2. Differential diagnosis of Bipolar disorder
Implications for treatment
Differentiating Bipolar disorder from other
mood disorders and checking underlying
etiology is crucial for optimal patient
management
Misdiagnosis may have adverse
consequences for the patient:
−Prescription of treatment which adversely
affects condition
−Lack of appropriate pharmacologic treatment
−Lack of appropriate psychotherapy
3. Under-recognition and
misdiagnosis
Very common in Bipolar disorder
− diagnostic criteria limitations
− lack of patient awareness, reluctance to
receive treatment (especially if hypomanic)
Currently, 40–60% of patients with Bipolar I
disorder are thought not to be receiving
treatment
Time between first symptoms and first treatment
is about 10 years
Conversion rate of unipolar depression to Bipolar
disorder is around 5–10%
1,2
3
4
Kessler RC et al. Psychol Med 1997;27(5):1079–89;
Reiger DA et al. Arch Gen Psychiatry 1993;50:85–94;
Goodale LC, Lewis L. Bipolar Disord 2001;3(Suppl. 1):19
American Psychiatric Association, 1994
1
2
3
4
4. Areas of confusion in Bipolar
disorder
Substance
abuse
Anxiety
Hyperactivity
ADHD
Unipolar
depression
Social
phobia
Depressive
symptoms
Delusional
disorder
Psychotic
symptoms
Personality
disorders
Schizophrenia
Schizoaffective
disorder
5. DSM-IV and ICD-10 criteria
Two major sets of criteria for Bipolar disorder diagnosis
− DSM-IV: Diagnostic and Statistical Manual of the
American Psychiatric Association, 4th edition
− ICD-10: International Classification of Diseases,
10th edition
Broad diagnosis: at least one episode of mania,
hypomania or a mixed episode
− Type I: manic episode results in hospitalization or seriously
affects normal daily functioning
− Type II: milder episodes of mania
Additional subtypes of Bipolar disorder proposed
− Type III
− soft Bipolar spectrum
6. Awareness For Better
Diagnosis
Education of physicians for correct diagnosis
Accurate history-taking will lead to identification of the types
− assess long-term symptoms
− obtain information from family and friends
Increase patient’s awareness of Bipolar disorder symptoms,
particularly mild mood elevations
7. What is the best treatment strategy
for Bipolar disorder?
The strategy that results in the fewest, mildest or
briefest episodes
Primary therapeutic objectives
− treat acute mania
− treat acute depression
− prevent recurrence of manic/depressive
episodes (prophylaxis)
Efficacy across a broad range of clinical
presentations (e.g. rapid cycling, mixed mania)