‘Working Diagnosis’ as a Means to Reduce Cognitive Bias

Abstract

Hibberd et al. emphasise bipolar disorder as an associated feature of Behçet's disease (BD). 1 Talarico et al. recently reported on psychiatric involvement in 116 patients with BD and compared them to a control group of patients with systemic lupus erythematosus (SLE) and chronic hypertension. 2 The BD cohort was divided in two groups depending on the presence or otherwise of neurological features. The frequency of bipolar disorder was signifi cantly higher in the BD cohort than in disease controls (p < 0.001). However, there was no signifi cant difference in unipolar depression and insomnia in the BD, SLE and chronic arterial hypertension groups. In addition, the presence of bipolar disorder in BD patients (mainly hypomanic episodes) was not related to the presence of neurological involvement; however, the presence of manic bipolar disorder was associated with active disease.The higher frequency of psychiatric manifestations in BD adds to the importance of a multidisciplinary approach to patients. A clinical psychologic or psychiatric input is important. The recently published EULAR recommendations for the management of BD need to be updated to include management of psychological aspects of the disease. 3