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While a lot has been written about the prevalence and missed
diagnosis of Bipolar Disorder, and the widened concept of bipolarity, the
possibility of overdiagnosing mania is likely to pose a challenge.
First,diagnostic practices vary a a great deal which is to say that the so
called diagnostic criteria are not true or pure and their clinical
application is always a question of clinical judgement. This has a
significnat bearing on the nature of published evidence regarding
treatments. Second, comorbid conditions such as anxiety disorders are
likely to confound the clinical picture creating biologically
unexplainable entity such as "Mixed Episode" with attendant consequences.
Third, just becasue a patient has Bipolar Disorder, it does not mean that
he cannot develop an independent Adjustment Disorder with depressed mood
or (Reactive) Depression arising from unpleasant life events. There is a
risk that the symptoms may be misattributed to Bipolar Disorder, with
treatment implications. Further, the concept of bipolar spectrum may
sometimes lead to unjustified avoidance fo antidepressants and use of
"mood stabilizers" with no obvious antidepressant effects. The use of
"Mood Charts" may lead to false labelling as "Rapid Cycling" the emotions
which may be essentially appropriate affective responses to day to day
events, and pathologize them.
The risk of misdaignosing and missing the diagnoses are the same-
ineffctive treatments. Notably, despite the explosion of literature on
varius forms of bipolar conditions, no major advance has occurred in our
ability to diagnose mania accurately nor in our understanding of the
underlying brain mechanisms. The current redifnition of the concept is
just that-redefinition.
Issues in the recognition of Bipolar Disorder
While a lot has been written about the prevalence and missed
diagnosis of Bipolar Disorder, and the widened concept of bipolarity, the
possibility of overdiagnosing mania is likely to pose a challenge.
First,diagnostic practices vary a a great deal which is to say that the so
called diagnostic criteria are not true or pure and their clinical
application is always a question of clinical judgement. This has a
significnat bearing on the nature of published evidence regarding
treatments. Second, comorbid conditions such as anxiety disorders are
likely to confound the clinical picture creating biologically
unexplainable entity such as "Mixed Episode" with attendant consequences.
Third, just becasue a patient has Bipolar Disorder, it does not mean that
he cannot develop an independent Adjustment Disorder with depressed mood
or (Reactive) Depression arising from unpleasant life events. There is a
risk that the symptoms may be misattributed to Bipolar Disorder, with
treatment implications. Further, the concept of bipolar spectrum may
sometimes lead to unjustified avoidance fo antidepressants and use of
"mood stabilizers" with no obvious antidepressant effects. The use of
"Mood Charts" may lead to false labelling as "Rapid Cycling" the emotions
which may be essentially appropriate affective responses to day to day
events, and pathologize them.
The risk of misdaignosing and missing the diagnoses are the same-
ineffctive treatments. Notably, despite the explosion of literature on
varius forms of bipolar conditions, no major advance has occurred in our
ability to diagnose mania accurately nor in our understanding of the
underlying brain mechanisms. The current redifnition of the concept is
just that-redefinition.
Competing interests:
None declared
Competing interests: No competing interests