Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10

doi:10.1016/j.jad.2004.11.001

Journal of Affective Disorders

Volume 85, Issue 3, April 2005, Pages 293-299

https://doi.org/10.1016/j.jad.2004.11.001 Get rights and content

Abstract

Background

The diagnostic stability of the ICD-10 diagnosis of mania/bipolar disorder has not been investigated in clinical practice.

Methods

All patients who got a diagnosis of mania/bipolar disorder at least once in a period from 1994 to 2002 at outpatient treatment or at discharge from psychiatric hospitalisation in Denmark were identified in a nationwide register.

Results

Totally, 4116 patients got a diagnosis of mania/bipolar disorder at least once; among these, 2315 patients (56.2%) got the diagnosis at the first contact, whereas the remaining patients (43.8%) got the diagnosis at later contacts. Approximately 30% of patients with an initial diagnosis of mania/bipolar disorder eventually changed diagnosis during follow-up. A substantial proportion of patients initially presented with prodromal syndromes such as transient psychosis, reaction to stress/adjustment disorder or mental and behavioural disorder due to psychoactive substance use and got a diagnosis of bipolar disorder later on. Especially younger but also female patients were at increased risk of delay of the diagnosis of bipolar disorder.

Limitations

Only patients from psychiatric settings were included.

Conclusions

Clinicians should, especially in younger and female patients, be more observant on manic symptoms in patients who as first glance presents with transient psychosis, reaction to stress/adjustment disorder or with psychoactive substance abuse and follow these patients more closely over time identifying putable hypomanic and manic symptoms as early as possible.

Section snippets

The register

The Danish Psychiatric Central Research Register (DPCRR) is nation-wide with registration of all psychiatric hospitalizations in Denmark for the 5.3 million inhabitants (Munk-Jorgensen and Mortensen, 1997). From January 1, 1995, the register included information on patients in psychiatric ambulatories and community psychiatry centers, also. General practitioners and private practicing psychiatrist do not report to the DPCRR.

All inhabitants in Denmark have a unique person identification number

Results

Totally, 4116 patients got a main diagnosis of a manic episode (F30) or bipolar affective disorder (F31) at least once during the study period from 1994 to 2002. Among these, 2315 patients (56.2%) got the main diagnosis at the end of the first contact period, whereas the remaining patients (1801=43.8%) got the diagnosis at later contacts. Table 1 presents characteristics of gender and age at first contact. As can be seen, only 36.6% of women younger than 20 years and 32.5% of men younger than

Discussion

This is the first study investigating the diagnostic stability of the ICD-10 diagnosis of mania/bipolar disorder in clinical practice. The study included a Danish nationwide sample of all in- and outpatients treated for mania/bipolar disorder at least once in psychiatric settings. In Denmark, doctors are obliged to make a diagnosis when a treatment period is terminated, i.e. at discharge from hospital or at the end of an ambulatory treatment period, and all diagnoses are reported to the Danish

Acknowledgements

This study was supported by: “The Lundbeck Foundation”.

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Citation Excerpt :
Subsequently the four mentioned published studies and one ongoing study (Angst et al., 2020; Fredskild et al., 2019, 2020; Gordon-Smith et al., 2017; Machado-Vieira et al., 2017) have investigated the prevalence of bipolar disorder according to DSM-5 versus DSM-IV or ICD-10 criteria, but further studies are greatly needed. Thus, further studies are needed within the sixth mentioned validation areas: 1) Clinical presentation according to DSM-5 versus DSM-IV/ICD-10, 2) Associations of the phenotype with para-clinical data such as brain imaging and blood-based data, 3) Delimitation from other disorders, specifically schizophrenia, schizoaffective disorder, depressive disorder, personality disorders, 4) Pathogenesis - associations to family history / genetics and environmental stressors, 5) Prognosis, specifically in relation to implications for diagnostic delay and early intervention as well as long-term diagnostic stability (Kessing, 2005; Kessing et al., 2015; Laursen et al., 2020), 6) Medical treatment effects of lithium and other mood stabilizers. At some point, the official classification systems will need to incorporate information from sources other than symptoms, and this may come not only from genetic, neuroimaging, and biomarker data, but also from the increasing use of digital markers, in the frame of so-called precision psychiatry (Manchia et al., 2020; Salagre et al., 2018).
This narrative review summarizes and discusses the implications of the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and the upcoming International Classification of Diseases (ICD)-11 classification systems on the prevalence of bipolar disorder and on the validity of the DSM-5 diagnosis of bipolar disorder according to the Robin and Guze criteria of diagnostic validity. Here we review and discuss current data on the prevalence of bipolar disorder diagnosed according to DSM-5 versus DSM-IV, and data on characteristics of bipolar disorder in the two diagnostic systems in relation to extended Robin and Guze criteria: 1) clinical presentation, 2) associations with para-clinical data such as brain imaging and blood-based biomarkers, 3) delimitation from other disorders, 4) associations with family history / genetics, 5) prognosis and long-term follow-up, and 6) treatment effects. The review highlights that few studies have investigated consequences for the prevalence of the diagnosis of bipolar disorder and for the validity of the diagnosis. Findings from these studies suggest a substantial decrease in the point prevalence of a diagnosis of bipolar with DSM-5 compared with DSM-IV, ranging from 30–50%, but a smaller decrease in the prevalence during lifetime, corresponding to a 6% reduction. It is concluded that it is likely that the use of DSM-5 and ICD-11 will result in diagnostic delay and delayed early intervention in bipolar disorder. Finally, we recommend areas for future research.
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Research reportDiagnostic stability in bipolar disorder in clinical practise as according to ICD-10

Abstract

Background

Methods

Results

Limitations

Conclusions

Section snippets

The register

Results

Discussion

Acknowledgements

J. Affect. Disord.

Diagnostic stability of first-episode psychosis. Comparison of ICD-10 and DSM-III-R systems

Br. J. Psychiatry

Stability of diagnosis in bipolar disorder

J. Nerv. Ment. Dis.

Six-month stability of psychiatric diagnoses in first-admission patients with psychosis

Am. J. Psychiatry

Research report
Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10