title: DSM-IV diagnosis in depressed primary care patients with previous psychiatric ICD-10 bipolar disorder.
abstract: BACKGROUND
  In the past 20 years, much evidence has accumulated against the overly restrictive diagnostic concepts of hypomania in DSM-IV and DSM-IV-TR. We tested DSM-IV-TR and a broader modified version (DSM-IV-TRm) for their ability to detect bipolarity in patients who had been treated for bipolar disorders (BD) in psychiatric settings, and who now consulted general practitioners (GPs) for new major depressive episodes (MDE).
  
  
  METHODS
  Bipolact II was an observational, single-visit survey involving 390 adult patients attending primary care for MDE (DSM-IV-TR criteria) in 201 GP offices in France. The participating GPs (53.3 ± 6.5 years old, 80.1% male) were trained by the Bipolact Educational Program, and were familiar with the medical care of depressive patients.
  
  
  RESULTS
  Of the 390 patients with MDE, 129 (33.1%) were previously known as bipolar patients (ICD-10 criteria). Most of the latter bipolar patients (89.7%) had previously been treated with antidepressants. Only 9.3% of them met DMS-IV-TR criteria for BD. Conversely, 79.1% of the 129 bipolar patients met DMS-IV-TRm criteria for BD and showed strong associations with impulse control disorders and manic/hypomanic switches during antidepressant treatment.
  
  
  CONCLUSIONS
  Limited training of participating GPs, recall bias of patients, and the study not being representative for untreated bipolar patients.
  
  
  CONCLUSIONS
  Very few ICD-10 bipolar patients consulting French GPs for MDE met DSM-IV-TR criteria for bipolar diagnosis, which suggests that DSM-IV-TR criteria are insufficient and too restrictive for the diagnosis of BD. DSM-IV-TRm was more sensitive, but 20% of bipolar patients were undetected.
authors.affiliation: Zurich University Psychiatric Hospital, Zurich, Switzerland.
authors.forename: Jules
authors.initials: J
authors.lastname: Angst
authors.forename: Elie
authors.initials: E
authors.lastname: Hantouche
authors.forename: Hervé
authors.initials: H
authors.lastname: Caci
authors.forename: Raphael
authors.initials: R
authors.lastname: Gaillard
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lancrenon
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Azorin
mesh_terms: D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000453:epidemiology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000706:statistics & numerical data
keywords: Bipolar disorder; DSM-IV-TR; Detection; Hypomania; Questionnaire