Fritz Kristina, Russell Alex M T, Allwang Christine, Kuiper Sandy, Lampe Lisa, Malhi Gin S
Academic Department of Psychiatry, Northern Sydney Local Health District, St Leonards, NSW, Australia.
Sydney Medical School Northern, University of Sydney, Sydney, NSW, Australia.
Bipolar Disord. 2017 Aug;19(5):396-400. doi: 10.1111/bdi.12499. Epub 2017 May 22.
A diagnosis of bipolar disorder (BD) is often preceded by an initial diagnosis of depression, creating a delay in the accurate diagnosis and treatment of BD. Although previous research has focused on predictors of a diagnosis change from depression to BD, the research on this delay in diagnosis is sparse. Therefore, the present study examined the time taken to make a BD diagnosis following an initial diagnosis of major depressive disorder in order to further understand the patient characteristics and psychological factors that may explain this delay.
A total of 382 patients underwent a clinical evaluation by a psychiatrist and completed a series of questionnaires.
Ninety patients were initially diagnosed with depression with a later diagnosis of BD, with a mean delay in diagnostic conversion of 8.74 years. These patients who were later diagnosed with BD were, on average, diagnosed with depression at a younger age, experienced more manic symptoms, and had a more open personality style and better coping skills. Cox regressions showed that depressed patients with diagnoses that eventually converted to BD had been diagnosed with depression earlier and that this was related to a longer delay to conversion and greater likelihood of dysfunctional attitudes.
The findings from the present study suggested that an earlier diagnosis of depression is related to experiencing a longer delay in conversion to BD. The clinical implications of this are briefly discussed, with a view to reducing the seemingly inevitable delay in the diagnosis of BD.
双相情感障碍（BD）的诊断通常在最初被诊断为抑郁症之后，这导致了BD准确诊断和治疗的延迟。尽管先前的研究聚焦于从抑郁症转变为BD诊断的预测因素，但关于这种诊断延迟的研究却很稀少。因此，本研究考察了在最初被诊断为重度抑郁症之后做出BD诊断所需的时间，以便进一步了解可能解释这种延迟的患者特征和心理因素。
共有382名患者接受了精神科医生的临床评估并完成了一系列问卷。
90名患者最初被诊断为抑郁症，后来被诊断为BD，诊断转换的平均延迟为8.74年。这些后来被诊断为BD的患者，平均而言，被诊断为抑郁症时年龄更小，经历过更多躁狂症状，且具有更开放的人格风格和更好的应对技巧。Cox回归显示，最终诊断转变为BD的抑郁症患者被诊断为抑郁症的时间更早，这与更长的转换延迟和功能失调态度的更大可能性有关。
本研究结果表明，抑郁症的早期诊断与转变为BD的延迟时间更长有关。本文简要讨论了这一发现的临床意义，以期减少BD诊断中看似不可避免的延迟。
