Bipolar disorders diagnostic inaccuracies prof. fareed minha

1,100 views

Published on

Published in: Education, Health & Medicine
  • Be the first to comment

Bipolar disorders diagnostic inaccuracies prof. fareed minha

  1. 1. Diagnostic Accuracies In Bipolar Disorder FAREED A. MINHAS Prof. & Head Institute of Psychiatry Rawalpindi Medical College
  2. 2. Differential diagnosis of Bipolar disorder Implications for treatment Differentiating Bipolar disorder from other mood disorders and checking underlying etiology is crucial for optimal patient management Misdiagnosis may have adverse consequences for the patient: −Prescription of treatment which adversely affects condition −Lack of appropriate pharmacologic treatment −Lack of appropriate psychotherapy
  3. 3. Under-recognition and misdiagnosis  Very common in Bipolar disorder − diagnostic criteria limitations − lack of patient awareness, reluctance to receive treatment (especially if hypomanic)  Currently, 40–60% of patients with Bipolar I disorder are thought not to be receiving treatment  Time between first symptoms and first treatment is about 10 years  Conversion rate of unipolar depression to Bipolar disorder is around 5–10% 1,2 3 4 Kessler RC et al. Psychol Med 1997;27(5):1079–89; Reiger DA et al. Arch Gen Psychiatry 1993;50:85–94; Goodale LC, Lewis L. Bipolar Disord 2001;3(Suppl. 1):19 American Psychiatric Association, 1994 1 2 3 4
  4. 4. Areas of confusion in Bipolar disorder Substance abuse Anxiety Hyperactivity ADHD Unipolar depression Social phobia Depressive symptoms Delusional disorder Psychotic symptoms Personality disorders Schizophrenia Schizoaffective disorder
  5. 5. DSM-IV and ICD-10 criteria  Two major sets of criteria for Bipolar disorder diagnosis − DSM-IV: Diagnostic and Statistical Manual of the American Psychiatric Association, 4th edition − ICD-10: International Classification of Diseases, 10th edition  Broad diagnosis: at least one episode of mania, hypomania or a mixed episode − Type I: manic episode results in hospitalization or seriously affects normal daily functioning − Type II: milder episodes of mania  Additional subtypes of Bipolar disorder proposed − Type III − soft Bipolar spectrum
  6. 6. Awareness For Better Diagnosis  Education of physicians for correct diagnosis  Accurate history-taking will lead to identification of the types − assess long-term symptoms − obtain information from family and friends  Increase patient’s awareness of Bipolar disorder symptoms, particularly mild mood elevations
  7. 7. What is the best treatment strategy for Bipolar disorder?  The strategy that results in the fewest, mildest or briefest episodes  Primary therapeutic objectives − treat acute mania − treat acute depression − prevent recurrence of manic/depressive episodes (prophylaxis)  Efficacy across a broad range of clinical presentations (e.g. rapid cycling, mixed mania)
  8. 8. Standard treatments for Bipolar disorder Mood stabilisers Antipsychotics Benzodiazepines Antidepressants
  9. 9. YOUNG MANIA RATING SCALE A Rating Scale For Mania 1 Elevated Mood 0 1 2 3 4 2 Increased Motor Activity - Energy 0 1 2 3 4 3 Sexual Interest 0 1 2 3 4 4 Sleep 0 1 2 3 4 5 Irritability 0 2 4 6 8 6 Speech (Rate and Amount) 0 2 4 6 8 7 Language - Thought Disorder 0 1 2 3 4 8 Content 0 2 4 6 8 9 Disruptive - Aggressive Behaviour 0 2 4 6 8 10 Appearance 0 1 2 3 4 11 Insight 0 1 2 3 4 0 15 30 45 60 Total Rating Patient's Score
  10. 10. THE HAMILTON RATING SCALE 1 Depressed Mood 0 1 2 3 4 2 Feeling of Guilt 0 1 2 3 4 3 Suicide 0 1 2 3 4 4 Insomnia Early 0 1 2 5 Insomnia Middle 0 1 2 6 Insomnia Late 0 1 2 7 Work And Activities 0 1 2 3 4 8 Retardation : Psychomotor 0 1 2 3 4 9 Agitation 0 1 2 3 4 10 Anxiety (Psychological) 0 1 2 3 4 11 Anxiety Somatic 0 1 2 3 4 12 Somatic Symptoms (Gastrointestinal) 0 1 2 13 Somatic Symptoms General 0 1 2
  11. 11. THE HAMILTON RATING SCALE 14 Genital Symptoms 0 1 2 15 Hypochondriasis 0 1 2 3 16 Loss of Weight 0 1 2 3 17 Insight 0 1 2 18 - A Diurnal Variation 0 1 2 18 - B Diurnal Variation 0 1 2 19 Depersonalization and Derealization 0 1 2 3 20 Paranoid Symptoms 0 1 2 3 21 Obsessional and Compulsive Symptoms 0 1 2 Total Rating 0 22 44 Patient's Score 36 4 4 40

×