Conference paper
CAN WE PREVENT UNDER-DIAGNOSIS AND MISDIAGNOSIS OF BIPOLAR AFFECTIVE DISORDER? Repeat audits to assess the epidemiological change in the Caseload of a Community Mental Health Team when Bipolar Disorder is accurately assessed and diagnosed
Eva Nora Bongards
; School of Clinical Medicine, University of Cambridge, United Kingdom ; Christ’s College, University of Cambridge, United Kingdom
Rashid Zaman
; South Essex University Partnership Foundation Trust, United Kingdom ; Department of Psychiatry, University of Cambridge, United Kingdom
Mark Agius
; South Essex University Partnership Foundation Trust, United Kingdom ; Department of Psychiatry, University of Cambridge, United Kingdom ; Clare College, University of Cambridge, United Kingdom
Abstract
Background: Bipolar Affective Disorder is frequently under-diagnosed and misdiagnosed, particularly as unipolar depression.
This has serious implications on treatment and outcome of the condition. A community mental health team (CMHT) in Bedford,
United Kingdom, has therefore reassessed patients to examine whether it is possible to increase the sensitivity of diagnosis of bipolar
affective disorder; to identify more cases and to identify them earlier, in order to be able to offer adequate treatment as early as
possible.
Method: Standards were decided within the team for the diagnosis of bipolar disorder based on the DSM4 criteria for the
diagnosis of Bipolar I and Bipolar II illness. Patients were reassessed and patient data from 2006, 2007, 2010 and 2011, as well as
from 2013, with respect to psychiatric diagnoses. The results were audited and analysed in every year in question. The proportions of
total bipolar, bipolar I affective disorder and bipolar II affective disorder diagnoses, as well as the proportions of recurrent
depressive disorder and other unipolar depression diagnoses were determined.
Results: There was a steady increase in the proportions of both bipolar I and bipolar II diagnoses –from 10.5% in 2006 to 11.0%
in 2013 for bipolar I affective disorder, and from 0% in 2006 (4.9% in 2007) to 9.7% in 2013 for bipolar II affective disorder–, and a
steady decrease in the proportions of both recurrent depressive disorder and other unipolar depression diagnoses – from 16.1% and
18.7%, respectively, in 2006, to 4.8% and 8.0%, respectively, in 2013.
Discussion: The results confirm that it is possible to increase the sensitivity of bipolar affective disorder diagnosis and that this
results in an increased number of diagnoses of the disorder, and a decreased number of diagnoses of unipolar depression.
Unexpectedly, the data also showed that increasingly more patients are receiving multiple psychiatric diagnoses.
Conclusions: This paper shows that it is possible to increase the sensitivity of diagnosis of bipolar affective disorder. This may
be particularly useful in the light of increasingly more mental health problems being treated exclusively in primary care, since
bipolar diagnoses will be less likely to be missed. Better identification, and therefore treatment, of bipolar affective disorder is likely
to lead to better social and professional functioning of affected individuals.
Keywords
bipolar disorder; under-diagnosis; misdiagnosis; reassessment
Hrčak ID:
266470
URI
Publication date:
26.8.2013.
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