Bipolar disorder, a debilitating mood disorder, is often misdiagnosed, delaying appropriate treatment and even increasing the severity of a patient's illness.
People with bipolar disorder alternate between episodes of major depression and mania, sometimes with periods of relative stability in between. Physicians normally treat them with mood stabilizing medications.
Unfortunately, misdiagnosing bipolar disorder is common. The symptoms overlap with other psychiatric disorders, especially depression, and the line between different psychiatric disorders is somewhat blurry. Bipolar disorder often co-exists with depression, anxiety disorders, substance abuse, and Attention-Deficit and Hyperactivity Disorder (ADHD) in children.
According to research, physicians initially diagnose 25 to 50 percent of bipolar patients with depression, since depressive symptoms are the most frequent initial symptom of bipolar disorder. A survey by the Depression and Bipolar Support Alliance found that 69 percent of bipolar patients were initially misdiagnosed and, in one-third of the cases, it took 10 years before someone correctly diagnosed them.
Physicians often treat depression with antidepressant medications. However, when someone with bipolar disorder takes antidepressants, the medications do not work and may even make manic episodes worse. The delay in initiating appropriate treatment increases patients' risk for recurrence or long-term episodes of symptoms. Furthermore, instead of finding relief through treatment, patients have a lower quality of life and ability to function. Misdiagnosing bipolar disorder is linked to higher rates of psychiatric hospitalization and medical costs.
Bipolar disorder often begins earlier than depression and may affect children more severely than adults. When physicians misdiagnose children and treat them with antidepressant or other medications, it puts them at long-term risk for medication side effects. Unfortunately, there are no diagnostic criteria for pediatric bipolar disorder, so mental health professionals refer to the same criteria they use for adults. Children are often misdiagnosed with ADHD and bipolar disorder; the two frequently overlap.
Prevent Misdiagnosis
Physicians and nurses need to be cognizant of the symptoms of these diseases, recognize the potential for misdiagnosis, carefully screen for current and past symptoms, and closely follow up with patients. The American Psychological Association is revising its diagnostic criteria, which may help.
In the meantime, having a family member provide input on patient behavior can give physicians a clearer picture of what's going on with patients, who may not remember or recognize certain significant behaviors. Lack of response, or unexpected response to treatment, should prompt the patient's physician to re-evaluate the diagnosis.
Sources
"CHILDHOOD-ONSET BIPOLAR DISORDER: THE DANGER OF MISDIAGNOSIs." Neuropsychiatric Reviews June 2000. Web. http://www.neuropsychiatryreviews.com/jun00/npr_jun00_Bipolar.html
Bowden, Charles L., M.D. "Strategies to reduce misdiagnosis of Bipolar Depression." Psychiatric Services 52 (2001):51-55. Web. http://psychservices.psychiatryonline.org/cgi/content/full/52/1/51
"Managing Bipolardisorder: Misdiagnosis and Quality of Life. "The American Journal of Managed Care 11 (2005): S267. Web. 9 October 2005.
http://www.ajmc.com/supplement/managed-care/2005/2005-10-vol11-n9Suppl/Oct05-2150pS267
"Imaging Studies Help Pinpoint Child Bipolar Circuitry." Science Update. National Institute of Mental Health. Web. 8 April 2010. http://www.nimh.nih.gov/science-news/2010/imaging-studies-help-pinpoint-child-Bipolar-circuitry.shtml
Stokowski, Laura A. RN, MS "Bipolar Disorder and ADHD in Children: Confusion and Comorbidity." Topics in Advanced Practice Nursing. Medscape Medical News. Web. 27 October 2009. http://www.medscape.com/viewarticle/711223
Busko, Marlene ."Adults Admitted to a Mood-Disorder Clinic are Often Misdiagnosed. Medscape Medical Nws. 16 October 2008. http://www.medscape.com/viewarticle/582125
"Bipolar Disorder Misdiagnosed In A Quarter Of Cases." Annual Meeting of the Royal College of Psychiatrists, 2 -5 June 2009. Medical News Today. 07 Jun 2009. http://www.medicalnewstoday.com/articles/152814.php
