Marlene Busko

October 16, 2008

October 16, 2008 (Chicago, Illinois) — A study of 100 patients with a primary diagnosis of major depression or bipolar disorder found that 26% actually had an anxiety disorder, a thought disorder (schizoaffective disorder), or a personality disorder.

David J. Muzina, MD, and colleagues examined 100 consecutive patients admitted to the Cleveland Clinic Center for Mood Disorders at Lutheran Hospital, in Ohio, and reported that anxiety disorders, thought disorders, and other health problems are commonly misdiagnosed as a mood disorder.

"We can say that about 1 in 4 patients didn't have the correct diagnosis, which is quite a big number," study author Akhil Sethi, MD, told Medscape Psychiatry.

"It is very important for patients, healthcare providers, and society to understand that there are many reasons for emotional distress and depression beyond a diagnosable major mood disorder," Dr. Muzina told Medscape Psychiatry, adding that other psychiatric conditions may be mistaken as major depression or bipolar disorder, and not every experience of emotional human suffering is a "mental disorder."

"The implications are clear: safe and effective treatment hinges on making the right diagnosis. Not everyone needs medication; sometimes talk therapy is the primary treatment needed, and if medication must be prescribed, it is of paramount importance to get the diagnosis right, since the appropriate medications differ greatly among these diagnostic categories," he said.

The study was presented at here at the American Psychiatric Association 60th Institute on Psychiatric Services.

First, Make the Correct Diagnosis

Increasing emphasis is being placed on providing evidence-based care for psychiatric patients. However, appropriate treatment hinges on an accurate diagnosis.

Little is known about the prevalence and characteristics of misdiagnosis among psychiatric patients, although some studies, based on retrospective chart reviews and subjective patient reporting, have reported misdiagnosis of bipolar disorder.

According to the investigators, misdiagnosis of mood disorders has been linked to higher rates of psychiatric hospitalization and medical costs. They sought to investigate the prevalence of misdiagnosis of mood disorders in adult patients admitted to a mood-disorders unit in 2008.

This study reports on results from the first 100 patients admitted to the inpatient unit from other psychiatry units, emergency departments, or by psychiatrist referral.

After the patients were admitted to the unit, they were interviewed by a research assistant using the Mini-International Neuropsychiatric Interview (MINI-Plus). Diagnosis was then confirmed based on the results of this structured diagnostic interview in combination with the psychiatric evaluation performed by Dr. Muzina.

Seventy patients were admitted to the unit with a primary diagnosis of unipolar major depression, and this diagnosis remained the same for 53 patients following a MINI-Plus evaluation. However, in the remaining patients, the primary diagnosis was changed to bipolar disorder (7 patients), anxiety disorder (2), thought disorder (5), or other (3).

Of the 30 patients who had been admitted with a primary diagnosis of bipolar disorder, 11 kept the same diagnosis based on the MINI-Plus evaluation. However, in the remaining patients, the primary diagnosis was changed to unipolar major depression (3 patients), anxiety disorder (8), thought disorder (4), or other (4).

"Of the patients admitted with a diagnosis of bipolar disorder, only about 60% really had bipolar disorder," Dr. Sethi pointed out. "If you don’t have a correct diagnosis, you can't give patients the appropriate treatment," he said.

MINI-Plus Can Help

When a physician sees a patient for the first time, it can be difficult to pin down a correct diagnosis, since symptoms from different mental disorders can overlap, the investigators note. Spending a bit more time and using a structured diagnostic interview such as the MINI-Plus or other screening measures can strengthen the diagnostic process.

They call for further study to better understand factors that place patients at risk for misdiagnosis. Dr. Muzina's center is collaborating with the mood-disorders psychopharmacology unit at the University of Toronto, in Ontario, to further explore this important health issue through the creation of a large, international mood-disorders database.

Dr. Muzina is a consultant to AstraZeneca Pharmaceuticals, GlaxoSmithKline, Pfizer, and Sepracor and has received research grant and support from Abbott Laboratories, Eli Lilly, GlaxoSmithKline, Novartis Pharmaceuticals, and Wyeth-Ayerst.

American Psychiatric Association 60th Institute on Psychiatric Services meeting: Poster 85. Presented October 3, 2008.

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