School of Clinical Medicine, Christ's College, University of Cambridge, United Kingdom.
Psychiatr Danub. 2013 Sep;25 Suppl 2:S129-34.
Bipolar Affective Disorder is frequently under-diagnosed and misdiagnosed, particularly as unipolar depression. This has serious implications on treatment and outcome of the condition. A community mental health team (CMHT) in Bedford, United Kingdom, has therefore reassessed patients to examine whether it is possible to increase the sensitivity of diagnosis of bipolar affective disorder; to identify more cases and to identify them earlier, in order to be able to offer adequate treatment as early as possible.
Standards were decided within the team for the diagnosis of bipolar disorder based on the DSM4 criteria for the diagnosis of Bipolar I and Bipolar II illness. Patients were reassessed and patient data from 2006, 2007, 2010 and 2011, as well as from 2013, with respect to psychiatric diagnoses. The results were audited and analysed in every year in question. The proportions of total bipolar, bipolar I affective disorder and bipolar II affective disorder diagnoses, as well as the proportions of recurrent depressive disorder and other unipolar depression diagnoses were determined.
There was a steady increase in the proportions of both bipolar I and bipolar II diagnoses -from 10.5% in 2006 to 11.0% in 2013 for bipolar I affective disorder, and from 0% in 2006 (4.9% in 2007) to 9.7% in 2013 for bipolar II affective disorder-, and a steady decrease in the proportions of both recurrent depressive disorder and other unipolar depression diagnoses - from 16.1% and 18.7%, respectively, in 2006, to 4.8% and 8.0%, respectively, in 2013.
The results confirm that it is possible to increase the sensitivity of bipolar affective disorder diagnosis and that this results in an increased number of diagnoses of the disorder, and a decreased number of diagnoses of unipolar depression. Unexpectedly, the data also showed that increasingly more patients are receiving multiple psychiatric diagnoses.
This paper shows that it is possible to increase the sensitivity of diagnosis of bipolar affective disorder. This may be particularly useful in the light of increasingly more mental health problems being treated exclusively in primary care, since bipolar diagnoses will be less likely to be missed. Better identification, and therefore treatment, of bipolar affective disorder is likely to lead to better social and professional functioning of affected individuals.
双相情感障碍经常被漏诊和误诊，尤其是误诊为单相抑郁症。这对疾病的治疗和预后有严重影响。英国贝德福德的一个社区心理健康团队（CMHT）因此重新评估了患者，以研究是否有可能提高双相情感障碍诊断的敏感性；识别更多病例，并尽早识别，以便尽早提供足够的治疗。
团队根据 DSM4 对双相 I 型和双相 II 型疾病的诊断标准，为双相障碍的诊断制定了标准。对患者进行重新评估，并对 2006 年、2007 年、2010 年和 2011 年以及 2013 年的患者数据进行了精神病学诊断。对每个相关年份的结果进行了审核和分析。确定了总双相、双相 I 型情感障碍和双相 II 型情感障碍诊断的比例，以及复发性抑郁障碍和其他单相抑郁障碍诊断的比例。
双相 I 型和双相 II 型诊断的比例稳步上升-从 2006 年的 10.5%上升到 2013 年的 11.0%，双相 II 型情感障碍从 2006 年的 0%（2007 年的 4.9%）上升到 2013 年的 9.7%，而复发性抑郁障碍和其他单相抑郁障碍的比例则稳步下降-分别从 2006 年的 16.1%和 18.7%下降到 2013 年的 4.8%和 8.0%。
结果证实，提高双相情感障碍诊断的敏感性是有可能的，这会导致更多的患者被诊断为这种疾病，而更少的患者被诊断为单相抑郁。出乎意料的是，数据还显示，越来越多的患者同时接受多种精神科诊断。
本文表明，提高双相情感障碍诊断的敏感性是有可能的。这在精神健康问题越来越多地在初级保健中得到专门治疗的情况下尤其有用，因为双相诊断不太可能被遗漏。更好地识别和因此更好地治疗双相情感障碍，可能会导致受影响个体的社会和职业功能更好。
