Lars Vedel Kessing1. 1. Department of Psychiatry, University of Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9 DK 2100 Copenhagen Ø, Denmark. lars.kessing@rh.dk
Abstract
BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of mania/bipolar disorder has not been investigated in clinical practice. METHODS: All patients who got a diagnosis of mania/bipolar disorder at least once in a period from 1994 to 2002 at outpatient treatment or at discharge from psychiatric hospitalisation in Denmark were identified in a nationwide register. RESULTS: Totally, 4116 patients got a diagnosis of mania/bipolar disorder at least once; among these, 2315 patients (56.2%) got the diagnosis at the first contact, whereas the remaining patients (43.8%) got the diagnosis at later contacts. Approximately 30% of patients with an initial diagnosis of mania/bipolar disorder eventually changed diagnosis during follow-up. A substantial proportion of patients initially presented with prodromal syndromes such as transient psychosis, reaction to stress/adjustment disorder or mental and behavioural disorder due to psychoactive substance use and got a diagnosis of bipolar disorder later on. Especially younger but also female patients were at increased risk of delay of the diagnosis of bipolar disorder. LIMITATIONS: Only patients from psychiatric settings were included. CONCLUSIONS: Clinicians should, especially in younger and female patients, be more observant on manic symptoms in patients who as first glance presents with transient psychosis, reaction to stress/adjustment disorder or with psychoactive substance abuse and follow these patients more closely over time identifying putable hypomanic and manic symptoms as early as possible.
BACKGROUND: The diagnostic stability of the ICD-10 diagnosis of mania/bipolar disorder has not been investigated in clinical practice. METHODS: All patients who got a diagnosis of mania/bipolar disorder at least once in a period from 1994 to 2002 at outpatient treatment or at discharge from psychiatric hospitalisation in Denmark were identified in a nationwide register. RESULTS: Totally, 4116 patients got a diagnosis of mania/bipolar disorder at least once; among these, 2315 patients (56.2%) got the diagnosis at the first contact, whereas the remaining patients (43.8%) got the diagnosis at later contacts. Approximately 30% of patients with an initial diagnosis of mania/bipolar disorder eventually changed diagnosis during follow-up. A substantial proportion of patients initially presented with prodromal syndromes such as transient psychosis, reaction to stress/adjustment disorder or mental and behavioural disorder due to psychoactive substance use and got a diagnosis of bipolar disorder later on. Especially younger but also female patients were at increased risk of delay of the diagnosis of bipolar disorder. LIMITATIONS: Only patients from psychiatric settings were included. CONCLUSIONS: Clinicians should, especially in younger and female patients, be more observant on manic symptoms in patients who as first glance presents with transient psychosis, reaction to stress/adjustment disorder or with psychoactive substance abuse and follow these patients more closely over time identifying putable hypomanic and manic symptoms as early as possible.
Authors: Paola Salvatore; Ross J Baldessarini; Mauricio Tohen; Hari-Mandir K Khalsa; Jesus Perez Sanchez-Toledo; Carlos A Zarate; Eduard Vieta; Carlo Maggini Journal: J Clin Psychiatry Date: 2010-07-13 Impact factor: 4.384
Authors: Martha Sajatovic; Sergio A Strejilevich; Ariel G Gildengers; Annemiek Dols; Rayan K Al Jurdi; Brent P Forester; Lars Vedel Kessing; John Beyer; Facundo Manes; Soham Rej; Adriane R Rosa; Sigfried Ntm Schouws; Shang-Ying Tsai; Robert C Young; Kenneth I Shulman Journal: Bipolar Disord Date: 2015-09-19 Impact factor: 6.744
Authors: Lars Vedel Kessing; Klaus Munkholm; Maria Faurholt-Jepsen; Kamilla Woznica Miskowiak; Lars Bo Nielsen; Ruth Frikke-Schmidt; Claus Ekstrøm; Ole Winther; Bente Klarlund Pedersen; Henrik Enghusen Poulsen; Roger S McIntyre; Flavio Kapczinski; Wagner F Gattaz; Jakob Bardram; Mads Frost; Oscar Mayora; Gitte Moos Knudsen; Mary Phillips; Maj Vinberg Journal: BMJ Open Date: 2017-06-23 Impact factor: 2.692