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Bipolar Disorder Often Misdiagnosed: Presented at APA

By Charlene Laino

WASHINGTON, DC -- May 12, 2008 -- More than half of patients who have been diagnosed with bipolar disorder may not actually have the condition, according to research presented here at the 161st Annual Meeting of the American Psychiatric Association (APA).

In a study of 145 psychiatric outpatients who reported they had been previously diagnosed with bipolar disorder, the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) confirmed the diagnosis in only 43.5%.

The SCID is the "gold standard" for diagnosis of mental disorders, said investigator Mark Zimmerman, MD, Associate Professor of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, and Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island.

The study findings were also published online (J Clin Psychiatry. 2008. http://www.psychiatrist.com/abstracts/oap/ej07m03888.htm. Accessed May 12, 2008). Dr. Zimmerman presented the results on May 8.

The study also showed that 27 of 555 patients who had not been diagnosed with bipolar disorder actually had the condition according to SCID criteria, he said.

The study involved 700 psychiatric outpatients who were interviewed using the SCID and who completed a questionnaire that asked whether the patient had been previously diagnosed with bipolar or manic-depressive disorder.

The structured evaluation confirmed a diagnosis of bipolar disorder in 63 of the 145 (43.5%) patients reporting a previous bipolar diagnosis.

Dr. Zimmerman said that one of the chief dangers of overdiagnosis is unnecessary exposure to mood stabilizers and "their potential powerful liver, kidney, and metabolic side effects."

Patients with anxiety, agitation, irritability, and restlessness that does not persist are sometimes misdiagnosed with bipolar disorder, he said.

"These could be symptoms of bipolar disorder. But they really have to be accompanied by other criteria, such as hyperactivity, feeling energetic despite just a few hours of sleep, or inflated self-esteem," he explained.

Ironically, one reason the disorder is being overdiagnosed is "because so much has been written about it being under-recognized," Dr. Zimmerman added. "So clinicians are loath to miss it."


[Presentation title: Is Bipolar Disorder Overdiagnosed? Abstract 67]

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