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Current Psychiatry Reviews


ISSN (Print): 1573-4005
ISSN (Online): 1875-6441

The Over-Under on the Misdiagnosis of Bipolar Disorder: A Systematic Review

Author(s): Jeffrey J. Rakofsky and Boadie W. Dunlop

Volume 11, Issue 4, 2015

Page: [222 - 234] Pages: 13

DOI: 10.2174/1573400512666151117211523

Price: $65


The misdiagnosis of bipolar disorder is widely prevalent as evidenced by patient surveys, administrative claims data and studies measuring clinicians’ diagnostic accuracy. The consequences of a missed or incorrect bipolar disorder diagnosis can have serious short and long-term repercussions for a patient. In this review, a systematic analysis was conducted of over-diagnosis and under-diagnosis rates calculated from all adult bipolar studies comparing patient reported diagnoses with diagnoses resulting from DSM-IV based structured assessments/checklists. Five of the 368 publications were selected using OVID medline and demonstrated under-diagnosis rates of 30-51% and over-diagnosis rates of 12-13%. These results contrast with earlier publications suggesting over-diagnosis of bipolar disorder occurred more frequently than under-diagnosis. An in-depth discussion of the various mechanisms contributing to the over and under-diagnosis of bipolar disorder are provided. These include limitations in the design of structured research interviews, racial bias, and patients’ memory impairment, to name a few. In this manuscript the authors also provide recommendations to improve the diagnosis of bipolar disorder and discuss the implications of bipolar spectrum research on the diagnostic process.

Keywords: Assessment, bipolar disorder, misdiagnosis, sensitivity, specificity, test-validity.

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