Is a delay in the diagnosis of bipolar disorder inevitable?

Fritz, Kristina; Russell, Alex; Allwang, Christine; Kuiper, Sandy; Lampe, Lisa; Malhi, Gin S

doi:10.1111/bdi.12499

Cited by 91 publications

(59 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It typically commences in late adolescence and first manifests with depressive symptoms (Box 1, A), which creates a diagnostic challenge because there are no clinical features that reliably distinguish bipolar depression from major depression 8 . Typically, individuals who develop bipolar disorder experience several episodes of depression before eventually manifesting symptoms of mania 9 . The early detection of symptoms suggestive of mania is therefore critical (Box 1, B).…”

Section: Introductionmentioning

confidence: 99%

“…8 Typically, individuals who develop bipolar disorder experience several episodes of depression before eventually manifesting symptoms of mania. 9 The early detection of symptoms suggestive of mania is therefore critical (Box 1, B). Elevated or irritable mood and increased goal-directed activity are notable symptoms, along with a decreased need for sleep, increased self-esteem, and cognitive changes such as distractibility.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

Malhi

Outhred

Morris

et al. 2018

Medical Journal of Australia

Self Cite

View full text Add to dashboard Cite

In December 2015, the Royal Australian and New Zealand College of Psychiatrists published a comprehensive set of mood disorder clinical practice guidelines for psychiatrists, psychologists and mental health professionals. This guideline summary, directed broadly at primary care physicians, is an abridged version that focuses on bipolar disorder. It is intended as an aid to the management of this complex disorder for primary care physicians working in collaboration with psychiatrists to implement successful long term management. Main recommendations: The guidelines address the main phases of bipolar disorder with a particular emphasis on long term management, and provide specific clinical recommendations. Mania: All physicians should be able to detect its early signs so that treatment can be initiated promptly. At the outset, taper and cease medications with mood-elevating properties and institute measures to reduce stimulation, and transfer the patient to specialist care. Bipolar depression: Treatment is complicated and may require trialling treatment combinations. Monotherapy with mood-stabilising agents or second generation antipsychotics has demonstrated efficacy but using combinations of these agents along with antidepressants is sometimes necessary to achieve remission. Commencing adjunctive structured psychosocial treatments in this phase is benign and likely effective. Long term management: Physicians should adjust treatment to prevent the recurrence of manic and/or depressive symptoms and optimise functional recovery. Closely monitor the efficacy of pharmacological and psychological treatments, adverse effects and compliance. Changes in management as a result of the guidelines: The guidelines position bipolar disorder as part of a spectrum of mood disorders and provide a longitudinal perspective for assessment and treatment. They provide new management algorithms for the maintenance phase of treatment that underscore the importance of ongoing monitoring to achieve prophylaxis. As a first line treatment, lithium remains the most effective medication for the prevention of relapse and potential suicide, but requires nuanced management from both general practitioners and specialists. The guidelines provide clarity and simplicity for the long term management of bipolar disorder, incorporating the use of new medications and therapies alongside established treatments.

show abstract

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

Malhi

Outhred

Morris

et al. 2018

Medical Journal of Australia

Self Cite

View full text Add to dashboard Cite

show abstract

“…Establishing whether this is the case could help us further understand traits that are unique and common to these two disorders in order to better define them. This is particularly important in the case of bipolar disorder, which commonly presents first as depression and thus is treated as such . Treating undiagnosed bipolar disorder with antidepressants can trigger mania, increase the risk of suicide, and negatively impact on future response to mood stabilizing treatment .…”

Section: Introductionmentioning

confidence: 99%

Investigating the neural basis of cognitive control dysfunction in mood disorders

et al. 2019

View full text Add to dashboard Cite

Objectives: Dysfunction of cognitive control is a feature of both bipolar disorder (BP) and major depression (MDD) and persists through to remission. However, it is unknown whether these disorders are characterized by common or distinct disruptions of cognitive control function and its neural basis. We investigated this gap in knowledge in asymptomatic BP and MDD participants, interpreted within a framework of normative function.Methods: Participants underwent fMRI scans engaging cognitive control through a working memory task and completed a cognitive battery evaluating performance across multiple subdomains of cognitive control, including attention, impulsivity, processing speed, executive function, and memory. Analysis was performed in two stages: (i) cognitive control-related brain activation and deactivation were correlated with cognitive control performance in 115 healthy controls (HCs), then, (ii) significantly correlated regions from (i) were compared between 25 asymptomatic BP, 25 remitted MDD, and with 25 different HCs, matched for age and gender.Results: Impulsivity and executive function performance were significantly worse in BP compared to both MDD and HCs. Both BP and MDD had significantly poorer memory performance compared to HCs. Greater deactivation of the medial prefrontal cortex (MPFC) during the fMRI task was associated with better executive function in healthy controls. Significantly less deactivation in this region was present in both BP and MDD compared to HCs. Conclusions:Failure to deactivate the MPFC, a key region of the default mode network, during working memory processing is a shared neural feature present in both bipolar and major depression and could be a source of common cognitive dysfunction. K E Y W O R D Sbipolar disorders, cognitive control, depression, euthymic, fMRI activation | 287 BREUKELAAR Et AL.

show abstract

“…(ie, patients with a depressive index episode take around a decade to experience their first manic episode). 5 In conclusion, DD could be improving over the last decade.…”

Section: Discussionmentioning

confidence: 95%

Improving diagnostic delays in bipolar disorders in clinical practice

Szmulewicz

Quiroz²,

Padilla

et al. 2019

Bipolar Disorders

View full text Add to dashboard Cite

Is a delay in the diagnosis of bipolar disorder inevitable?

Abstract: The findings from the present study suggested that an earlier diagnosis of depression is related to experiencing a longer delay in conversion to BD. The clinical implications of this are briefly discussed, with a view to reducing the seemingly inevitable delay in the diagnosis of BD.

Cited by 91 publications

References 26 publications

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders: bipolar disorder summary

Investigating the neural basis of cognitive control dysfunction in mood disorders

Improving diagnostic delays in bipolar disorders in clinical practice

Contact Info

Product

Resources

About