Diagnostic Disagreements in Bipolar Disorder: The Role of Substance Abuse Comorbidities

Rowena Shalini Theodore,John R Biggan,Monica Ramirez Basco

doi:10.1155/2012/435486

Rowena Shalini Theodore, John R Biggan + Show 1 more

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https://doi.org/10.1155/2012/435486

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Abstract

Substance abuse can produce symptoms similar to other psychiatric disorders, thus confusing the diagnostic picture. This paper attempts to elucidate how misdiagnosis in bipolar disorder might be explained by the presence of substance abuse comorbidities. The overlap of symptoms, limited information about symptom onset, and inexperienced clinicians can result in the misinterpretation of symptoms of substance abuse disorders for bipolar disorder. The present study found that the presence of a substance abuse comorbidity, the polarity of last episode (depressed, manic, mixed, not otherwise specified), and the total number of comorbidities affected the reliability of a bipolar disorder diagnosis.

Highlights

The symptoms of Bipolar Disorder (BPD) during manic episodes are quite distinct and relatively easy to identify including elevated mood, rapid speech, agitation, and participation in high-risk behaviors [1]
Each person was reevaluated using the Structured Clinical Interview for DSM Disorders (SCID for DSM-IV) [7]. They found that only 43.4% of patients who claimed they had been previously diagnosed with BPD met criteria based on the Structured Clinical Interview for DSM-IIIR (SCID)
Consistent with previous studies [5, 12], we found that there were, more diagnostic disagreements for patients diagnosed with BPD who met criteria for comorbid alcohol or substance abuse or dependence than for those who did not have substance use disorders

Summary

Introduction

The symptoms of Bipolar Disorder (BPD) during manic episodes are quite distinct and relatively easy to identify including elevated mood, rapid speech, agitation, and participation in high-risk behaviors [1]. During depressive, mixed, or hypomanic episodes, or when accompanied by psychotic features, BPD shares symptoms with major depressive disorder, schizophrenia, substance abuse disorders, and several personality disorders and can be difficult to distinguish. It is this overlap in symptoms that makes the diagnostic process challenging [2,3,4]. Each person was reevaluated using the Structured Clinical Interview for DSM Disorders (SCID for DSM-IV) [7] They found that only 43.4% of patients who claimed they had been previously diagnosed with BPD met criteria based on the SCID. This is consistent with other studies [5, 8]

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