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Bipolar misdiagnosis

Roger S McIntyre, Yena Lee, Rodrigo B Mansur
Mixed features specifier (MFS) is a new nosological entity defined and operationalized in the Diagnostic and Statistical Manual of Mental Disorders (DSM), 5th Edition. The impetus to introduce the MFS and supplant mixed states was protean, including the lack of ecological validity, high rates of misdiagnosis, and guideline discordant treatment for mixed states. Mixed features specifier identifies a phenotype in psychiatry with greater illness burden, as evidenced by earlier age at onset, higher episode frequency and chronicity, psychiatric and medical comorbidity, suicidality, and suboptimal response to conventional antidepressants...
December 2016: CNS Spectrums
Kanglai Li, Qinling Wei, Guanying Li, Xiangjun He, Yingtao Liao, Zhaoyu Gan
INTRODUCTION: Medication nonadherence remains a big challenge for depressive patients. This study aims to assess and compare the medication persistence between unipolar depression (UD) and bipolar depression (BD). METHODS: A total of 146 UD and 187 BD patients were recruited at their first index prescription. Time to lack of persistence with pharmacological treatment (defined as a gap of at least 60 days without taking any medication) was calculated, and clinical characteristics were collected...
2016: Patient Preference and Adherence
Stephen Hogg, Sereena Ansari, Qasim Masood, Mark Agius, Zoltan Rihmer
Concerns have recently been raised about a possible link between suicidal ideation and the use of SSRIs in teenagers diagnosed with unipolar depression, such that the USA FDA and UK CSM have issued warnings regarding the use of SSRIs in adolescents with depression. We investigated this phenomenon first by recognizing that the initial presentation of unipolar and bipolar depression may only differ in subtle ways and with the result being that a significant number of patients are misdiagnosed at the expense of patient outcomes...
September 2016: Psychiatria Danubina
Wu Hong, Chen Zhang, Meng Juan Xing, Dai Hui Peng, Zhi Guo Wu, Zuo Wei Wang, Jun Chen, Cheng Mei Yuan, You Song Su, Ying Yan Hu, Lan Cao, Yong Wang, Jia Huang, Wei Hong Lu, Zheng Hui Yi, Xin Yu, Jing Ping Zhao, Qinting Zhang, Yi Ru Fang
BACKGROUND: With attention to misdiagnosis of bipolar disorder (BP), long duration of undiagnosed bipolar disorder (DUBP) had been reported recently in years. This study aims to investigate the contributions of long DUBP to the frequency of relapse in bipolar patients, and explore affect factors of DUBP. METHOD: From 26 hospitals throughout China, 3896 participants diagnosed with BP according to International Classification of Diseases 10th criteria were enrolled in this study...
October 2016: Comprehensive Psychiatry
Guoqing Zhao, Chen Zhang, Jun Chen, Yousong Su, Rubai Zhou, Fan Wang, Weiping Xia, Jia Huang, Zuowei Wang, Yingyan Hu, Lan Cao, Xiaoyun Guo, Chengmei Yuan, Yong Wang, Zhenghui Yi, Weihong Lu, Yan Wu, Zhiguo Wu, Wu Hong, Daihui Peng, Yiru Fang
There is a high rate of misdiagnosis between major depressive disorder (MDD) and bipolar disorder (BD) in clinical practice. Our previous work provided suggestive evidence for brain-derived neurotrophic factor (BDNF) in differentiating BD from MDD. In this study, we aimed to investigate the role of mature BDNF (mBDNF) and its precursor (proBDNF) in distinguishing bipolar depression (BP) from MDD during acute depressive episode. A total of 105 participants, including 44 healthy controls, 37 MDD patients and 24 BP patients, were recruited...
September 9, 2016: Molecular Neurobiology
Raman Baweja, Susan D Mayes, Usman Hameed, James G Waxmonsky
Disruptive mood dysregulation disorder (DMDD) was introduced as a new diagnostic entity under the category of depressive disorders in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It was included in DSM-5 primarily to address concerns about the misdiagnosis and consequent overtreatment of bipolar disorder in children and adolescents. DMDD does provide a home for a large percentage of referred children with severe persistent irritability that did not fit well into any DSM, Fourth Edition (DSM-IV) diagnostic category...
2016: Neuropsychiatric Disease and Treatment
Ann Marie Kriebel-Gasparro
OBJECTIVE: The goal of this mixed methods descriptive study was to explore Advanced Practice Registered Nurses' (APRNs') knowledge of bipolar disorder (BPD) and their perceptions of facilitators and barriers to screening patients with known depression for BPD. METHODS: A mixed method study design using surveys on BPD knowledge and screening practices as well as focus group data collection method for facilitators and barriers to screening. RESULTS: 89 APRNs completed the survey and 12 APRNs participated in the focus groups...
2016: Open Nursing Journal
Haichen Yang, Linling Li, Hongjun Peng, Tiebang Liu, Allan H Young, Jules Angst, Rong Ye, Han Rong, Erni Ji, Yunhai Qiu, Lingjiang Li
BACKGROUND: Bipolar disorder (BD) is difficult to diagnose in the early stages of the illness, with the most frequent misdiagnosis being major depressive disorder (MDD). We aimed to use a regional homogeneity (ReHo) approach with resting-state functional magnetic resonance imaging (rs-fMRI) to investigate the features of spontaneous brain activity in MDD patients screening positive on the 32-item Hypomania Checklist (HCL-32). METHODS: Nineteen MDD patients screening positive (HCL-32(+); 9 males; 24...
October 2016: Journal of Affective Disorders
A Leblanc, M Jarroir, F Vorspan, F Bellivier, S Leveillee, L Romo
BACKGROUND: Studies have shown that patients with borderline personality disorder are often misdiagnosed to have bipolar disorder and conversely. Indeed, a number of characteristics common to both disorders could explain this problem: emotional instability as well as impulsivity represent confounding factors and contribute to the risk of misdiagnosis. However, it appears that these characteristics manifest themselves in different ways according to the pathology. The aim of the study is to show differences between affective lability, emotional intensity and impulsivity dimensions...
March 23, 2016: L'Encéphale
Paul A Vöhringer, Roy H Perlis
Rates of misdiagnosis between major depressive disorder and bipolar disorder have been reported to be substantial, and the consequence of such misdiagnosis is likely to be a delay in achieving effective control of symptoms, in some cases spanning many years. Particularly in the midst of a depressive episode, or early in the illness course, it may be challenging to distinguish the 2 mood disorders purely on the basis of cross-sectional features. To date, no useful biological markers have been reliably shown to distinguish between bipolar disorder and major depressive disorder...
March 2016: Psychiatric Clinics of North America
Henry A Nasrallah
Bipolar depression is difficult to diagnose and is often mistaken for unipolar depression. Unfortunately, this misdiagnosis creates a cascade of negative outcomes. Patients will probably receive inadequate or inappropriate treatment that will not alleviate the symptoms or impairment of the disorder and may even further destabilize their mood. These individuals are then at risk for experiencing numerous social and occupational impairments, alcohol or substance abuse, and suicidal behavior. An accurate diagnosis and appropriate treatment of bipolar disorder are necessary to prevent this chain of potentially disastrous events...
October 2015: Journal of Clinical Psychiatry
Frieder Haenisch, Jason D Cooper, Andreas Reif, Sarah Kittel-Schneider, Johann Steiner, F Markus Leweke, Matthias Rothermundt, Nico J M van Beveren, Benedicto Crespo-Facorro, David W Niebuhr, David N Cowan, Natalya S Weber, Robert H Yolken, Brenda W J H Penninx, Sabine Bahn
BACKGROUND: Bipolar disorder (BD) is a costly, devastating and life shortening mental disorder that is often misdiagnosed, especially on initial presentation. Misdiagnosis frequently results in ineffective treatment. We investigated the utility of a biomarker panel as a diagnostic test for BD. METHODS AND FINDINGS: We performed a meta-analysis of eight case-control studies to define a diagnostic biomarker panel for BD. After validating the panel on established BD patients, we applied it to undiagnosed BD patients...
February 2016: Brain, Behavior, and Immunity
Diogo Ferreira Branquinho, Miguel Pinto-Gouveia, Sofia Mendes, Carlos Sofia
A 45-year-old man presented with follicular exanthema in his lower limbs, alternating bowel habits and significant weight loss. His medical history included seronegative arthritis, bipolar disease and an inconclusive diagnostic laparoscopy. Diagnostic work up revealed microcytic anaemia and multivitamin deficiency. Skin biopsy of the exanthema suggested scurvy. Owing to these signs of malabsorption, upper endoscopy with duodenal biopsies was performed, exhibiting villous atrophy and extensive periodic acid-Schiff-positive material in the lamina propria, therefore diagnosing Whipple's disease (WD)...
2015: BMJ Case Reports
Giulio Perugi, Elie Hantouche, Giulia Vannucchi, Olavo Pinto
Data emerging from both academic centers and from public and private outpatient facilities indicate that from 20% to 50% of all subjects that seek help for mood, anxiety, impulsive and addictive disorders turn out, after careful screening, to be affected by cyclothymia. The proportion of patients who can be classified as cyclothymic rises significantly if the diagnostic rules proposed by the DSM-5 are reconsidered and a broader approach is adopted. Unlike the DSM-5 definition based on the recurrence of low-grade hypomanic and depressive symptoms, cyclothymia is best identified as an exaggeration of cyclothymic temperament (basic mood and emotional instability) with early onset and extreme mood reactivity linked with interpersonal and separation sensitivity, frequent mixed features during depressive states, the dark side of hypomanic symptoms, multiple comorbidities, and a high risk of impulsive and suicidal behavior...
September 1, 2015: Journal of Affective Disorders
A Carlo Altamura, Massimiliano Buoli, Alice Caldiroli, Lea Caron, Claudia Cumerlato Melter, Cristina Dobrea, Michela Cigliobianco, Francesco Zanelli Quarantini
BACKGROUND: A number of data show the negative role of duration of untreated illness (DUI) on outcome in mood disorders, but no investigation has been carried out about the impact of this variable in bipolar disorder (BD) with psychotic symptoms. Clinical experience shows that many bipolar patients with psychotic symptoms receive other diagnoses and often are chronically treated with first generation antipsychotics, with the effect to reduce duration of untreated psychosis/untreated episode with psychotic symptoms (DUP), but not DUI...
August 15, 2015: Journal of Affective Disorders
Timothy Peters
Recent studies have shown that the claim that King George III suffered from acute porphyria is seriously at fault. This article explores some of the causes of this misdiagnosis and the consequences of the misleading claims, also reporting on the nature of the king's recurrent mental illness according to computer diagnostics. In addition, techniques of cognitive archaeology are used to investigate the nature of the king's final decade of mental illness, which resulted in the appointment of the Prince of Wales as Prince Regent...
April 2015: Clinical Medicine: Journal of the Royal College of Physicians of London
Joel Paris, Donald W Black
Borderline personality disorder (BPD) and bipolar disorder (types I and II) are frequently confused because of their symptomatic overlap. Although affective instability is a prominent feature of each, the pattern is entirely different. BPD is characterized by transient mood shifts that occur in response to interpersonal stressors, whereas bipolar disorder is associated with sustained mood changes. These disorders can be further distinguished by comparing their phenomenology, etiology, family history, biological studies, outcome, and response to medication...
January 2015: Journal of Nervous and Mental Disease
Andrée Daigneault, Catherine Duclos, Sybille Saury, Jean Paquet, Daniel Dumont, Serge Beaulieu
BACKGROUND: Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement. METHODS: The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care...
March 15, 2015: Journal of Affective Disorders
Cumhur Tas, Merve Cebi, Oguz Tan, Gokben Hızlı-Sayar, Nevzat Tarhan, Elliot C Brown
INTRODUCTION: Understanding the biological underpinnings of unipolar (UD) and bipolar depression (BD) is vital for avoiding inappropriate treatment through the misdiagnosis of bipolar patients in their first depressive episode. One plausible way to distinguish between UD and BD is to compare EEG brain dynamics to identify potential neurophysiological biomarkers. Here we aimed to test group differences in EEG power, cordance and coherence values between UD and BD. METHODS: Twenty-five bipolar and 56 unipolar depression patients were recruited...
February 1, 2015: Journal of Affective Disorders
Larry Culpepper
Bipolar disorder is a chronic episodic illness, characterized by recurrent episodes of manic or depressive symptoms. Patients with bipolar disorder frequently present first to primary care, but the diversity of the potential symptoms and a low index of suspicion among physicians can lead to misdiagnosis in many patients. Frequently, co-occurring psychiatric and medical conditions further complicate the differential diagnosis. A thorough diagnostic evaluation at clinical interview, combined with supportive case-finding tools, is essential to reach an accurate diagnosis...
2014: Primary Care Companion to CNS Disorders
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