January 15, 1999

A new coalition of leading psychiatrists and patient advocates is developing strategies to increase the accurate diagnosis of people with bipolar illness. The coalition declared in a press release last month that the disorder is diagnosed correctly in only one of two people affected by it. Thus, three million Americans face unnecessary hospitalizations, disability, lost productivity, and even death.

Coalition chair and bipolar expert Robert Hirschfeld, M.D., told Psychiatric News, "That figure is an underestimate because it represents only people with bipolar I disorder, which includes a manic episode and not other types of the disorder."

Hirschfeld is the Titus Harris Distinguished Professor and chair of the department of psychiatry and behavioral sciences at the University of Texas Medical Branch, Galveston.

Coalition members include several other psychiatrists who are experts in bipolar disorder and representatives of the National Alliance on Mental Illness, National Institute of Mental Health, and National Depressive and Manic-Depressive Association (NDMDA), which initiated the idea.

The coalition's goal is to increase awareness and recognition of bipolar disorder in patients presenting in clinical settings. "We want to help physicians, starting with psychiatrists, do a better job of diagnosing the illness," said Hirschfeld. "We then plan to educate primary care physicians."

According to a 1993 study conducted by the NDMDA, many patients with the disorder consulted several physicians for nearly a decade before receiving a proper diagnosis. In addition, the overwhelming majority of the 500 NDMDA members surveyed reported having been diagnosed with other illnesses, usually depression or schizophrenia, before receiving a correct diagnosis.

"Most people present their depressive symptoms and thus receive inadequate treatment," noted Hirschfeld.

The coalition is field-testing a screening instrument that includes several questions about hypomania and mania. For example, "Has there ever been a period of time when you were not your usual self and felt very self-confident?" "Have you gotten much less sleep than usual and not missed it?" Patients can fill out the checklist, which will be available in the spring, in five minutes while they are waiting in the doctor's office.

Hirschfeld commented, "Bipolar disorder is not fully appreciated in terms of its devastating impact on individuals and families. We are hopeful this screening instrument will help to remedy that. Moreover, we have reasonably good treatments, primarily mood stabilizers, that improve the acute symptoms and prevent recurrences of the illness, both the depression and mania."

More information and resources about bipolar disorder are posted on the DBSA's Web site at www.DBSAlliance.org.