Diagnostic stability and evolution of bipolar disorder in clinical practice: a prospective cohort study.
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.
Baca-Garcia
E
E
Department of Psychiatry, Fundacion Jimenez Diaz University Hospital, Autonoma University of Madrid, Madrid, Spain. ebacgar2@yahoo.es
Perez-Rodriguez
M M
MM
Basurte-Villamor
I
I
López-Castromán
J
J
Fernandez del Moral
A L
AL
Jimenez-Arriero
M A
MA
Gronzalez de Rivera
J L
JL
Saiz-Ruiz
J
J
Leiva-Murillo
J M
JM
de Prado-Cumplido
M
M
Santiago-Mozos
R
R
Artés-Rodríguez
A
A
Oquendo
M A
MA
de Leon
J
J
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