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Reducing Misdiagnosis of Psychiatric Disorders

Washington, D.C. - Misdiagnosis or incomplete diagnosis of bipolar disorder is extensive among psychiatric patients, according to a study published in the January 2001 Journal of Psychiatric Services.

Psychiatrists who reconsider diagnoses in overlapping areas of bipolar depression, major depression and other disorders are more likely to make correct diagnoses, according to the study, which suggests that between 15% and 40% of patients with bipolar disorder are misdiagnosed. Bipolar disorder is characterized by episodes of a major depressive disorder with manic tendencies.

Lead author Charles L. Bowden, M.D., chairman of the department of psychiatry at the University of Texas Health Science Center, says the most effective way to prevent misdiagnosis is to fully discuss comorbid, or multiple disorders with any patient that may be at high risk. Encouraging patients to look for subtle yet diagnosis-defining manic sides of the illness is crucial.

"It's important to put it in the person's consciousness, rather than just relying on your own assessment," Bowden says. One reason is that the effects of depression can be long-lasting, whereas the manic symptoms are generally more fleeting and less likely to be recognized by a doctor who does not have the benefit of observing a patient at all times.

It is also a good idea to have a significant other or family member participate in some components of a patient's assessment. Patients may not always acknowledge parts of their illness, especially the manic parts. "Often, they're not withholding or denying, but it just doesn't register," Bowden says. "Having a family member there can give them objectivity."

The study indicates that current limitations of diagnostic tools and resources result in patients who are treated with antidepressants without the benefit of mood stabilizers. For this reason, it is important that clinicians be aware of any hint of bipolar disorder developing in the course of antidepressant therapy.

Because the Diagnostic and Statistical Manual, Fourth-Edition requires a manic episode to make a diagnosis of bipolar disorder, many patients are initially diagnosed and treated as having major depression. A manic episode involves a distinct period of abnormal, irritable moods, characterized by inflated self-esteem, sleeplessness and other traits.

In some cases, misdiagnosis is a function of symptom overlap, while other patients may truly have more than one disorder. In the past, bipolar disorder was often misdiagnosed as schizophrenia, but this problem diminished with the realization that psychosis is common in both disorders, rather than specifically to schizophrenia.

["Strategies to Reduce Misdiagnosis of Bipolar Depression," by Charles L. Bowden, M.D., et al., p. 51, Journal of Psychiatric Services, January 2001.]

---American Psychiatric Association

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