Unrecognised bipolar disorder in primary care patients with depression

Department of Psychological Medicine and Neurology, Cardiff University School of Medicine, University Hospital of Wales, Cardiff, UK.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 02/2011; 199(1):49-56. DOI: 10.1192/bjp.bp.110.083840
Source: PubMed


Bipolar disorder is complex and can be difficult to diagnose. It is often misdiagnosed as recurrent major depressive disorder.
We had three main aims. To estimate the proportion of primary care patients with a working diagnosis of unipolar depression who satisfy DSM-IV criteria for bipolar disorder. To test two screening instruments for bipolar disorder (the Hypomania Checklist (HCL-32) and Bipolar Spectrum Diagnostic Scale (BSDS)) within a primary care sample. To assess whether individuals with major depressive disorder with subthreshold manic symptoms differ from those individuals with major depressive disorder but with no or little history of manic symptoms in terms of clinical course, psychosocial functioning and quality of life.
Two-phase screening study in primary care.
Three estimates of the prevalence of undiagnosed bipolar disorder were obtained: 21.6%, 9.6% and 3.3%. The HCL-32 and BSDS questionnaires had quite low positive predictive values (50.0 and 30.1% respectively). Participants with major depressive disorder and with a history of subthreshold manic symptoms differed from those participants with no or little history of manic symptoms on several clinical features and on measures of both psychosocial functioning and quality of life.
Between 3.3 and 21.6% of primary care patients with unipolar depression may have an undiagnosed bipolar disorder. The HCL-32 and BSDS screening questionnaires may be more useful for detecting broader definitions of bipolar disorder than DSM-IV-defined bipolar disorder. Subdiagnostic features of bipolar disorder are relatively common in primary care patients with unipolar depression and are associated with a more morbid course of illness. Future classifications of recurrent depression should include dimensional measures of bipolar symptoms.

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    • "Prevalance for bipolar disorder (combining schizophrenia, other psychoses, and severe bipolar disorder). However, it is important to note that there is a growing international literature expounding the hypothesis that bipolar spectrum disorders are in fact frequently misdiagnosed as major depressive disorder; most pertinently in the Primary Care setting [26,27]. This is an important point, given that treatment with antidepressants may in fact be harmful in this population, and there are notably high rates of suicide associated with a diagnosis of bipolar disorder. "
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    BMC Neurology 06/2014; 14(1):128. DOI:10.1186/1471-2377-14-128 · 2.04 Impact Factor
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    • "Neuropsychiatric Genetics antidepressants, undiagnosed bipolar disposition has received the most attention [Ghaemi et al., 2002; Ghaemi, 2008; Smith et al., 2009; Perlis et al., 2011; Smith et al., 2011]. The distinction between major depressive disorder (MDD) and bipolar disorder can be difficult in individuals who present during a depressive episode and impossible in those who have not yet developed their first episode of mania but may have a latent bipolar disposition [Ghaemi et al., 2002]. "
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    ABSTRACT: The high heterogeneity of response to antidepressant treatment in major depressive disorder (MDD) makes individual treatment outcomes currently unpredictable. It has been suggested that resistance to antidepressant treatment might be due to undiagnosed bipolar disorder or bipolar spectrum features. Here, we investigate the relationship between genetic susceptibility for bipolar disorder and response to treatment with antidepressants in MDD. Polygenic scores indexing risk for bipolar disorder were derived from the Psychiatric Genomics Consortium Bipolar Disorder whole genome association study. Linear regressions tested the effect of polygenic risk scores for bipolar disorder on proportional reduction in depression severity in two large samples of individuals with MDD, treated with antidepressants, NEWMEDS (n = 1,791) and STAR*D (n = 1,107). There was no significant association between polygenic scores for bipolar disorder and response to treatment with antidepressants. Our data indicate that molecular measure of genetic susceptibility to bipolar disorder does not aid in understanding non-response to antidepressants. © 2013 Wiley Periodicals, Inc.
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    • "The diagnosis of Bipolar disorder is missed many times, especially when it is of type 2, when a diagnosis of unipolar disorder (MDD) is made instead. Several recent studies have found that manic symptoms, occurring at an intensity and duration just below the DSM-IV- TR diagnostic threshold for hypomania, are relatively common in patients who experience recurrent Major depressive episodes and are then presumed to be 'unipolar'[6] [7]. This can be attributed to two causes; the first consists of the fact that some clinical practitioners do not consider any bipolar disorder beyond the classic type 1 as a valid clinical entity [8] and the second is the poor capacity of patients to recall hypomanic episodes [9]. "

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