The overdiagnosis of bipolar disorder

Abstract

Presents a case report of a 18-year-old female student was referred to a mood disorders clinic by her psychiatrist with a diagnosis of bipolar disorder, type II, characterized by prominent "mood swings" for which she had been started on quetiapine (900mg/day). Her "up" swings consisted of periods lasting up to 2 hours when she felt "happy, positive and more outgoing." The patient's "down" swings consisted of several months of sadness and anhedonia after moving provinces for her studies. This case exemplifies 2 disturbing trends in bipolar disorder diagnosis and treatment. As is the case for all psychiatric disorders, bipolar disorder lacks pathophysiologic indicators or tests that provide a gold standard for diagnosis. Its diagnosis, therefore, remains predominantly clinical. With respect to the increasing use of monotherapy atypical antipsychotics, this may originate from several sources: the ease of dosing and monitoring; more sedative effects to control manic irritability and disruptive activity; updates from practice guidelines regarding trials with their use; and popularization of their use through pharmaceutical promotion. As gatekeepers to diagnosis and experts responsible for treatment, clinicians should remain stable and vigilant about the potential for overdiagnosis and be judicious and cautious prescribers of medication that has been clearly associated with other chronic disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)