Mantere Outi, Suominen Kirsi, Arvilommi Petri, Valtonen Hanna, Leppämäki Sami, Isometsä Erkki
Department of Mental Health and Alcohol Research, National Public Health Institute, Helsinki.
Bipolar Disord. 2008 Mar;10(2):238-44. doi: 10.1111/j.1399-5618.2007.00501.x.
Bipolar disorder (BD) is correctly diagnosed in only 40-50% of patients. No previous study has investigated the characteristics of bipolar patients in psychiatric care with or without clinical diagnoses of BD. We investigated the demographic and clinical predictors of the absence of a clinical diagnosis of BD I and II among psychiatric patients.
In the Jorvi Bipolar Study, 1,630 psychiatric in- and outpatients were screened with the Mood Disorder Questionnaire. Suspected cases were diagnosed with the Structured Clinical Interview for DSM-IV Axis I Disorders-Patient version (SCID-I/P) for BD. Patients with no preceding clinical diagnosis of BD, despite previous manic, hypomanic or mixed phases and treatment in psychiatric care, were classified as undiagnosed. The clinical characteristics of unrecognized BD I patients (23 of 90 BD I patients) and BD II patients (47 of 93 BD II patients) were compared to those of patients who had been correctly diagnosed.
No previous hospitalizations [odds ratio (OR) = 10.6, p = 0.001] or psychotic symptoms (OR = 4.4, p = 0.045), and the presence of rapid cycling (OR = 11.6, p = 0.001) predicted lack of BD I diagnosis. No psychotic symptoms (OR = 3.3, p = 0.01), female gender (OR = 3.0, p = 0.03), and shorter time in treatment (OR = 1.1, p = 0.03) predicted the lack of a BD II diagnosis.
Correct diagnosis of BD I is related to the severe phases of illness leading to hospitalizations. In BD II, the illness factors may not be as important as time elapsed in treatment, a factor that often leads to a delay in diagnosis or none at all. Excessive reliance on typical and cross-sectional presentations of illness likely explain the non-recognition of BD. The challenge for correctly diagnosing bipolar patients is in outpatient settings.
双相情感障碍（BD）在仅40 - 50%的患者中得到正确诊断。此前尚无研究调查过接受精神科护理的双相情感障碍患者（无论有无BD的临床诊断）的特征。我们调查了精神科患者中未得到BD I型和II型临床诊断的人口统计学和临床预测因素。
在约尔维双相情感障碍研究中，对1630名精神科门诊和住院患者进行了心境障碍问卷筛查。疑似病例采用DSM - IV轴I障碍患者版结构化临床访谈（SCID - I/P）进行BD诊断。尽管之前有过躁狂、轻躁狂或混合发作阶段且接受过精神科护理治疗，但之前无BD临床诊断的患者被归类为未确诊。将未被识别的BD I型患者（90名BD I型患者中的23名）和BD II型患者（93名BD II型患者中的47名）的临床特征与已被正确诊断的患者进行比较。
既往未住院（优势比[OR]=10.6，p = 0.001）或有精神病性症状（OR = 4.4，p = 0.045），以及存在快速循环（OR = 11.6，p = 0.001）可预测未得到BD I型诊断。无精神病性症状（OR = 3.3，p = 0.01）、女性（OR = 3.0，p = 0.03）以及治疗时间较短（OR = 1.1，p = 0.03）可预测未得到BD II型诊断。
BD I型的正确诊断与导致住院的疾病严重阶段有关。在BD II型中，疾病因素可能不如治疗持续时间重要，而这一因素常常导致诊断延迟或根本无法诊断。过度依赖疾病典型和横断面表现可能解释了BD未被识别的情况。正确诊断双相情感障碍患者面临的挑战在于门诊环境。
