Diagnosing bipolar disorder : how can we do it better?

• Accurate diagnosis of bipolar disorder is essential for effective treatment.<br /><br />• The diagnosis of bipolar disorder is particularly complex, resulting in lengthy delays between first presentation and initiation of appropriate therapy. Inappropriate therapy destabilises the course and outcome of the disease.<br /><br />• Although the defining features of bipolar disorder are manic or hypomanic episodes, patients typically present for treatment of depression and commonly deny symptoms of mood elevation.<br /><br />• A correct diagnosis can easily be masked by comorbidities, personality issues and complex phenomenology.<br /><br />• A diagnosis of bipolar disorder can be assisted by:<br /><br />   → asking about symptoms of mania or hypomania in every patient presenting with symptoms of depression.<br /> <br />   → recognising mixed states in which manic and depressive symptoms occur simultaneously.<br /><br />   → identifying the features of bipolar depression that distinguish it from unipolar depression. <br /><br />• There is a risk of over-diagnosis of bipolar disorder among patients who are histrionic, show abnormal illness behaviour MJA 2006; 184: 459–462 and/or have issues of secondary gain.<br />