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| |  Accurate Diagnosis Eludes Millions With Bipolar Disorder CHICAGO, IL -- November 15, 2000 -- Individuals living with bipolar disorder, also known as manic-depressive illness, are misdiagnosed at an alarming rate and struggle with symptoms for an average of ten years before they are correctly diagnosed by a physician, according to a recent survey conducted by the National Depressive and Manic-Depressive Association (National DMDA). Only one in four receives an accurate diagnosis in less than three years. Moreover, the seven in ten who are misdiagnosed consult four physicians and are misdiagnosed an average of 3.5 times before their illness is identified. "The widespread failure to diagnose bipolar disorder is an under-recognized public health problem that needs to be taken seriously," said Lydia Lewis, Executive Director, National DMDA. "What makes these survey results so disturbing is the high suicide rate associated with people untreated for this disorder -- people don't realize that bipolar disorder is a potentially fatal illness." Bipolar disorder is a complex mental illness characterized by abnormal swings in mood from manic episodes, marked by euphoria, elation and irritability, to episodes of deep depression interspersed with periods of normal mood. Roughly 2.5 million adult Americans suffer from bipolar disorder. An estimated one in four persons with the illness attempts suicide, one of the highest incidence-rates for any psychiatric disorder. Individuals who were misdiagnosed believe a lack of understanding about bipolar disorder among health professionals is the primary barrier to more timely diagnoses. Lewis urges individuals and families to seek information to better recognize their symptoms and to get a second opinion if they have doubts about a diagnosis. "Due to the complex nature of bipolar disorder, it's essential to seek diagnosis from a professional," she said. "However, arming yourself with information is a powerful tool in facilitating a correct diagnosis." According to the survey, depression is the most common misdiagnosis. Women, who are more likely than men to be misdiagnosed, are much more likely to be misdiagnosed with depression. Men are more likely to be misdiagnosed with schizophrenia. Robert M.A. Hirschfeld, M.D., Chair, Department of Psychiatry and Behavioral Sciences, The University of Texas Medical Branch, is not surprised that the illness is often mistaken for depression. "The nature of bipolar disorder is such that many patients don't seek help during a manic phase, because they enjoy how they feel or don't view their manic symptoms as a problem," said Dr. Hirschfeld. "Physicians who see patients in a depressive phase and fail to probe for a history of manic symptoms may misdiagnose them with depression. This leads to improper treatment and a possible worsening of symptoms." Dr. Hirschfeld offered further insight into why the misdiagnosis of bipolar disorder is so prevalent. "People with bipolar disorder present for treatment with a variety of problems, including depression, impulse control, substance abuse and interpersonal conflicts," he said. "They rarely present with mood swings or highs." The survey also found that the lack of quick, accurate diagnosis is exacerbated because people delay seeking help. Of the reported 12.5 years from onset of symptoms to an accurate diagnosis, just under six years were lost because respondents did not report their symptoms. "The experience becomes reality for people with bipolar disorder, who may not realize that there is life without extreme mood swings," said Lewis. "If people don't know that they can get better, they won't seek help." A similar National DMDA survey conducted in 1992 indicates that, despite major advances in the understanding of the neuroscience behind mental illnesses, diagnosis of bipolar disorder has shown only minimal improvement. Overall, the 2000 survey indicates that people are seeking help sooner. More respondents are seeking help within one year of first experiencing symptoms, and fewer are letting their symptoms drag on for more than a decade before seeking help. In addition, those who have been misdiagnosed are experiencing somewhat shorter lag times from seeking help to being correctly diagnosed, and more are being correctly diagnosed in less than one year. "These minimal gains are just plain inadequate," said Lewis. "People's lives are at stake; families are uprooted; careers are derailed. It's shocking how little diagnosis has improved in nearly a decade." In addition, the 2000 survey found that bipolar disorder had a more negative impact on social relationships and, when not managed effectively, on employment compared to 1992. Untreated, the disorder is often exhibited in activities such as spending sprees, sexual promiscuity, and alcohol or drug dependency. The 2000 survey found that bipolar disorder and a lack of proper treatment can affect many aspects of people's lives, including marriage, friendships, employment, finances, and physical health, and the burden of illness has increased in some areas. Significantly more respondents reported difficulty in maintaining long-term friendships, while significantly fewer reported having a good relationship with their families compared to 1992. Furthermore, the survey uncovered an increase in the disorder's effect on ability to perform job duties when the illness is not treated properly. Significantly more respondents reported having been passed up for a promotion or having to change jobs or quit work altogether. Considered a chronic illness, the onset of bipolar disorder often occurs in adolescence or early adulthood. In fact, 60 percent of survey respondents first experienced symptoms before age 20; other sources have found this number to be as high as 90 percent. "Without appropriate treatment, bipolar disorder can affect a person's life for decades," said Lewis. "When the illness is identified earlier, fewer personal, social and work-related problems are experienced, further emphasizing the need for early diagnosis." Nearly nine in ten survey respondents reported satisfaction with their treatment, which often includes medication, talk therapy and support groups. Recent advances in medication have provided new options, and more than one-third of respondents reported that they are already receiving the newer medications known as "atypical" antipsychotics (such as clozapine, olanzapine, and risperidone). Respondents who said they were very satisfied with their doctor were significantly more likely to feel confident that they could manage their illness than those who were less than very satisfied. "It's important that patients be satisfied with their doctor," said Dr. Hirschfeld. "These individuals have a more positive outlook in dealing with their illness, are far more likely to comply with their treatment plan and believe they are in control." Both Lewis and Dr. Hirschfeld agree that there is an urgent need for greater public and physician education to improve awareness and understanding of bipolar disorder and its treatment. "Increased public awareness will motivate more individuals with the disorder to report their manic symptoms," said Dr. Hirschfeld. "However, it's up to the medical community to be more thorough in evaluating depressive symptoms to ensure an accurate diagnosis. Only then will people receive the treatment they need to improve the quality of their lives."
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