title: Diagnosis of bipolar disorder in primary and secondary care: what have we learned over a 10-year period?
abstract: BACKGROUND
  Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement.
  
  
  METHODS
  The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care. Socio-demographic variables, reason for referral, and psychiatric diagnosis were compiled for patients assessed from 1998 to 2010. GP-psychiatrist agreement was established for BD type, gender, and age group (18-25, 26-35, 36-45, >45) using Cohen׳s Kappa coefficient (Κ).
  
  
  RESULTS
  From 1998 to 2010, MEL psychiatrists received 18,111 requests and carried out 10,492 (58%) assessments. There were 583 referrals for BD suspicion, while 640 assessments (6.1%) received a BD diagnosis (40.3% type I, 40.5% type II). The overall K was 0.35 (95% CI [0.31, 0.38]), and was significantly higher for type I than type II (I=0.35, 95% CI [0.30, 0.39]; II=0.25, 95% CI [0.21, 0.30]), though age group and gender had no impact.
  
  
  CONCLUSIONS
  Reasons for referral were converted into keywords and categories to facilitate agreement analyses. Only the main psychiatric diagnosis was available.
  
  
  CONCLUSIONS
  Our study suggests diagnosing BD remains strenuous, regardless of age and gender, though BD type I seems better understood by primary care GPs. The true measure of BD diagnosis remains a critical issue in clinical practice.
authors.affiliation: Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Douglas Mental Health University Institute, Montréal, Québec, Canada; Université de Montréal, Montréal, Québec, Canada; McGill University, Montréal, Québec, Canada. Electronic address: andree.daigneault@douglas.mcgill.ca.
authors.forename: Andrée
authors.initials: A
authors.lastname: Daigneault
authors.affiliation: Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Douglas Mental Health University Institute, Montréal, Québec, Canada; Université de Montréal, Montréal, Québec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Duclos
authors.affiliation: Douglas Mental Health University Institute, Montréal, Québec, Canada.
authors.forename: Sybille
authors.initials: S
authors.lastname: Saury
authors.affiliation: Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Paquet
authors.affiliation: Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada.
authors.forename: Daniel
authors.initials: D
authors.lastname: Dumont
authors.affiliation: Douglas Mental Health University Institute, Montréal, Québec, Canada; McGill University, Montréal, Québec, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Beaulieu
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000453:epidemiology*; D003951:Diagnostic Errors / Q000639:trends*; D005260:Female; D058005:General Practitioners; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011570:Psychiatry; D011792:Quebec / Q000453:epidemiology; D012017:Referral and Consultation / Q000639:trends*; D063127:Secondary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Bipolar disorder; GP; Misdiagnosis; Primary care; Referral; Secondary care