Overdiagnosis Of Bipolar Disorder Research Articles

Research on the Over Diagnosis of Bipolar Disorder among Teenagers in China

Recent research has revealed that the diagnosis rate of bipolar disorder is increasing rapidly, especially among adolescents. Although some attempts have been made to address this issue, it is still worth further research. This paper provides new insights into the phenomenon that bipolar disorder has been overdiagnosed among teenagers in China. Basically, the purpose of this paper is to make a more comprehensive and in-depth analysis of the background, current situation, controversy, factors, and possible consequences of the overdiagnosis of bipolar disorder. In the following, this paper introduces some domestic and foreign research results, and shares authoritative opinions and reflections about the overdiagnosis of bipolar disorder. To conclude, this paper provides detailed information about the overdiagnosis of bipolar disorder, analyzes the status quo of psychiatric diagnosis and summarizes related literature, suggesting that the process of diagnosing bipolar disorder is problematic. Therefore, its essential for us to revisit our diagnostic criteria as well as proper treatment.

DMDD overtaking BPD as diagnosis, with paradoxical consequences for treatment

The new diagnosis of disruptive mood dysregulation disorder (DMDD) in DSM‐5 (2013) was hoped by advocates to reduce what was thought to be the overdiagnosis of bipolar disorder (BPD). It was also hoped that this would result in a reduction in antipsychotic prescribing for the inaccurately classified youth. However, the first report on the rates of the treated prevalence of DMDD and BPD shows that the opposite has happened — youth diagnosed with DMDD are more, not less, likely to be prescribed not only antipsychotics, but ADHD medication, antidepressant medication, and multiple drugs at the same time than children with BPD.

The Overdiagnosis of Bipolar Disorder Within Marginalized Communities: A Call to Action

This paper argues that the overdiagnosis of bipolar disorder (BD) is an urgent and underrecognized problem within the U.S., threatening to expose vulnerable Americans to heightened stigma and harmful drug effects while disguising the environmental and traumagenic roots of their distress. The paper traces BD overdiagnosis to biomedical assumptions about mental illness and to the decline of social welfare policies over the past twenty-five years. It calls on policymakers to address BD overdiagnosis by revising criteria in the DSM 5, developing psychosocial models of mental illness, and reintroducing protective social welfare programs. Finally, the paper urges social workers to educate themselves about the harms of BD overdiagnosis as well as to recognize their own role in medicalizing their clients’ distress.

Disruptive mood dysregulation disorder

IntroductionFaced with a possible overdiagnosis of bipolar disorder in children and adolescents, a new diagnosis has been created in the mental illness classification system. This new diagnosis is named Disruptive Mood Dysregulation Disorder.ObjectivesWe propose to carry out a bibliographic review on the new diagnostic category of Disruptive Mood Dysregulation Disorder.MethodsWe present the clinical case of a 10-year-old boy showing severe irritability symptoms.ResultsDisruptive Mood Dysregulation Disorder refers to persistent irritability and frequent episodes of extreme behavioral disturbance in children up to 12 years of age. Onset must occur before 10 years of age and the diagnosis should not be applied to children under 6 years of age. The clinical course of these patients in adolescence and adulthood tends towards unipolar depressive disorders or anxiety disorders rather than bipolar disorders.ConclusionsThe new diagnosis of Disruptive Mood Dysregulation Disorder allows us to differentiate between the classic episodic presentations of mania from the non-episodic ones of severe irritability.DisclosureNo significant relationships.

The Globalization of Biological Psychiatry and the Rise of Bipolar Spectrum Disorder in Iran.

In recent years, psychiatry in Iran witnessed a dramatic increase in the use of the diagnosis of bipolar spectrum disorder (BSD). This qualitative study maps the journey of the BSD diagnosis from the West to Iran, examines the controversy surrounding the diagnosis and its treatment, and explores some of the structural factors that facilitate and maintain the widespread use of the BSD diagnosis in Iran and related practices of prescribing neuroleptic and mood stabilizers. The study methods include archival research and semi-structured interviews with 25 prominent Iranian psychiatrists in the field of mood disorders. Results show the importance of factors in addition to economics in driving changes in diagnostic fashion. Most psychiatrists interviewed reported what they viewed as an over-diagnosis of bipolar disorder and over-prescription of mood stabilizers and atypical antipsychotics among Iranian psychiatrists over the past decade. In addition to the influence of leading figures of American psychiatry, the dominance of Western psychiatric classifications and textbooks in Iran's psychiatry, and indirect intervention by pharmaceutical companies, local structural and political factors have played a significant role in the Iranian psychiatric system's embrace of the new concept of bipolarity. In Iran, the medicalization of social conflict has been embraced by government, families, and psychiatrists for cross-cutting purposes. These challenges and the continued controversy over the adoption of American psychiatric fads in a non-Western country like Iran point to the importance of elaborating a more ecosocial and cultural view of psychiatric practice to disentangle some of the complex trade-offs involved in adopting particular modes of diagnostic practice.

Are we Overdiagnosing Bipolar Disorder?

Bipolar disorder (BD) is an established diagnostic entity used by clinicians for over a century. It is distinguished by the distinct manic and depressive episodes with interepisode euthymia. It has an illness course where both recovery and recurrences are a rule and has a good long-term prognosis, as reported earlier by Emil Kraeplin. There is an opinion in the current literature that BD is often underdiagnosed as unipolar depression, and based on that opinion, spectrum concept was introduced. Here, we present 5 cases to highlight that overdiagnosis of BD is also not infrequent and we discuss its reasons and therapeutic implications.

Depolarizing Bipolar Disorder: Both the Illness and Our Views

Having recently ‘ removed ’ a diagnosis of bipolar II disorder from a number of patients attending a specialist outpatient clinic (CADE Clinic), a process colloquially referred to as ‘ depolarizing ’ , it is timely perhaps to discuss the complexities, and in particular, the misconceptions pertaining to the diagnosis of this abstruse illness. At a series of recent talks, psychiatrists were asked to rate their confi dence in making a diagnosis of major depressive disorder, bipolar I disorder and bipolar II disorder. Amongst the options provided, psychiatrists were able to nominate whether they were more than 80% accurate in making a specifi c mood disorder diagnosis. With nearly a hundred respondents over several meetings, a success rate of 80% or more for diagnosing major depression was nominated by 50%, but less than half this number (23%) had similar confi dence when diagnosing bipolar I disorder and this was further diminished to 11% when considering bipolar II disorder. This successive diminution in confi dence across the mood disorder subtypes was not related to clinical experience or kind of psychiatric practice. When asked more informally why there was greater uncertainty when diagnosing bipolar disorder, as compared to major depressive disorder, the two main reasons that emerged were “ uncertainty about how to differentiate hypomania from normal mood swings ” , and “ diffi culty in diagnosing mixed mood presentations ” . Recent reports have commented upon the over-diagnosis of bipolar disorder but have simultaneously noted the ongoing problem of under-diagnosis, and the delay that occurs in assigning a diagnosis of bipolar disorder [1,2]. Undoubtedly, part of the problem is the natural history of the illness that invariably commences with depressive episodes and only later progresses to hypomania and mania or mixed states. In practice this means that bipolar disorder often has to be ‘ fi shed out of a pool of depression ’ but only once suffi cient manic symptoms rise to the surface. Another obstacle to accurate detection and diagnosis, of at least equal if not greater importance, is the fact that DSM-IV is a poor approximation of clinical reality. For example, the duration requirements (4 days) for bipolar II disorder are often loosely applied because symptoms that last 2 – 3 days, although often signifi cant in terms of clinical impact, are not suffi cient to qualify for the diagnosis. In addition, the ‘ categories ’ of bipolar not otherwise specifi ed and cyclothymia that could perhaps capture these presentations are used rarely, if at all, possibly because they hold little or no prognostic value. Lastly, the inherent mood lability of personality disorders, particularly borderline personality disorders, make parsing these disorders far more complex than the Axis I and II divide would imply. However, despite a clear problem of bipolar disorder under-diagnosis, over-diagnosis is an equal concern. While it is a major clinical issue to either deny management of a treatable disorder, or to use agents such as antidepressants that have the capacity to worsen the disorder, it is equally problematic if a potentially stigmatizing diagnosis is made, and treatments that have an adverse risk – benefi t ratio are initiated [3,4]. To assist with this and provide some clarity, Australian and New Zealand Journal of Psychiatry 2011; 45:909–910 DOI: 10.3109/00048674.2011.624085

Bipolar and Substance Use Disorder Comorbidity: Diagnostic and Treatment Considerations

Both bipolar I and bipolar II disorders are highly comorbid with substance use disorders, and this comorbidity is associated with more severe illness course and early mortality. There is overdiagnosis of bipolar disorder in substance-misusing populations, but careful, structured diagnostic evaluation using family and other third-party confirmation can decrease this likelihood. Limited data for the use of pharmacological interventions to decrease drug and alcohol use in patients with bipolar disorder are available; nevertheless, the Food and Drug Administration-approved treatments for addictions, especially for nicotine and opiate dependence, may still be effective in patients with bipolar disorder. There is limited clinical trial evidence for treating mood episodes in patients with comorbid conditions; current substance use diagnoses do not lead to worse mood outcomes prospectively, suggesting that treatment should not be withheld from this group. Because the health consequences of substance misuse can be so grave, clinicians must be prepared to engage patients in treatment aimed to change behavior.

Overdiagnosis of Bipolar Disorder and Disability Payments

The diagnosis of bipolar disorder has received increasing attention during the past decade. Several research reports have suggested that bipolar disorder is under-recognized, and that many patients, particularly those with major depressive disorder, have, in fact, bipolar disorder. More recently, some reports have suggested that bipolar disorder is also overdiagnosed at times. There are several possible reasons for bipolar disorder overdiagnosis. In the present study, we examined whether secondary gain associated with receiving disability payments might be partially responsible for bipolar disorder overdiagnosis. A total of 82 psychiatric outpatients reported having been previously diagnosed with bipolar disorder, which was not confirmed when interviewed with the Structured Clinical Interview for DSM-IV. The percentage of patients receiving disability payments and the duration of disability payments were compared in these 82 patients and 528 patients who were not diagnosed with bipolar disorder. Compared with the patients who had never been diagnosed with bipolar disorder, the patients overdiagnosed with bipolar disorder were significantly more likely to have received disability payments at some point during the past 5 years, and were receiving disability payments for significantly more weeks. We conducted a regression analysis controlling for the number of lifetime diagnoses, and overdiagnosis of bipolar disorder was a significant predictor of disability status (OR = 3.8; 95% CI, 1.6-8.8). Thus, an unconfirmed diagnosis of bipolar disorder was significantly associated with receiving disability benefits.

Overdiagnosis of Bipolar Disorder Among Substance Use Disorder Inpatients With Mood Instability

Among substance use disorder (SUD) patients, mood instability and high-risk behaviors may suggest the presence of bipolar disorder. However, active substance abuse impedes efforts to diagnose bipolar illness validly in patients with mood complaints. The authors retrospectively reviewed records for 85 adults admitted sequentially over a 1-year period (August 1, 2005, to July 31, 2006) to a private inpatient dual-diagnosis unit for substance abuse/dependence and mood disorders. A senior research psychiatrist conducted diagnostic interviews based on DSM-IV criteria to ascertain current and lifetime manic or hypomanic episodes during abstinent periods. Only 33% of subjects with suspected bipolar diagnoses (28/85) met DSM-IV criteria for bipolar I or II disorder. DSM-IV bipolar patients were significantly older (p = .029) and more likely to have made past suicide attempts (p = .027), abused fewer substances (p = .027), and were less likely to abuse cocaine (p < .001) than those failing to meet DSM-IV criteria. Inability to affirm bipolar diagnoses most often resulted from insufficient DSM-IV "B" symptoms associated with mania or hypomania (55% or 45/82), inability to identify abstinent periods for assessing mood symptoms (36%, 29/81), and inadequate durations of manic/hypomanic symptoms for DSM-IV syndromic criteria (12%, 10/84). Patients not meeting DSM-IV criteria were most often presumed to have bipolar disorder solely on the basis of the presence of mood instability, although this feature held little predictive value for DSM-IV bipolar diagnoses. Many patients with active SUDs who are diagnosed in the community with bipolar disorder may not actually meet DSM-IV criteria for bipolar I or II disorder. Caution must be exercised when attempting to diagnose such patients, particularly when mood instability or cocaine use is present.

Adolescent bipolar disorder: a nine-year experience

The clinical records of 53 adolescent inpatients diagnosed with bipolar disorder were re-evaluated to examine their profiles and differential diagnoses. Seventy-two percent satisfied DSM-III-R Bipolar Disorder criteria and most presented with manic or mixed mood symptoms. Half were psychotic. Non-affective psychosis, unipolar depression, organic syndromes and disruptive behavioral disorders complicated the differential diagnoses, particularly among younger boys. The well-documented bipolars were characterized by affective symptoms prior to the first admission and shorter hospitalizations than the remaining subjects. A recent trend towards overdiagnosis of bipolar disorder is suggested in some patients.