the 409 patients with a diagnosis of recurrent depressive disorder (RDD) had been misdiagnosed. According to Mosolov’s findings, the patients were actually suffering from bipolar disorder, including 4.9 percent with bipolar I disorder, and 35.9 percent with bipolar II disorder.

“This non-recognition may be due to the absence of formal diagnostic criteria for [bipolar II disorder] in the ICD-10,” suggest the researchers in Bipolar Disorders.

They continued: “The consequences of misdiagnosis and inappropriate treatment with antidepressants include a deteriorating clinical course, an increased risk of rapid cycling, suicide, alcoholism, substance abuse, sexually transmitted infections, and criminal activity, and increased costs of care.”

For an example of how misdiagnosis can impede treatment, 17 percent of the patients with bipolar II disorder in the study were treated with antidepressants which are ineffective to the patients.

The study relied on the Mini International Neuropsychiatric Interview and clinical assessment to verify diagnoses. They then tested the sensitivity and specificity of the Russian versions of the hypomania checklist (HCL)-32 and Bipolarity Index to differentiate between those with bipolar II disorder and RDD.

The researchers noted there were no statistically significant demographic differences between those with bipolar II disorder and those with RDD, but they did mention the time from onset of illness to correct diagnosis was significantly longer for the patients with bipolar II disorder (15 years) than for those with RDD (12 years).

The team also admitted that their study may be limited due to the large majority of the study participants were inpatients. However, they believe the results and the development of ICD criteria for bipolar II disorder could help improve diagnosis rates in the future.

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