Academic journal article East Asian Archives of Psychiatry

Characteristics of Unrecognised Bipolar Disorder in Patients Treated for Major Depressive Disorder in China: General versus Psychiatric Hospitals

Academic journal article East Asian Archives of Psychiatry

Characteristics of Unrecognised Bipolar Disorder in Patients Treated for Major Depressive Disorder in China: General versus Psychiatric Hospitals

Article excerpt


In clinical practice, depressive episodes in bipolar disorders (BD) are typically more frequent and last longer than manic or hypomanic episodes. (1) Therefore, patients with BD are more likely to be misdiagnosed and treated for a major depressive disorder (MDD). (2) Different types of psychiatric services attract different clients, (3) and BD patients treated in different settings have different demographic and clinical features. (4-8) To date, no study has explored the characteristics of unrecognised BD patients between different mental health care settings anywhere in the world, including China.

Psychiatric hospitals (PHs) and general hospital psychiatric units (GHPUs) are the 2 major types of mental health services available in China. Psychiatric hospitals, usually located in suburban areas, provide both inpatient and outpatient services for patients with severe psychiatric symptoms, particularly for those with violent behaviours, refractory symptoms, and high risk of suicide. Relative to GHPUs, PHs usually provide more intensive services, such as medication and electroconvulsive therapy, and a considerable proportion of inpatients in PHs are admitted suddenly. In contrast, GHPUs are usually located in cities and provide more accessible outpatient services for patients with no aggressive symptoms and less risk of suicide. Some large GHPUs also provide less intensive inpatient services. As GHPUs are established in general hospitals, patients with somatic symptoms and major medical conditions can be easily referred to medical departments. We hypothesised that the type of treatment setting could predict different socio-demographic and clinical characteristics of unrecognised BD among patients treated for MDD. Understanding these characteristics of unrecognised BD patients could facilitate their early identification and improve clinical outcomes.

To improve the early recognition of BD in China, the Chinese Society of Psychiatry initiated the Diagnostic Assessment Service for People with bipolar disorders (DASP). Understanding how recognition and management of BD might differ by facility type can inform the tailored interventions that are most appropriate for different types of treatment setting. This study, which is a secondary analysis of the data from the DASP project, (9) compared PHs and GHPUs in China with respect to socio-demographic and clinical features of BD patients misdiagnosed with MDD.


Study Participants and Settings The DASP project was carried out in 13 major teaching mental health centres (6 GHPUs and 7 PHs) geographically located in the north, south, east, west, and central parts of China, representing a wide range of clinical settings, from 1 September 2010 to 28 February 2011. The study method has been described in detail elsewhere. (9) Briefly, inpatients and outpatients aged between 16 and 65 years were enrolled if they had a diagnosis of MDD according to the DSM-IV or ICD-10 criteria based on a review of medical records. The patients were given an explanation about the aims of the study and they or their guardians (for patients < 18 years) provided written informed consent. Exclusion criteria included a history of, or ongoing significant medical or neurological condition(s), depressive disorder secondary to a medical condition, or electroconvulsive therapy administered in the past month. The study protocol was approved by the Clinical Research Ethics Committees of the participating centres.

Instruments and Assessment

Inpatients and outpatients with a diagnosis of MDD receiving treatment in the participating hospitals / units were consecutively referred to the research team at each site for eligibility screening. All patients fulfilling the study criteria were invited to participate in the study. All members of the research team were psychiatrists.

A diagnostic assessment was conducted using the validated Chinese version of the Mini-International Neuropsychiatric Interview (MINI) version 5. …

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