Low self-recognition and awareness of past hypomanic and manic episodes in the general population
Altrecht Institute for Mental Health Care, Nieuwe Houtenseweg
Low self-recognition and awareness of past hypomanic and manic episodes in the general population
0 Altrecht Institute for Mental Health Care , Nieuwe Houtenseweg 12, 3524 SH Utrecht , The Netherlands
1 Department of Psychiatry, University Medical Center, University of Groningen , Groningen , The Netherlands
Background: Bipolar disorder is often underdiagnosed and undertreated. Its detection and correct diagnosis highly relies on the report of past hypomanic or manic episodes. We investigated the recognition and awareness of past hypomanic and manic episodes in a sample of respondents with bipolar disorder selected from a general population study. Methods: In a reappraisal study from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), we further investigated 40 respondents with lifetime bipolar disorder confirmed by the structured clinical interview for DSM-IV (SCID). Respondents were asked about awareness of past depressive, manic and hypomanic episodes, illness characteristics and treatment history. Results: Most respondents (82.5 %) recognized that they had experienced a depressive episode while 75 % had consulted a health professional for a depressive episode. Only a minority (22.5 %) recognized that they had experienced a (hypo)manic episode and only 17.5 % had consulted a health professional for a (hypo)manic episode. Only 12.5 % of the respondents reported having received a diagnosis of bipolar disorder. Recognition of previous (hypo)manic episodes was not related to severity of bipolar disorder. Conclusions: In routine clinical practice history-taking on a syndromal level, i.e., only inquiring whether a patient presenting with depression ever experienced a hypomanic or manic episode or received treatment for such an episode, is not sufficient to confirm or exclude a diagnosis of bipolar disorder. Other efforts, such as an interview with a significant other and the use of self report questionnaires or (semi-)structured interviews may be needed to recognize previous manic symptoms in patients with depression.
Bipolar disorder; Self-recognition; Awareness; General population
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Background
Population-based (Regier et al. 1993; Kessler et al. 1997;
ten Have et al. 2002; Hirschfeld et al. 2003a; Wang et al.
2005; Schaffer et al. 2006; Merikangas et al. 2007) and
clinical studies (Manning et al. 1997; Hantouche et al.
1998; Ghaemi et al. 1999, 2000; Mantere et al. 2004; Das
et al. 2005; Hirschfeld et al. 2005; Smith et al. 2011;
Rogers et al. 2012; Inoue et al. 2015) report that bipolar
disorder (BD) is often underdiagnosed and undertreated.
A late diagnosis of BD is partly inevitable since in most
patients with BD (BD patients) depressive episodes
precede a first (hypo)manic episode. However,
retrospective studies among BD patients report also long delays
between onset of the first manic/hypomanic episode and
receiving a correct diagnosis and the start of adequate
treatment (Lish et al. 1994; Suppes et al. 2001; Hirschfeld
et al. 2003b; Morselli and Elgie 2003; Berk et al. 2007;
Drancourt et al. 2013). Since most BD patients will
present with depressive symptoms (Kupka et al. 2007),
making a correct diagnosis highly relies on the report of past
(hypo)manic episodes. Patients must be aware that some
past behaviors were actually symptoms of a (hypo)manic
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episode. Moreover, if these past symptoms/episodes have
been recognized, this diagnosis must be remembered,
indicating that the patient is aware and acknowledges
that he is suffering from BD.
Previously we performed a reappraisal study with the
Structured Clinical Interview for DSM-IV axis I
(SCIDI) (Spitzer et al. 1992) among all respondents from the
Netherlands Mental Health Survey and Incidence Study
(NEMESIS) who were diagnosed with DSM-III-R BD
using the Composite International Diagnostic Interview
1.1 (CIDI 1.1). It can be assumed that a semi-structured
interview, such as the SCID, with the flexible
openended and conversational probing by clinicians will have
more concordance with clinical diagnoses than
diagnoses based on fully structured interviews with yes or no
answers administered by lay interviewers, such as the
CIDI. In a first paper resulting from that study, we
published on the prevalence of bipolar disorder in the general
population based on the SCID and the possible
explanations for discrepancies between the CIDI and SCID
diagnoses (Regeer et al. 2004).
For the present report, we investigated the
recognition and awareness of past depressive a (...truncated)