Magazine article Clinical Psychiatry News

Data on Bipolar Miss Complexity

Magazine article Clinical Psychiatry News

Data on Bipolar Miss Complexity

Article excerpt

SAN FRANCISCO -- Diagnosing bipolar disorder requires not just asking the right questions but the right people, Michael J. Gitlin, M.D., said.

In one national survey, more than one-third of 600 bipolar disorder patients sought help within a year of becoming symptomatic, but 69% were misdiagnosed--usually as having major depression. In fact, more than one-third of the patients waited 10 years or more before they got an accurate diagnosis.

And the patients consulted a mean of four physicians before receiving a correct diagnosis, the 2003 survey showed.

"My quarrel with these data that get published over and over is that the implication is that the physicians" erred, said Dr. Gitlin, who is professor of clinical psychiatry at the University of California, Los Angeles.

"I think it's more complex than that," he said.

Even physicians who do ask the right questions often fail to get the whole story from patients with bipolar disorder.

"You need corroborative evidence" obtained by getting the patient's permission to talk with significant others--a spouse, boyfriend or girlfriend, sibling, or parents, he said.

The same survey of 600 bipolar disorder patients found that they reported manic symptoms far less often than they reported depressive symptoms to physicians when seeking help (J. Clin. Psychiatry 2003;64:161-74).

That's not surprising, Dr. Gitlin noted, because depression feels bad and brings people into treatment.

Patients reported manic symptoms other than erratic sleep only 43% of the time or less. Only 37% of the patients, for example, told physicians of feeling elated at times. …

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