If bipolar disorder is over-diagnosed, what are the actual diagnoses?

July 29, 2009

Providence, RI - A year ago, a study by Rhode Island Hospital and Brown University researchers reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool --the Structured Clinical Interview for DSM-IV (SCID). In this follow-up study, the researchers have determined the actual diagnoses of those patients. Their study is published in the July 28 ahead of print online edition of The Journal of Clinical Psychiatry.

Under the direction of lead author Mark Zimmerman, MD, director of outpatient psychiatry at Rhode Island Hospital, the researchers' findings indicate that patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID, they were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.

Their research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to 528 patients who were not previously diagnosed with bipolar disorder. The study was conducted between May 2001 and March 2005.

Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, "In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder."

The results of the study also indicate that patients who had been over-diagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, posttraumatic stress disorder and eating and impulse disorders.

Zimmerman and colleagues note that "we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive."

In their previously published study that concluded bipolar disorder was over-diagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID. The authors state that the over-diagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, over-diagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

Zimmerman concludes, "Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment."
-end-
The report is from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project, for which Zimmerman is the principal investigator. Zimmerman said, "The MIDAS project is unique in its integration of research quality diagnostic methods into a community-based outpatient practice affiliated with an academic medical center."

Along with Zimmerman, other researchers involved in the study include Camile Ruggero, PhD; Iwona Chelminski, PhD and Diane Young, PhD, all of Rhode Island Hospital and Brown University.

Founded in 1863, Rhode Island Hospital (www.rhodeislandhospital.org) in Providence, RI, is a private, not-for-profit hospital and is the largest teaching hospital of the Warren Alpert Medical School of Brown University. A major trauma center for southeastern New England, the hospital is dedicated to being on the cutting edge of medicine and research. Many of its physicians are recognized as leaders in their respective fields of cancer, cardiology, diabetes, emergency medicine and trauma, neuroscience, orthopedics, pediatrics, radiation oncology and surgery. Rhode Island Hospital receives nearly $50 million each year in external research funding. It is home to Hasbro Children's Hospital, the state's only facility dedicated to pediatric care, which is ranked among the top 30 children's hospitals in the country by Parents magazine. Rhode Island Hospital is a founding member of the Lifespan health system.

Lifespan

Related Bipolar Disorder Articles from Brightsurf:

Amygdala changes in male patients with schizophrenia and bipolar disorder
Researchers in Japan have revealed that DNA methylation occurs in the serotonin transporter gene that regulates neurotransmitter transmission in schizophrenia and bipolar patients.

Effect of high-deductible insurance use in bipolar disorder
A new study led by the Department of Population Medicine finds that individuals with bipolar disorder who switched to high-deductible health plans (HDHPs) experienced a moderate decrease in nonpsychiatrist mental health outpatient visits, but rates of psychiatrist visits, medication use, emergency department visits, and hospitalizations did not change.

Is bipolar disorder associated with increased risk of Parkinson's disease?
This study, called a systematic review and meta-analysis, combined the results of seven studies with 4.3 million participants to examine a potential association between bipolar disorder with a later diagnosis of Parkinson's disease of unknown cause.

Bipolar disorder may be linked to Parkinson's disease
People who have bipolar disorder may be more likely to later develop Parkinson's disease than people who do not have bipolar disorder, according at a study published in the May 22, 2019, online issue of Neurology®, the medical journal of the American Academy of Neurology.

Probiotics could help millions of patients suffering from bipolar disorder
About 3 million people in the US are diagnosed every year with bipolar disorder, a psychiatric condition characterized by dramatic shifts in mood from depression to mania.

Novel intervention for anxiety symptoms among people with Bipolar Disorder
Psychologists at Lancaster University have devised a novel psychological intervention to address Anxiety in Bipolar Disorder (AIBD).

Mutation links bipolar disorder to mitochondrial disease
Mutations in the gene ANT1 may confer a risk for bipolar disorder through a complex interplay between serotonin and mitochondrial signaling in the brain.

A new path into bipolar disorder comes to light
A new article authored by an international group of researchers reveals a novel potential drug target for bipolar disorder and offers new insights into the underlying biology of this lifelong and devastating mental illness.

After searching 12 years for bipolar disorder's cause, U-M team concludes it has many
Nearly 6 million Americans have bipolar disorder, and most have probably wondered why.

Simple EKG can determine whether patient has depression or bipolar disorder
A groundbreaking Loyola Medicine study suggests that a simple 15-minute electrocardiogram could help a physician determine whether a patient has major depression or bipolar disorder.

Read More: Bipolar Disorder News and Bipolar Disorder Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.