Diagnosis of bipolar disorder in primary and secondary care: what have we learned over a 10-year period?

TitleDiagnosis of bipolar disorder in primary and secondary care: what have we learned over a 10-year period?
Publication TypeJournal Article
Year of Publication2015
AuthorsDaigneault A, Duclos C, Saury S, Paquet J, Dumont D, Beaulieu S
JournalJ Affect Disord
Volume174
Pagination225-32
Date Published2015 Mar 15
ISSN1573-2517
KeywordsAdolescent, Adult, Bipolar Disorder, Diagnostic Errors, Female, General Practitioners, Humans, Interprofessional Relations, Male, Middle Aged, Primary Health Care, Psychiatry, Quebec, Referral and Consultation, Secondary Care, Young Adult
Abstract

BACKGROUND: Studies suggest that misdiagnosis of bipolar disorders (BD) is frequent in primary care. This study aimed to evaluate agreement between referral for BD by general practitioners (GP) and BD diagnosis by secondary care psychiatrists, and to evaluate the impact of age, gender, and BD type on agreement.METHODS: The study was conducted at Hôpital du Sacré-Coeur de Montréal׳s "Module Evaluation/Liaison" (MEL), which establishes/clarifies psychiatric diagnoses requested mainly from GPs and directs patients to appropriate treatment and care. Socio-demographic variables, reason for referral, and psychiatric diagnosis were compiled for patients assessed from 1998 to 2010. GP-psychiatrist agreement was established for BD type, gender, and age group (18-25, 26-35, 36-45, >45) using Cohen׳s Kappa coefficient (Κ).RESULTS: From 1998 to 2010, MEL psychiatrists received 18,111 requests and carried out 10,492 (58%) assessments. There were 583 referrals for BD suspicion, while 640 assessments (6.1%) received a BD diagnosis (40.3% type I, 40.5% type II). The overall K was 0.35 (95% CI [0.31, 0.38]), and was significantly higher for type I than type II (I=0.35, 95% CI [0.30, 0.39]; II=0.25, 95% CI [0.21, 0.30]), though age group and gender had no impact.LIMITATIONS: Reasons for referral were converted into keywords and categories to facilitate agreement analyses. Only the main psychiatric diagnosis was available.CONCLUSIONS: Our study suggests diagnosing BD remains strenuous, regardless of age and gender, though BD type I seems better understood by primary care GPs. The true measure of BD diagnosis remains a critical issue in clinical practice.

DOI10.1016/j.jad.2014.10.057
Alternate JournalJ Affect Disord
PubMed ID25527992