The association between diagnosis, treatment delay and outcome among patients with Bipolar disorders

Prevalence rates for Bipolar (BP) disorder are difficult for exact evaluation since the high rates of misdiagnosis and the delay from the initial symptoms until the treatment with mood stabilizers. This study aimed to find whether there was such a delay in a sample of Israeli outpatients diagnosed with BP. The study also aimed to assess outcomes associated with a delay in treatment. The sample included 56 ambulatory patients. Data were evaluated by a demographical questionnaire, according the medical records and by the Outcome dysfunctions scale, addressing four areas: work, symptoms, social contacts and duration of hospitalizations. The results revealed a time lapse of 2.2 years from the onset of BP to the initiation of treatment and a time lapse of 6.7 years between the onset and initiation of mood stabilizers. The delay in treatment was not correlated with any functional outcome, or suicidal behavior. In addition, the younger the subject was at the onset, the longer it took to initiate treatment with mood stabilizers. This research found a significant delay in treatment of patients with BP disorder. This delay was not associated with the expected functional impairment. We assume that personal resources had moderated this effect. This research may suggest that in Israel the referral of children to psychiatric services is especially delayed, possibly because of the potential damage to the military service enrollment. This research highlights the need to improve clinicians' recognition of BP in general, and among patients with early onset in particular.