Misdiagnosis of Bipolar Disorder and the Impact on Patient Treatment

Delayed diagnosis of bipolar disorder can occur when the condition is mistakenly identified as something else, said Stephanie Hsia, PharmD, MAEd, BCPP, associate professor of clinical pharmacy, University of California, San Francisco School of Pharmacy. The cost to patients is huge as they will get started on treatments that have no impact on their symptoms.

This transcript was lightly edited for clarity.

Transcript

What is typically the reason for misdiagnosis among patients with bipolar disorder?

Typically, patients are misdiagnosed with unipolar depression because patients with bipolar disorder actually spend most of their year in a depressive episode. So, when they present their primary care doctor will usually diagnose them with depression. That's the most common one. Then, I'd say the second most common would be that patients who have bipolar disorder with psychotic features will get misdiagnosed as [having] schizophrenia or schizoaffective disorder.

What is the impact on patients, and do we know the cost to the system when treatment is delayed or inappropriate treatment started?

The cost to patients is huge. Usually if they're misdiagnosed, treatment of unipolar depression and psychotic disorders is quite different than bipolar disorder. So, you can imagine if they get that misdiagnosis, they're going to be started on medications that don't work for them. Their symptoms aren't going to get better, they might start to lose some kind of confidence in the health care system, as well, and that can also lead to costs.

There's been studies that have shown that it can be hundreds of dollars a month, and I think there's one study where they looked at patients who hadn't been diagnosed and they had like a 170% increase in their costs following them over 6 years compared to somebody who does get that diagnosis. Yeah, it's pretty bad.

What are the implications of stigma on the treatment and management of bipolar disorder within diverse communities?

I would say stigma is huge. I think it's definitely a thing in a lot of different cultures, and it can really be a big barrier to someone being able to seek help. So, one, getting support from their family members or their community, but also in taking that next step and actually seeing a health care provider because it can be so stigmatized.