BackgroundBipolar disorder is complex and can be difficult to diagnose. It is often
misdiagnosed as recurrent major depressive disorder.AimsWe had three main aims. To estimate the proportion of primary care
patients with a working diagnosis of unipolar depression who satisfy
DSM–IV criteria for bipolar disorder. To test two screening instruments
for bipolar disorder (the Hypomania Checklist (HCL–32) and Bipolar
Spectrum Diagnostic Scale (BSDS)) within a primary care sample. To assess
whether individuals with major depressive disorder with subthreshold
manic symptoms differ from those individuals with major depressive
disorder but with no or little history of manic symptoms in terms of
clinical course, psychosocial functioning and quality of life.MethodTwo-phase screening study in primary care.ResultsThree estimates of the prevalence of undiagnosed bipolar disorder were
obtained: 21.6%, 9.6% and 3.3%. The HCL–32 and BSDS questionnaires had
quite low positive predictive values (50.0 and 30.1% respectively).
Participants with major depressive disorder and with a history of
subthreshold manic symptoms differed from those participants with no or
little history of manic symptoms on several clinical features and on
measures of both psychosocial functioning and quality of life.ConclusionsBetween 3.3 and 21.6% of primary care patients with unipolar depression
may have an undiagnosed bipolar disorder. The HCL–32 and BSDS screening
questionnaires may be more useful for detecting broader definitions of
bipolar disorder than DSM–IV-defined bipolar disorder. Subdiagnostic
features of bipolar disorder are relatively common in primary care
patients with unipolar depression and are associated with a more morbid
course of illness. Future classifications of recurrent depression should
include dimensional measures of bipolar symptoms.
PCN7: ECONOMIC ASPECTS OF AN INTERNATIONAL STUDY OF MAJOR DEPRESSIVE DISORDER IN PRIMARY CARE PATIENTS (THE LIDO STUDY)
