Is bipolar disorder overdiagnosed among patients with substance abuse?
BACKGROUND
Bipolar illness is frequently misdiagnosed. Several studies have focused on the underdiagnosis of this condition and the frequent long delay in its recognition. However, the illness is difficult to diagnose and many of its symptoms are shared by other conditions. In order to determine the accuracy of the diagnosis of bipolar illness among subjects with substance abuse, we carried out a study in patients with a previous diagnosis of bipolar disorder (BD) and known history of substance abuse or dependence, who were currently engaged in treatment for substance abuse.


METHODS
Individuals participating in a community-based substance treatment program and who had a previous diagnosis of BD were invited to undergo a structured clinical interview for diagnosis performed by a psychiatrist. In addition to the interview, previous hospital records were reviewed whenever possible. Diagnosis was made following strict DSM-IV criteria.


RESULTS
Only 9 of 21 (42.9%) subjects met diagnostic criteria for BD. Seven were BD type II and two were BD I.


CONCLUSIONS
Bipolar disorder is frequently misdiagnosed following strict DSM-IV criteria. Among subjects with substance abuse, it may be overdiagnosed by psychiatrists.
Stewart
Christopher
C
Mood Disorders Research Program, Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY 40202, USA.
El-Mallakh
Rif S
RS
D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D017831:Diagnosis, Dual (Psychiatry); D003951:Diagnostic Errors; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D007406:Interview, Psychological; D008605:Mental Health Services; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis*