Bipolar disorder is often missed in people who misuse alcohol or drugsBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2766 (Published 22 May 2015) Cite this as: BMJ 2015;350:h2766
People with a prior diagnosis of alcohol or substance misuse disorder often experience substantial delays in receiving a diagnosis of bipolar disorder, a new study shows.
The research, published in the open access journal PLoS One,1 showed that the average time from presenting to mental healthcare services to the diagnosis of bipolar disorder was two months. However, among people with alcohol and substance misuse disorders the average time was two years, and some experienced delays of over five years.
The retrospective cohort study used anonymised electronic mental health records from South London and Maudsley NHS Foundation Trust on 1364 adults who had bipolar disorder diagnosed from 2007 to 2012. The median delay to diagnosis was 62 days but varied widely (interquartile range 17-243 days). No significant differences were seen in treatment delays depending on age, gender, ethnicity, or marital status. But prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol misuse disorder (hazard ratio 0.48 (95% confidence interval 0.33 to 0.41)) and substance misuse disorder (0.44 (0.31 to 0.61)).
The study authors said that the delays in diagnosis could be caused by clinicians misattributing symptoms to alcohol or substance misuse rather than considering a diagnosis of bipolar disorder or a dual diagnosis of both disorders.
Rashmi Patel, a study author from King’s College, London, said, “We need to develop better strategies to identify bipolar disorder, perhaps through specialised early intervention services, in order to offer appropriate treatment sooner. This is particularly important because treatments are more effective if they are given sooner rather than later.”
Patel added, “While current UK treatment guidelines highlight the need for prompt recognition and treatment of bipolar disorder and substance misuse disorders, there is a clear need for further research to better understand how to treat people with a dual diagnosis of both disorders.”
Cite this as: BMJ 2015;350:h2766
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