Delayed Diagnosis of Bipolar Disorder

It is quite unfortunate that many patients with bipolar disorder wait for many years fruitlessly seeing psychiatrists until the correct diagnosis is made. According to data collected by the Depression and Bipolar Support Alliance (DBSA) about 60% of patients ultimately diagnosed with bipolar disorder had the illness for at least 5 years before the correct diagnosis bas made.

There are several reason for this. Patients don’t typically come to the doctor complaining that they feel too good. In both hypomania and mania there is a lack of insight into the illness. Psychiatrists do not routinely ask carefully enough about past bipolar symptoms in every patient they see who is depressed. They may ask one screening question but then fail to probe deeply enough. Nowadays the diagnosis of bipolar disorder is much easier.

A psychiatrist called Robert Hirschfield MD developed a screening instrument called the Mood Disorders Scale (MDQ) which is self-administered and available on the web site of the Depression and Bipolar Support Alliance (dbsalliance.org). One should remember though that is a screening instrument and not a diagnostic one. If the screen is positive the next step is to see a psychiatrist and have a thorough assessment to determine if bipolar disorder is present or not.

Bipolar disorder often develops early in life. The peak age of onset is in young people 15-30 years old. It can even occur earlier in childhood. In teenage years the mood swings are more sustained and the depressions can be lengthy distinguishing it from normal teenage angst. The earlier the diagnosis is made and proper treatment is started the better the long-term prognosis. Therefore, any teenager with depression or who makes a suicide attempt needs to be screened carefully for bipolar disorder.