title: Diagnostic stability and evolution of bipolar disorder in clinical practice: a prospective cohort study.
abstract: OBJECTIVE
  To evaluate the long-term stability of International Classification of Diseases-10th revision bipolar affective disorder (BD) in multiple settings.
  
  
  METHODS
  A total of 34 368 patients received psychiatric care in the catchment area of a Spanish hospital (1992-2004). The analyzed sample included patients aged > or =18 years who were assessed on > or =10 occasions and received a diagnosis of BD at least once (n = 1153; 71,543 assessments). Prospective and retrospective consistencies and the proportion of subjects who received a BD diagnosis in > or =75% of assessments were calculated. Factors related to diagnostic shift were analyzed with traditional statistical methods and Markov's models.
  
  
  RESULTS
  Thirty per cent of patients received a BD diagnosis in the first assessment and 38% in the last assessment. Prospective and retrospective consistencies were 49% and 38%. Twenty-three per cent of patients received a BD diagnosis during > or =75% of the assessments.
  
  
  CONCLUSIONS
  There was a high prevalence of misdiagnosis and diagnostic shift from other psychiatric disorders to BD. Temporal consistency was lower than in other studies.
authors.affiliation: Department of Psychiatry, Fundacion Jimenez Diaz University Hospital, Autonoma University of Madrid, Madrid, Spain. ebacgar2@yahoo.es
authors.forename: E
authors.initials: E
authors.lastname: Baca-Garcia
authors.forename: M M
authors.initials: MM
authors.lastname: Perez-Rodriguez
authors.forename: I
authors.initials: I
authors.lastname: Basurte-Villamor
authors.forename: J
authors.initials: J
authors.lastname: López-Castromán
authors.forename: A L
authors.initials: AL
authors.lastname: Fernandez del Moral
authors.forename: M A
authors.initials: MA
authors.lastname: Jimenez-Arriero
authors.forename: J L
authors.initials: JL
authors.lastname: Gronzalez de Rivera
authors.forename: J
authors.initials: J
authors.lastname: Saiz-Ruiz
authors.forename: J M
authors.initials: JM
authors.lastname: Leiva-Murillo
authors.forename: M
authors.initials: M
authors.lastname: de Prado-Cumplido
authors.forename: R
authors.initials: R
authors.lastname: Santiago-Mozos
authors.forename: A
authors.initials: A
authors.lastname: Artés-Rodríguez
authors.forename: M A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: J
authors.initials: J
authors.lastname: de Leon
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies