Citation

Rakofsky JJ, Dunlop BW. Curr. Psychiatry Rev. 2015; 11(4): 222-234.

Copyright

(Copyright © 2015, Bentham Science Publishers)

DOI

10.2174/1573400512666151117211523

PMID

unavailable

Abstract

The misdiagnosis of bipolar disorder is widely prevalent as evidenced by patient surveys, administrative claims data and studies measuring clinicians' diagnostic accuracy. The consequences of a missed or incorrect bipolar disorder diagnosis can have serious short and long-term repercussions for a patient. In this review, a systematic analysis was conducted of over-diagnosis and under-diagnosis rates calculated from all adult bipolar studies comparing patient reported diagnoses with diagnoses resulting from DSM-IV based structured assessments/checklists. Five of the 368 publications were selected using OVID medline and demonstrated under-diagnosis rates of 30-51% and over-diagnosis rates of 12-13%. These results contrast with earlier publications suggesting over-diagnosis of bipolar disorder occurred more frequently than under-diagnosis. An in-depth discussion of the various mechanisms contributing to the over and under-diagnosis of bipolar disorder are provided. These include limitations in the design of structured research interviews, racial bias, and patients' memory impairment, to name a few. In this manuscript the authors also provide recommendations to improve the diagnosis of bipolar disorder and discuss the implications of bipolar spectrum research on the diagnostic process. © 2015 Bentham Science Publishers.

Language: en

Keywords

human; systematic review; Review; bipolar disorder; Bipolar disorder; Assessment; suicide attempt; major depression; lithium; Diagnostic and Statistical Manual of Mental Disorders; intoxication; social adaptation; antidepressant agent; neuroleptic agent; priority journal; sensitivity and specificity; diagnostic error; diagnostic accuracy; Sensitivity; Specificity; diagnostic test; health hazard; hypomania; schizoaffective psychosis; Misdiagnosis; mood stabilizer; memory disorder; outcome assessment; Structured Clinical Interview for DSM Disorders; structured interview; clinical trial (topic); Mood Disorder Questionnaire; medication therapy management; Test-validity