Bipolar Disorder
S. Nassir Ghaemi, MD
How often are people misdiagnosed and why?
About 40% of people with bipolar disorder are misdiagnosed with unipolar (major)
depression. This excludes people who just have depression before they show
any manic symptoms.
There are many issues around misdiagnosis. First, patients may only experience
depression for years before having any manic episodes. Second, clinicians
often just don't know about manic symptoms or don't ask about them. Third,
patients often don't describe the manic symptoms. They have what is called
a 'lack of insight.'
What is lack of insight?
Lack of insight means a lack of awareness of your illness, that there is something
wrong with you. Some bipolar patients and many patients with schizophrenia
have a lack of insight. 50% of bipolar patients have lack of insight and do
not realize they are ill. For example, bipolar patients may just think they
are a high-energy person.
Half of bipolar patients do not describe their manic symptoms, because they
do not realize they are abnormal. These patients will deny their symptoms.
On top of that, when patients are depressed when they come in, they may have
a hard time remembering their manic symptoms in the past.
How do you diagnose patients if half of them
have a lack of insight?
Clinicians need to talk not only to patients, but also to their family members.
Half of bipolar patients appear to be extremely informed when I talk to them.
But, when I pick up the phone and talk to a spouse, parent, sibling, or a
good friend who has known the patient for a while and ask about the manic
symptoms, in five to ten minutes I can find that the patient has manic symptoms,
but doesn't realize it. I need the patient's permission to talk to their families.
How can families help when their loved ones with
bipolar disorder?
It is really important for family members to remain involved in their bipolar
family member's care. This means the family member should come at least to
the first doctor's appointment. I need the information from the family member
from the beginning. Some family members come to the meetings often with the
bipolar patient. Usually it is very helpful for them to be involved on an
ongoing basis. The older psychiatric care protocol just treated the patient
and ignored the family, but now we encourage family members to help manage
treatment. Family members have valuable insight into the symptoms and help
patients comply with their medication.
One half of bipolar patients stop taking their medication or rarely take
their medication. They need family support to remain compliant. Research has
shown that a supportive family environment greatly improves the outcome of
bipolar disorder. Families need to help, become very educated about treatment,
and ensure the patient is not misdiagnosed.
© 2001 Families for Depression Awareness
