title: Clinical predictors of unrecognized bipolar I and II disorders.
abstract: OBJECTIVE
  Bipolar disorder (BD) is correctly diagnosed in only 40-50% of patients. No previous study has investigated the characteristics of bipolar patients in psychiatric care with or without clinical diagnoses of BD. We investigated the demographic and clinical predictors of the absence of a clinical diagnosis of BD I and II among psychiatric patients.
  
  
  METHODS
  In the Jorvi Bipolar Study, 1,630 psychiatric in- and outpatients were screened with the Mood Disorder Questionnaire. Suspected cases were diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient version (SCID-I/P) for BD. Patients with no preceding clinical diagnosis of BD, despite previous manic, hypomanic or mixed phases and treatment in psychiatric care, were classified as undiagnosed. The clinical characteristics of unrecognized BD I patients (23 of 90 BD I patients) and BD II patients (47 of 93 BD II patients) were compared to those of patients who had been correctly diagnosed.
  
  
  RESULTS
  No previous hospitalizations [odds ratio (OR) = 10.6, p = 0.001] or psychotic symptoms (OR = 4.4, p = 0.045), and the presence of rapid cycling (OR = 11.6, p = 0.001) predicted lack of BD I diagnosis. No psychotic symptoms (OR = 3.3, p = 0.01), female gender (OR = 3.0, p = 0.03), and shorter time in treatment (OR = 1.1, p = 0.03) predicted the lack of a BD II diagnosis.
  
  
  CONCLUSIONS
  Correct diagnosis of BD I is related to the severe phases of illness leading to hospitalizations. In BD II, the illness factors may not be as important as time elapsed in treatment, a factor that often leads to a delay in diagnosis or none at all. Excessive reliance on typical and cross-sectional presentations of illness likely explain the non-recognition of BD. The challenge for correctly diagnosing bipolar patients is in outpatient settings.
authors.affiliation: Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki.
authors.forename: Outi
authors.initials: O
authors.lastname: Mantere
authors.forename: Kirsi
authors.initials: K
authors.lastname: Suominen
authors.forename: Petri
authors.initials: P
authors.lastname: Arvilommi
authors.forename: Hanna
authors.initials: H
authors.lastname: Valtonen
authors.forename: Sami
authors.initials: S
authors.lastname: Leppämäki
authors.forename: Erkki
authors.initials: E
authors.lastname: Isometsä
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000145:classification / Q000175:diagnosis / Q000523:psychology; D003951:Diagnostic Errors; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires