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Response to: ‘I want to be bipolar’... a new phenomenon - The importance of early and accurate diagnosis [eLetter]

Craddock, Nicholas John, Jones, Ian Richard and Smith, Daniel J. 2010. Response to: ‘I want to be bipolar’... a new phenomenon - The importance of early and accurate diagnosis [eLetter]. The Psychiatrist

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This article is very timely because there is ongoing debate about the extent to which bipolar disorder may be over- (2), or under-diagnosed (3). It is also possible, and we think very likely, both over- and under- diagnosis occur and are problematic. Some people may be inappropriately labelled while others who would benefit from the diagnosis are missed. Optimal treatment of depression is different in bipolar and unipolar disorders. This is one of many examples in psychiatry where making an early and correct diagnosis is highly likely to have a very direct and important effect on the quality of care offered to, and quality of life experienced by, a patient (4). Chan and Sireling highlight new cases of bipolar disorder from the primary care setting. Preliminary data from our ongoing studies of primary care depressed patients suggest that bipolar (ie.manic/hypomanic) features are relatively common in this group (unpublished data). In our wider research in individuals with both bipolar and unipolar mood disorders we have found that those with a diagnosis of recurrent unipolar depression who have a history of mild manic symptoms tend to respond less well to antidepressants (5). Inevitably, increasing awareness of any medical illness has the potential to lead to over-diagnosis, and this could cause problems for the patient as well as for services. Thus, a balance must always be struck between the need to increase awareness appropriately amongst patients, public and clinicians, whilst not causing a tsunami of uncritical over- diagnosis and self-labelling (Smith, D.J., Thapar, A., Simpson, S. Bipolar spectrum disorders in primary care: optimising diagnosis and treatment. British Journal of General Practice, In press). As psychiatrists we must ensure we are pragmatic and put the patient’s well-being at the centre of decision making. This will require us to have knowledge of the developing evidence base, make a comprehensive diagnosis based on a detailed lifetime history of both depressed and manic mood (including asking an informant) and have an awareness of the boundaries of clinically-relevant symptomatology.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
MRC Centre for Neuropsychiatric Genetics and Genomics (CNGG)
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Publisher: The Royal College of Psychiatrists
ISSN: 1758-3209
Last Modified: 04 Jun 2017 04:45

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