Delayed Diagnosis in Bipolar Disease

August 26, 2014
Jeannette Y. Wick, RPh, MBA, FASCP

A recent study examines the effects of delayed diagnosis on the treatment outcomes of bipolar patients with bipolar disorder.

A recent study examines the effects of delayed diagnosis on the treatment outcomes of bipolar patients with bipolar disorder.

Bipolar disorder (BD)’s onset usually begins with a depressive episode, prompting clinicians to diagnose depression. Most bipolar patients learn their correct diagnoses only after being misdiagnosed and re-diagnosed incorrectly several times. Some languish with incorrect diagnoses for up to 10 years (with an average of 8.6 years to correct diagnosis), taking medications that don’t work and wondering why they remain in mental health limbo.

Diagnosis delays are disruptive for bipolar patients and their loved ones. Does a longer duration of undiagnosed bipolar disorder (DUB) leads to an inferior treatment response? Researchers from Syndey, Australia, think not. They have published a study explaining their opinion in the August 2014 issue of The Journal of Affective Disorders.

This article describes 2 studies that enrolled BD patients. In the first (n = 173), they included patients who received a first-time diagnosis of BD. In the second (n = 64), they examined response to mood stabilizing medication in relationship to DUB.

Mean DUB was 18 to 20 years from the onset of mood episodes—a period much longer than usually reported. Patients with longest DUB had more employment difficulties than others, a finding consistent with most other study finding. BD creates economic hardship if uncontrolled.

Those with shorter DUBs were more likely to have engaged in self-harm behaviors and less likely to have incurred social costs (eg, losing friends and contacts) due to the mood disorder. Patients with longer DUB had higher social avoidance scores also.

The researchers found no association between mood episode profile, global functioning scores, treatment history, hospital admissions, suicide attempts, drug and alcohol use, or life satisfaction and DUB.

Once diagnosed and treated with BD-directed treatment, improvement was rapid for most patients, with 80% of patients reporting symptom improvement and 80% of clinicians observing the same within 3 months.

The researchers conclude that participants' disease trajectory over the study period was not significantly related to the DUB. The fact that patients self-reported is a study limitation recognized by the researchers, as was the lack of medication monitoring for appropriate dose. They indicate that early detection and intervention can reduce morbidity and risks associated with untreated BD.