Bipolar disorder in a low socioeconomic population. Difficulties in diagnosis

The diagnosis of manic-depressive disorder, manic type, does not usually present a diagnostic problem when there is a clear history of the onset of symptoms. However, when the manic patient deteriorates and reaches the "end-state" of the illness, his symptoms may be similar to those of schizophrenia. This report describes three cases from a largely black, low socioeconomic population that were misdiagnosed as schizophrenic rather than as manic. Delay in seeking immediate treatment for early symptoms of mania is cited as the primary reason for these misdiagnoses. Other possible reasons are discussed.