MedWire News: Around half of psychiatrists make the wrong diagnosis when presented with a complex bipolar disorder case, study results demonstrate.
The researchers found that the presence of hallucinations was most likely to confuse the diagnosis, although such symptoms are quite common in bipolar disorder.
“More research is needed to better understand diagnostic decision-making, especially under real life settings, and this might also be of interest when revising diagnostic manuals such as DSM,” study co-authors Friederike Meyer (University of Tübingen, Germany) and Thomas Meyer (Newcastle University, UK) comment.
According to chart records reviewed in previous studies, 31% of bipolar patients are diagnosed with schizophrenia or other psychotic disorders at the onset of their illness. The consequences of misdiagnosing bipolar disorder as a psychotic disorder can be severe, leading to ineffective or even harmful treatment.
However, there is little information on the symptom patterns that can confuse bipolar diagnosis, notes the team.
To investigate, the researchers sent a questionnaire-style case study to 142 psychiatrists in Germany.
There were four versions of a case vignette that all described the same bipolar disorder patient in a manic state and differed only in two aspects: the presence or absence of auditory hallucinations, and of decreased need for sleep.
The psychiatrists were asked to make a diagnosis, to rate their confidence in their diagnosis, and to recommend treatments.
The most frequent diagnosis was manic episode of bipolar disorder (37.3%) followed by schizoaffective disorder (24.6%). Bipolar affective disorder (16.9%) and schizophrenia (14.8%) were diagnosed approximately the same number of times.
The researchers point out that almost half (45%) of the 142 psychiatrists did not diagnose bipolar disorder correctly.
Mentioning hallucinations decreased the likelihood for diagnosing bipolar disorder. The information about decreased need for sleep only affected the diagnosis significantly where physicians considered schizoaffective disorder to be part of the bipolar spectrum.
“When revising diagnostic systems such as the DSM, it seems worth keeping in mind such factors that influence diagnostic decision making to decrease the gap between research and everyday clinical routine,” Meyer and Meyer comment in the Journal of Affective Disorders.
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