Diagnosing bipolar disorder in the community setting.

Area of Science:

• Psychiatry
• Clinical Psychology

Background:

• Bipolar disorder (BD) is a prevalent psychiatric condition.
• Diagnosis is complicated by reliance on historical symptoms, lack of specificity, and absence of objective measures.
• Diagnostic uncertainty is exacerbated by differing clinical opinions and time pressures.

Purpose of the Study:

• To examine the diagnostic process for BD.
• To review factors that complicate BD diagnosis.
• To discuss methods for improving diagnostic sensitivity and specificity.

Main Methods:

• Comprehensive literature search including MEDLINE, textbooks, and scientific meeting abstracts.
• Inclusion of English-language publications without time restrictions.

Main Results:

• Psychiatric interview remains the primary diagnostic tool for BD.
• Laboratory, genetic, radiographic, and neuroimaging tests are still investigational.
• Psychological tests and questionnaires play a secondary role; diagnostic accuracy is suboptimal.

Conclusions:

• Factors contributing to diagnostic uncertainty in BD are identified.
• Strategies to enhance the sensitivity and specificity of BD diagnosis are explored.
• A framework for differentiating BD from borderline personality disorder is proposed.