Providence, RI, USA. Researchers have identified problems with applying the Structured Clinical Interview for DSM-IV (SCID), reporting that fewer than half the patients previously diagnosed with bipolar disorder received a diagnosis based on a comprehensive, psychiatric diagnostic interview — the SCID. The study in the Journal of Clinical Psychiatry concludes that while recent reports indicate that there is a problem with underdiagnosis of bipolar disorder, an equal if not greater problem exists with overdiagnosis.

 

Principal investigator Mark Zimmerman, M.D., presented the study team's findings at the annual meeting of the American Psychiatric Association (APA) (7 May 2008).

The study method involved 700 psychiatric outpatients who were interviewed using the SCID and completed a self-administered questionnaire between May 2001 and March 2005. The questionnaire asked patients whether they had been previously diagnosed with bipolar or manic-depressive disorder by a health care professional. Family history of bipolar disorder was used as an index of diagnostic validity.

 

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. Further, the study showed that patients diagnosed with bipolar disorder based on the SCID had a significantly higher morbid risk of bipolar disorder in first-degree relatives.

 

Unnecessary side effects are a significant concern of overdiagnosis. Because mood stabilizers are the treatment of choice for bipolar disorder, overdiagnosing can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.

 

Lead author Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, notes, “Clinicians are inclined to diagnose disorders that they feel more comfortable treating. We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive.”

 

He continues that “This bias is reinforced by the marketing message of pharmaceutical companies to physicians, which has emphasized the literature on the delayed and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder.”

 

Zimmerman concludes that “The results of this study suggest that bipolar disorder is being overdiagnosed and we recommend that clinicians use a standardized, validated method in diagnosing bipolar disorder.”

 

Mark Zimmerman, M.D., is the director of outpatient psychiatry at Rhode Island Hospital and principal investigator of the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project. The goal of the MIDAS project has been to integrate research methodology into routine clinical practice in order to examine a number of issues related to diagnostic comorbidity and treatment outcome. Thus far more than 100 papers have been published in peer-reviewed journals from the MIDAS project database.

Zimmerman says “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.”

Bipolar Disorder (previously known as manic-depression) is a mood disorder characterized by alternating episodes of profound depression and periods of extreme mania and elation. Treatment with lithium or mood stabilizers may be effective, but medication regimens are sometimes difficult to tolerate and maintain, thus increasing risk of relapse. Lithium or mood stabilizers may be effective in thise cases, but medication regimens often are difficult to tolerate and maintain, with increasing risk of relapse.

 

Is Bipolar Disorder Overdiagnosed? Mark Zimmerman, M.D.; Camilo J. Ruggero, Ph.D.; Iwona Chelminski, Ph.D.; and Diane Young, Ph.D. The Journal of Clinical Psychiatry. Pubished ahead of print.

 

 

 

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