Crucial opportunities to manage bipolar disorder early are being lost because individuals are waiting an average of almost six years after the onset of the condition before diagnosis and treatment.
The study was conducted by the researchers of the University of New South Wales' School of Psychiatry and St John of God Research Centre, Italy and was published in the Canadian Journal of Psychiatry
‘Delay in diagnosis of bipolar disorder is a lost opportunity in providing early treatment. Early diagnosis not only ensures a good prognosis but also improves quality of life.’
Many patients experience distressing and disruptive symptoms for many years until receiving proper treatment for bipolar disorder, which was previously known as manic-depressive illness. Bipolar disorder is a condition that can cause severe mood swings. The high moods, or periods of elation, are called mania or hypomania, and the low mood is called depression.
According to the lead researcher, Professor Large, a psychiatrist at Prince of Wales Hospital, the delay is often longer for young people because moodiness is sometimes mistaken by parents and doctors as the ups and downs of the teenage years rather than the emergence of bipolar disorder, which can be effectively treated with mood stabilizing medication. It is often masked by substance abuse or dismissed altogether.
"This is a lost opportunity because the severity and frequency of episodes can be reduced with medication and other interventions," Professor Large said. "While some patients, particularly those who present with psychosis, probably do receive timely treatment, the diagnosis of the early phase of bipolar disorder can be difficult," he said.
He added that the diagnosis of bipolar disorder can also be missed because it relies on a detailed life history and corroborative information from carers and family, information that takes time and care to gather. And often the clinicians are unable to distinguish the depressed phase of bipolar disorder from other types of depression. Stigma is another reason why diagnosis is delayed. Other common barriers to diagnosis include costly and the difficult treatment, confusion about the symptoms and misdiagnosis.
"Clinicians should look more closely at a patient's history of mood symptoms, looking for distinct changes in mood, and other risk factors, for example, a family history and mood swings caused by external events such as treatment with antidepressants, overseas travel and taking drugs," Professor Large said.
Having bipolar disorder does not have to mean a life-long regime of taking drugs with lots of side-effects, Professor Large said. There are a whole variety of things a person can do early on in the course of their condition that might help their prognosis. These include keeping a tight rein on illicit substance use, exercise, developing stress-management strategies and keeping educated about the disorder.
The researchers are calling for a consistent approach to the recording of the onset of symptoms of bipolar disorder, further studies on the early symptoms and predictors of bipolar disorder and the reasons for treatment delay.