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Bipolar misdiagnosis

Margaret O Akinhanmi, Joanna M Biernacka, Stephen M Strakowski, Susan L McElroy, Joyce E Balls Berry, Kathleen R Merikangas, Shervin Assari, Melvin G McInnis, Thomas G Schulze, Marion LeBoyer, Carol Tamminga, Christi Patten, Mark A Frye
OBJECTIVES: Health disparities between individuals of African and European ancestry are well documented. The disparities in bipolar disorder may be driven by racial bias superimposed on established factors contributing to misdiagnosis, including: evolving empirically based diagnostic criteria (International Classification of Diseases [ICD], Research Diagnostic Criteria [RDC] and Diagnostic and Statistical Manual [DSM]), multiple symptom domains (i.e. mania, depression and psychosis), and multimodal medical and additional psychiatric comorbidity...
March 12, 2018: Bipolar Disorders
Kenji Hashimoto
Major depressive disorder (MDD) and bipolar disorder (BD) are the most common mood disorders. They are etiologically related, but clinically distinct psychiatric illnesses. Their shared clinical features result in high rates of misdiagnosis due to a lack of biomarkers that allow their differentiation. BD is more frequently misdiagnosed as MDD because of overlapping symptomology, often later onset of mania, and frequent occurrence of depressive episodes in patients with BD. Misdiagnosis is also increased when patients with BD present symptoms indicative of a clinically significant depressive episode, but are premorbid for manic symptoms, or previous manic states not recognized...
2018: Advances in Clinical Chemistry
Michael Thomson, Verinder Sharma
Mood disorders including major depressive disorder and bipolar disorder are common during and after pregnancy. Timely identification and appropriate management of mood episodes is essential to maximize maternal well-being and minimize adverse outcomes. Failure to do so results in maternal suffering and impaired child bonding, and has the potential for devastating outcomes including suicide and infanticide. Women are routinely screened for unipolar depression during or after pregnancy but not for bipolar disorder, in spite of the fact that childbirth is associated with a major risk for onset or exacerbation of bipolar disorder...
December 2017: CNS Spectrums
Jinling Li, Xiaohong Hong, Haiyun Xu
Turner's syndrome (TS) is the most common sex chromosome abnormality in females and characterized with short stature and ovarian dysgenesis. Patients with TS may also present many other physical diseases and mental disorders. In this case report, we present a 49-year-old woman with TS, who also met criteria for bipolar disorder, type 2 diabetes mellitus, and autoimmune hypothyroidism. The patient was admitted to the mental health center for depressive symptoms in 1991 and was misdiagnosed as hypopituitarism, which was not corrected until 2005 when her karyotype of 45, X/46, X, i(Xq) was identified...
2017: Neuropsychiatric Disease and Treatment
Sukhmeet Singh, Paul Scouller, Daniel J Smith
Aims and method The mean delay for bipolar disorder diagnosis is 10 years. Identification of patients with previous hypomania is challenging, sometimes resulting in misdiagnosis. The aims of this study were: (a) to estimate the proportion of primary care patients with depression currently taking antidepressants who have undiagnosed bipolar disorder and (b) to compare a brief 3-item manic features questionnaire with the Hypomania Checklist (HCL-13). The sample comprised patients with a recorded diagnosis of depression, either on long-term antidepressant therapy or with previous multiple courses of antidepressants...
August 2017: BJPsych Bulletin
Rajesh Sagar, Raman Deep Pattanayak
Bipolar disorder (BD) is a severe, recurrent mood disorder, associated with a significant morbidity and mortality, with high rates of suicides and medical comorbidities. There is a high risk of mood disorders among the first-degree relatives of patients with BD. In the current clinical practice, the diagnosis of BD is made by history taking, interview and behavioural observations, thereby lacking an objective, biological validation. This approach may result in underdiagnosis, misdiagnosis and eventually poorer outcomes...
January 2017: Indian Journal of Medical Research
Roshan Sutar, Anirban Ray, Shekhar P Sheshadri
Leukodystrophy is a group of demyelinating neurodegenerative diseases of brain with varied presentation and multiple etiologies. Prognosis is predominantly dismal. Misdiagnosis and wrong treatment are common in this group of rare neurological disorders, especially when it presents with psychiatric symptoms. In this case, importance of neurological and radiological evaluation and need for high diagnostic suspicion in treatment-resistant psychiatric disorders is highlighted.
March 2017: Indian Journal of Psychological Medicine
Anna R Van Meter, Eric A Youngstrom, Boris Birmaher, Mary A Fristad, Sarah M Horwitz, Thomas W Frazier, L Eugene Arnold, Robert L Findling
OBJECTIVES: Epidemiological studies suggest that cyclothymic disorder is the most prevalent subtype of bipolar disorder (BD). However, it is rarely diagnosed, especially in youth. This may be because it can be difficult to ascertain whether a youth meets diagnostic criteria. Clearer, easy-to-apply criteria could reduce misdiagnosis. The objective oftable this study was to determine whether proposed research diagnostic criteria for cyclothymic disorder (RDCyc), based on DSM-5 criteria, could be quantified and validated in youth...
June 2017: Journal of Affective Disorders
Ling Zhang, Xin Yu, Yi-Ru Fang, Gabor S Ungvari, Chee H Ng, Helen F K Chiu, Hui-Chun Li, Hai-Chen Yang, Qing-Rong Tan, Xiu-Feng Xu, Gang Wang, Yu-Tao Xiang
Little is known about the demographic and clinical differences between short and long duration of untreated bipolar disorder (DUB) in Chinese patients. This study examined the demographic and clinical features of short (≤2 years) and long DUB (>2 years) in China. A consecutively recruited sample of 555 patients with bipolar disorder (BD) was examined in 7 psychiatric hospitals and general hospital psychiatric units across China. Patients' demographic and clinical characteristics were collected using a standardized protocol and data collection procedure...
March 22, 2017: Scientific Reports
Jonathan Repple, Susanne Meinert, Dominik Grotegerd, Harald Kugel, Ronny Redlich, Katharina Dohm, Dario Zaremba, Nils Opel, Christian Buerger, Katharina Förster, Theresa Nick, Volker Arolt, Walter Heindel, Michael Deppe, Udo Dannlowski
OBJECTIVE: The absence of neurobiological diagnostic markers of bipolar disorder (BD) leads to its frequent misdiagnosis as unipolar depression (UD). We investigated if changes in fractional anisotropy (FA) could help to differentiate BD from UD in the state of depression. METHODS: Using diffusion tensor imaging (DTI) we employed a voxel-based analysis approach to examine fractional anisotropy (FA) in 86 patients experiencing an acute major depressive episode according to DSM-IV (N=39 BD, mean age 39...
February 2017: Bipolar Disorders
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 2017: 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
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