Low self-recognition and awareness of past hypomanic and manic episodes in the general population

International Journal of Bipolar Disorders, Oct 2015

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.

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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 - 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 © 2015 Regeer et al. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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)


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Eline J. Regeer, Ralph W. Kupka, Margreet ten Have, Wilma Vollebergh, Willem A. Nolen. Low self-recognition and awareness of past hypomanic and manic episodes in the general population, International Journal of Bipolar Disorders, 2015, pp. 22, Volume 3, Issue 1, DOI: 10.1186/s40345-015-0039-8