title: Diagnosing bipolar disorder in the community setting.
abstract: BACKGROUND
  Bipolar disorder (BD) is a common psychiatric illness. Diagnosing this condition is challenging, due to the frequent need to make the diagnosis based on historical symptoms, the lack of specificity of many of the symptoms, and the absence of accurate objective measures to confirm the diagnosis. A lack of consensus among psychiatrists as to the breadth of the diagnosis, increasing pressures to make a diagnosis quickly in clinical settings, and the availability of broader spectrum treatments have also served to foster uncertainty in diagnosis. This article examines the process of diagnosing BD, reviews factors that can confound the diagnostic process, and discusses how the sensitivity and specificity of the diagnosis can be improved.
  
  
  METHODS
  A MEDLINE search and a manual search of textbooks and abstracts from scientific meetings were conducted. Results were limited to publications in English, but no timeframe limitations were used.
  
  
  RESULTS
  The standard for diagnosing BD remains the psychiatric interview, with laboratory, genetic, radiographic, and neuroimaging tests still investigational, and psychological tests and questionnaires serving an ancillary role. The sensitivity and specificity of the BD diagnosis is less than optimal, with the condition being both overlooked and diagnosed when it is not present.
  
  
  CONCLUSIONS
  Factors leading to diagnostic uncertainty and approaches to improve the sensitivity and specificity of the BD diagnosis are discussed. A paradigm for differentiating between BD and borderline personality disorder is offered.
authors.affiliation: Delaware Psychiatry, Residency Program, New Castle, DE, USA. Andrew.donohue@state.de.us
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Donohue
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis* / Q000235:genetics; D006801:Humans; D011570:Psychiatry / Q000295:instrumentation / Q000379:methods* / Q000592:standards; D012111:Residence Characteristics