Diagnostic stability and evolution of bipolar disorder in clinical practice: a prospective cohort study.

  • Baca-Garcia E
  • Perez-Rodriguez M
  • Basurte-Villamor I
 et al. 
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OBJECTIVE: To evaluate the long-term stability of International Classification of Diseases-10th revision bipolar affective disorder (BD) in multiple settings. METHOD: A total of 34 368 patients received psychiatric care in the catchment area of a Spanish hospital (1992-2004). The analyzed sample included patients aged > or =18 years who were assessed on > or =10 occasions and received a diagnosis of BD at least once (n = 1153; 71,543 assessments). Prospective and retrospective consistencies and the proportion of subjects who received a BD diagnosis in > or =75% of assessments were calculated. Factors related to diagnostic shift were analyzed with traditional statistical methods and Markov's models. RESULTS: Thirty per cent of patients received a BD diagnosis in the first assessment and 38% in the last assessment. Prospective and retrospective consistencies were 49% and 38%. Twenty-three per cent of patients received a BD diagnosis during > or =75% of the assessments. CONCLUSION: There was a high prevalence of misdiagnosis and diagnostic shift from other psychiatric disorders to BD. Temporal consistency was lower than in other studies.

Author-supplied keywords

  • Adolescent
  • Adult
  • Bipolar Disorder
  • Cohort Studies
  • Diagnosis, Differential
  • Diagnostic and Statistical Manual of Mental Disord
  • Disease Progression
  • Female
  • Humans
  • Male
  • Practice Patterns, Physicians'
  • Prospective Studies
  • diagnosis
  • psychology

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  • E Baca-Garcia

  • M M Perez-Rodriguez

  • I Basurte-Villamor

  • J Lopez-Castroman

  • A L Fernandez del Moral

  • M A Jimenez-Arriero

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