title: Sociodemographic and clinical features of bipolar disorder patients misdiagnosed with major depressive disorder in China.
abstract: OBJECTIVE
  Bipolar disorder (BD) is frequently misdiagnosed as major depressive disorder (MDD), which may lead to inappropriate treatment and poor outcomes. This study aimed to compare demographic and clinical features between patients with MDD and those with BD, but being misdiagnosed as MDD, in China.
  
  
  METHODS
  A total of 1487 patients diagnosed with MDD were consecutively evaluated in 13 psychiatric hospitals or psychiatric units of general hospitals nationwide in China. The patients' sociodemographic and clinical characteristics were recorded using a standardized protocol and data collection procedure. The Mini-International Neuropsychiatric Interview (MINI) was used to establish DSM-IV diagnoses, and identify patients with MDD and those with BD, but being misdiagnosed with MDD.
  
  
  RESULTS
  The proportions of BD (all types), bipolar I disorder (BD-I), and bipolar II disorder (BD-II) misdiagnosed as MDD in clinical practice were 20.8%, 7.9%, and 12.8%, respectively. Multiple logistic regression analyses revealed that compared to MDD patients, BD-I was characterized by more atypical depressive features (increased appetite, increased sleep, and weight gain) [odds ratio (OR) = 2.0, 95% confidence interval (CI): 1.2-3.2], more psychotic symptoms (OR = 2.1, 95% CI: 1.3-3.5), more lifetime depressive episodes (OR = 1.1, 95% CI: 1.1-1.2), and earlier age of onset (OR = 0.97, 95% CI: 0.9-0.99); BD-II was characterized by more psychotic symptoms (OR = 2.1, 95% CI: 1.4-3.1) and earlier age of onset (OR = 0.96, 95% CI: 0.9-0.97). In addition, compared to BD-II patients, BD-I patients were characterized by more frequent depressive episodes per year (OR = 3.1, 95% CI: 1.5-6.6).
  
  
  CONCLUSIONS
  Depressive episodes in the context of BD-I and BD-II, among those who were misclassified as MDD, present some different clinical features compared to MDD. This finding should be taken into account in guiding diagnostic practices in China.
authors: Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, Beijing, China. xyutly@gmail.com
authors: Yu-Tao
authors: YT
authors: Xiang
authors: Ling
authors: L
authors: Zhang
authors: Gang
authors: G
authors: Wang
authors: Chen
authors: C
authors: Hu
authors: Gabor S
authors: GS
authors: Ungvari
authors: Faith B
authors: FB
authors: Dickerson
authors: Amy M
authors: AM
authors: Kilbourne
authors: Tian-Mei
authors: TM
authors: Si
authors: Yi-Ru
authors: YR
authors: Fang
authors: Zheng
authors: Z
authors: Lu
authors: Hai-Chen
authors: HC
authors: Yang
authors: Kelly Y C
authors: KY
authors: Lai
authors: Edwin H M
authors: EH
authors: Lee
authors: Jian
authors: J
authors: Hu
authors: Zhi-Yu
authors: ZY
authors: Chen
authors: Yi
authors: Y
authors: Huang
authors: Jing
authors: J
authors: Sun
authors: Xiao-Ping
authors: XP
authors: Wang
authors: Hui-Chun
authors: HC
authors: Li
authors: Jin-Bei
authors: JB
authors: Zhang
authors: Helen F K
authors: HF
authors: Chiu
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology; D002681:China / Q000453:epidemiology; D003710:Demography; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011569:Psychiatric Status Rating Scales