Bipolar Disorder: The High Rate of Misdiagnosis

1. Mood disorders: prolonged and disturbed emotional state that affects almost all of a person’s thoughts, feelings, and behaviors

2. 69% Initially Misdiagnosed 35% were symptomatic for more than10 years before correct diagnosis 10+ years Bipolar Disorder: The High Rate of Misdiagnosis 2000 National DMDA Bipolar Survey of 600 bipolar patients: Most frequent misdiagnosis: Unipolar depression60% National Depressive and Manic-Depressive Association (NDMDA), Constituent Survey. 2001; Chicago, IL. Hirschfeld RMA, et al. J Clin Psychiatry. 2003;64:161-174.

4. Bipolar I and Bipolar II Disorder Prevalence: 1% lifetime risk of developing Bipolar Equally common in women as men Usually begin symptoms between the ages of 15 – 35 years

5. Manic Episode- the "highs" of bipolar disorder

7. Major Depressive Episode - the "lows" of bipolar disorder

9. Time Magazine, August 19, 20024000% increase in childhood bipolar? Unlike the well-studied bipolar illness in adults, there is strong academic debate about the key symptoms that indicate bipolar disorder in children. Top experts offer a range of reasons. They acknowledge some of the increase is likely due to bipolar being mislabeled; some think "bipolar disorder" has become a catch-all diagnosis for kids with a range of problems. But many experts say the increase is simply because doctors are better at identifying bipolar in children today than they were 10 years ago. They believe these kids have always existed, but that doctors failed to recognize the symptoms of bipolar and called these children oppositional or diagnosed them with ADHD. Some experts even speculate that environmental factors are playing a role in triggering childhood bipolar.

10. Developmental Manifestations of Manic Symptoms in Children • Elation/euphoria • giggling uncontrollably in class while peers are calm; laughing hysterically when talking about killing others • Dancing and laughing at home while telling parents’ they are “suspended” • Finds everything funny & they don’t know why • Decreased need for sleep • Up at 2 AM rearranging furniture, cleaning, then awake at 6 AM dressed and ready for school • Child awake at 4 AM during summer vacation Geller et al., 2002

11. Developmental Manifestations of Manic Symptoms in Children(cont’) • Grandiosity • Telling principal to “shut up” and listen because the principal is the child’s “slave”; demanding that teacher be fired for stupidity • child stealing go-kart because he felt rules did not apply to him (acute onset of conduct d/o) • child believing he/she is a superhero & tries to fly • child spends evenings “practicing” when they become president, despite failing in school

12. Cyclothymia diagnosis: mild depression, interspersed with periods of hypomania, for more than two years

13. Mood Disorders-Bipolar PET scans show that brain energy consumption rises and falls with emotional switches Depressed state Manic state Depressed state

14. Causes and Treatments • Genetic Factors: close relatives of individuals with bipolar have a 4-20% likelihood of developing the same disorder • Twin studies: Identical twins 70+% concordance rates, fraternal twin 20-25% From left: view of a nomal brain; patient with bipolar disorder has enlarged ventricles; bright white spots of hyperintensity associated with bipolar illness.

15. Causes and Treatments • Lithium: medication that affects at least 5 different biochemical systems (including glutamate) within nerves but can have serious side effects including; tremors, nausea, diarrhea, weight gain, and skin rashes