Clinical predictors of unrecognized bipolar I and II disorders

Abstract

Correct diagnosis of BD I is related to the severe phases of illness leading to hospitalizations. In BD II, the illness factors may not be as important as time elapsed in treatment, a factor that often leads to a delay in diagnosis or none at all. Excessive reliance on typical and cross-sectional presentations of illness likely explain the non-recognition of BD. The challenge for correctly diagnosing bipolar patients is in outpatient settings.

Treatment Delay and Excessive Substance Use in Bipolar Disorder

“…This is in line with previous studies showing that patients with co-occurring mental illness and substance use disorders are more likely to use health care services than patients with only 1 disorder (Jacobi et al, 2004;Regier et al, 1993;Urbanoski et al, 2007;Wu et al, 1999). It also converges with findings of higher rates of substance use disorders in patients with recognized BD compared with patients with unrecognized BD (Mantere et al, 2008).…”

“…Among those who receive this treatment, many experience long delays from illness onset to correct diagnosis (Berk et al, 2007;Kessing, 2005;Lish et al, 1994) and/or initiation of adequate treatment (Altamura et al, 2009;Baethge et al, 2003b;Post et al, 2003). Female patients (Baldessarini et al, 2007;Kessing, 2005;Mantere et al, 2008), patients with an earlier onset of the BD (Berk et al, 2007;Kessing, 2005;Larsson et al, 2009;Suominen et al, 2007), and patients with BD II rather than BD I disorder (Baldessarini et al, 2007;Mantere et al, 2008) seem to have longer delays. Whereas long durations of untreated illness is found to be clearly associated with a more severe course and outcome in schizophrenia (Marshall et al, 2005;Melle et al, 2008), it is more disputed whether treatment delays lead to a poorer outcome in BD (Baethge et al, 2003a;Baldessarini et al, 2007).…”

“…BD patients with more severe clinical presentations are, on the other hand, more likely to seek help rapidly (ten Have et al, 2002) and also receive treatment faster (Baethge et al, 2003b;Baldessarini et al, 2003;Goldberg and Ernst, 2002;Mantere et al, 2008) than patients with less severe symptomatology. In general, the odds for patients with co-occurring mental and substance use disorders using health services are higher than for patients with a single disorder (Jacobi et al, 2004;Regier et al, 1993;Urbanoski et al, 2007;Wu et al, 1999).…”

Psychiatric and clinical correlates of rapid cycling bipolar disorder: a cross-sectional study

“…In general, RCBD has been associated with worse disease outcome 9,10 and more severe disability. 7,11,12 More specifically, many factors have been described to be associated with RC, such as female gender, 5,13 earlier age at onset, 6,12 increased risk for suicide, 13,14 predominance of depression, 15,16 hypothyroidism, 6,17 bipolar type II disorder, 8,18,19 and higher rates of antidepressants use. 7,20 However, some of these associations are still controversial, and many studies have been criticized regarding aspects such as lack of a uniform definition of RC and use of heterogeneous samples.…”

Would Broadening the Diagnostic Criteria for Bipolar Disorder Do More Harm Than Good? Implications From Longitudinal Studies of Subthreshold Conditions

“…A number of studies have found that the rate of missed diagnoses of bipolar disorder is fairly high, especially when a broader definition of hypomania is used than the one specified in DSM-IV. 15,16,21,[28][29][30] As a clinician, it is often the case that early in the course of treatment I am not sure if a currently depressed patient has bipolar disorder. This uncertainty occurs despite an extensive evaluation that includes the administration of a semistructured interview, a review of prior records, and an interview with an informant.…”