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Posted by admin on March 19th, 2010

19
Mar

Depressed patients who are wrongly diagnosed with bipolar disorder are more chronically ill and have more comorbidities than depressed patients without this diagnosis, conclude US researchers.

Although several studies have indicated that bipolar disorder is under-recognized and that many patients with major depressive disorder actually have bipolar disorder, an earlier investigation by Mark Zimmerman and colleagues from Brown University School of Medicine in Providence, Rhode Island, found the opposite pattern.

To investigate further, Zimmerman’s team studied 40 depressed patients previously diagnosed with bipolar disorder that was not later confirmed and 233 depressed patients not diagnosed with bipolar disorder.

There were no demographic differences between the two groups. Compared with non-overdiagnosed patients, patients overdiagnosed with bipolar disorder had significantly more lifetime Axis I disorders, at 5.8 versus 4.4, and were significantly more likely to have three or more such disorders, at 90.0% versus 71.7%.

The team reports in the journal Comprehensive Psychiatry that overdiagnosed patients had significantly higher lifetime rates of specific phobias and eating disorders, at 25.0% versus 11.6%, and 30.0% versus 14.6%, respectively.

Overdiagnosed patients were also significantly more likely to have certain current diagnoses, such as specific phobia, post-traumatic stress disorder, drug abuse/dependence, and personality disorder, particularly borderline personality disorder.

Overdiagnosed patients were also more chronically ill, experienced more episodes, and were more likely to have been hospitalized and attempted suicide than other patients. In addition, they missed more time from work for psychiatric reasons and had poorer social functioning.

Logistic regression analysis indicated that current specific phobia, number of depressive episodes, current episode duration, Global Assessment of Functioning score, and history of psychiatric hospitalization predicted overdiagnosis with bipolar disorder, at odds ratios of 3.4, 1.1, 2.8, and 2.9, respectively.

The team writes: “To our surprise, a history of specific phobia was also independently associated with increased odds of being overdiagnosed.

“If not an error, then the link between specific phobia and a history of misdiagnosis has no ready explanation. One possibility is that specific phobia may simply be one more marker for a more complicated presentation, which in turn increases the chances of a misdiagnosis.”

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

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