National Public Radio aired a segment on its May 6th 2008 broadcast of All Things Considered reporting that a major talking point at the American Psychiatric Association's 2008 National conference, going on now in Washington DC, is the over-diagnosis of Bi-Polar Disorder (BPD). A study conducted at the University of Rhode Island found that over half of some 700 patients whose diagnostic profiles were reviewed were wrongly assigned the diagnosis, a situation that is of great concern to the psychiatric community.
Mark Zimmerman, of the Rhode Island Hospital and Brown University, has been studying the way that Bi-polar Disorder is diagnosed for more than a decade. He states that until about 6 years ago the disorder was typically under-diagnosed, when he began to see a reversal in diagnostic trends. He undertook to look at 145 patients who volunteered to have their diagnosis reviewed and found that, while many showed signs and symptoms that placed them on the depression spectrum, more than half did not meet the criteria for Bi-polar, despite that diagnosis.
One key piece of information was the detailed family history that Zimmerman and his team compiled for these patients. Typically, a person with Bi-polar Disorder evidences a family history of the same. In the case of the patients reviewed, this qualifier did not stand up to scrutiny, with none of the subjects in the study showing a family history of the disorder. Zimmerman will present his findings in a May 7, 2008 Scientific Forum discussion.
Gary Sachs, of Harvard, is also presenting on this topic. He points out that one of the major influences on the change in diagnostic trends may be the educational sessions that doctors are attending, which are sponsored by drug manufacturers. These sessions often contain consistent admonitions not to "miss the diagnosis", as well as emphasizing the propensity for under-diagnosis of certain disorders.
Sachs also points out that the diagnostic reviews done in an academic setting are far more involved than those undertaken in general clinical practice. Where the academic reviews are quite detailed, clinical diagnosis tends more to take on the form of generalized conversation and a more superficial history, which can lead to snap judgements. Although this can contribute to inconsistencies, Sachs says it is no excuse for sloppy diagnosis, as the tools for determining whether a patient meets the criteria for Bi-Polar Disorder have been in place for more than 30 years.
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