Comparison of women with confirmed versus presumably misdiagnosed bipolar disorder.
OBJECTIVE
Because bipolar disorder can be difficult to diagnose, we compared characteristics of women with confirmed versus presumably misdiagnosed bipolar disorder.


METHODS
This cohort study was conducted from July 2005 to January 2010 in the outpatient clinic of the Emory Women's Mental Health Program, Atlanta, Georgia. Young adult women (mean age = 32 years) who were either pregnant or planning to conceive and who reported having previous clinical diagnoses of bipolar disorder completed 2 independent diagnostic assessments: the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and an evaluation by a perinatal mood-disorder expert who was masked to the SCID findings. We compared clinical characteristics of women with confirmed versus presumably misdiagnosed bipolar disorder by bivariate testing followed by multivariate logistic regression modeling.


RESULTS
Of 199 participants, 141 (70.9%) had confirmed DSM-IV bipolar disorder on the basis of concordant assessments, 23 (11.6%) were considered misdiagnosed, and 35 (17.6%) who had discordant diagnostic assessments were excluded from further analysis. Multivariate modeling indicated that confirmed bipolar disorder was associated with a history of antidepressant-associated mania/hypomania (OR = 13.30; 95% CI, 3.32-53.20; P = .0003), psychotic symptoms (OR = 12.40; 95% CI, 2.14-71.10; P = .005), and sustained euthymia during mood-stabilizer treatment (OR = 4.53; 95% CI, 1.32-15.60; P = .02); presumably misdiagnosed bipolar disorder was associated with childhood physical abuse (OR = 8.73; 95% CI, 2.33-32.70; P = .001) and comorbid obsessive-compulsive disorder (OR = 7.26; 95% CI, 1.86-28.30; P = .004).


CONCLUSIONS
Several clinical factors found to distinguish women with confirmed versus presumably misdiagnosed bipolar disorder may help to refine clinical diagnosis.
Department of Psychiatry, Emory University School of Medicine, Atlanta, GA 30322, USA. jeff.newport@emory.edu
D Jeffrey
DJ
Newport
Ross J
RJ
Baldessarini
Bettina T
BT
Knight
Susana V
SV
Fernandez
Natalie J
NJ
Morris
Adele C
AC
Viguera
Zachary N
ZN
Stowe
D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000175:diagnosis*; D015331:Cohort Studies; D003951:Diagnostic Errors / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D005845:Georgia; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors