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Bipolar disorder underdiagnosed according to new study

11 Aug 2011

People with bipolar disorder may be prescribed the wrong type of medication because clinicians are using inadequate screening tools, according to a new study involving Trust research professor Allan Young.

The BRIDGE study, which looked at more than 5,500 people diagnosed with major depression around the world, found that the less-commonly-used ‘bipolar specifier’ diagnosed 30% more people with bipolar disorder than the standard tool.

A misdiagnosis of bipolar disorder as depression may lead to ineffective treatment with antidepressants without the use of mood stabilisers – a key drug treatment for the disorder.

The benefits of antidepressants in bipolar disorder are thought to be modest at best, and treatment that is based solely on anti-depressants may have adverse consequences.

Prof Allan Young from West London Mental Health Trust, lead investigator in the UK, said: “The outcomes of this study could be life-changing for people who may have been misdiagnosed for years. Clinicians should investigate patients who present with depression carefully before they make a decision to prescribe anti-depressants.”

The key message of the study is clear: improved detection of bipolar disorder is relatively simple with newer screening tools and could lead to significantly improved outcomes for people with underlying, but unrecognised, bipolar disorder.

Diagnostic tools for bipolar disorder

The most commonly used diagnostic tool used to detect bipolar disorder is called DSM-IV-TR. Bipolar disorders are narrowly diagnosed using this tool and doctors have long suspected that they are not optimal. The “Bipolar Specifier” was developed by Professor Angst and colleagues and seems to be more likely to detect bipolar disorder than DSM and, importantly, has low rates of over-diagnosis.

The BRIDGE study

BRIDGE stands for Bipolar Disorders: Improving Diagnosis, Guidance and Education. The study arose from the BRIDGE initiative and was both multi-national and transcultural. It took place in community and hospital settings, looking at 5,635 patients with an ongoing major depressive episode.

Major depressive disorder

Major depressive disorder is the most common psychiatric illness and is often experienced over many years.

About Prof Allan Young

Professor Allan Young is the clinical lead for the Affective Disorders service at West London Mental Health NHS Trust. He is also Chair of Psychiatry at Imperial College London. His interests are in the causes and treatment of severe neuro-psychiatric disorders, particularly affective disorders.

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