Bipolar Diagnoses Often Inaccurate
> 5/6/2008 2:51:51 PM

It would appear, according to ongoing research, that bipolar disorder is both over- and underdiagnosed. In a strange compliment to earlier stories regarding the considerable number of bipolar individuals who don't get the help they desperately need because their condition is mistaken for major depression, a new study demonstrates the fact that quite a few of those who receive positive diagnoses do not actually qualify. This discrepancy stems from both an incomplete understanding of the condition and a failure to follow accepted diagnostic standards. It's unclear why many clinicians seem so imprecise in naming the disorder, but firmer practical guidelines clearly need to be drawn - and meticulously followed.  

The study, sponsored by Rhode Island Hospital and Brown University, involved some 700 psychiatric outpatients who were surveyed using the industry standard Structured Clinical Interview for DSM-IV (SCID), a survey-guide text used for diagnosing various mental health conditions. Researchers also asked each individual whether he or she had been diagnosed with bipolar disorder in the past and determined the accuracy of initial diagnoses by comparing them to the tests performed in conjuction with the survey. Their results were somewhat startling: only 43% of the 145 individuals who were previously diagnosed with bipolar disorder qualified for the condition under the SCID.

Did doctors fail to consult the SCID in more than half of these positive cases? No lab test for bipolar disorder currently exists, but the number of incorrect diagnoses uncovered by this study discredits the apparent tendency to offer diagnoses based on personal impressions. In the face of pharmaceutical initiatives advertising an anti-psychotic drug boom and reminding clinicians not to miss bipolar diagnoses, they may be identifying the condition too aggressively. Another notable finding: genetics plays a considerable role in the bipolar equation, and the fact that far more of the patients diagnosed under the manual's guidelines also had that familial predisposition lends further credence to the idea that the methods used to diagnose these individuals need to be reconsidered. 

This study was part of a larger, ambitious project aiming to highlight deficiencies in common diagnostic practices. The project previously found fault with eating disorder diagnoses, calling them too narrow to serve the needs of individuals who suffer from conditions that do not fit into either of the two major types (anorexia, bulimia) named in the DSM. Overdiagnosis may be particularly troublesome in the case of bipolar disorder because medication is nearly always recommended and many of the mood-stabilizing drugs used to treat the condition (lithium, antiseizure and antipsychotic meds, benzodiazapenes) have severe side effects. Researchers involved in this study believe that many clinicians err on the side of diagnosing disorders treatable by medication because the subsequent treatments are so much more familiar to them.

The solution, as offered by the researchers, is fairly simple: clinicians should use the universal standard when diagnosing bipolar disorder because the interests of the affected patient are paramount. Despite the sometimes nebulous nature of mental illness, precise diagnoses better serve those affected. But we do have an increasingly nuanced understanding of bipolar disorder. While it is officially limited to two distinct types based on symptomatic intensity, many experts now believe it to be a spectrum disorder in a fashion similar to autism. Does the SCID need to be updated? As our knowledge base expands, we will surely need to revise many definitions, and a greater variety of treatments is inevitable. But for now we need to be as precise as we possibly can to ensure that patients are diagnosed correctly and that every individual who receives the powerful medications designed for the treatment of bipolar disorder truly needs them.

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