Can we prevent under-diagnosis and misdiagnosis of bipolar affective disorder? Repeat audits to assess the epidemiological change in the caseload of a community mental health team when bipolar disorder is accurately assessed and diagnosed.

BACKGROUND Bipolar Affective Disorder is frequently under-diagnosed and misdiagnosed, particularly as unipolar depression. This has serious implications on treatment and outcome of the condition. A community mental health team (CMHT) in Bedford, United Kingdom, has therefore reassessed patients to examine whether it is possible to increase the sensitivity of diagnosis of bipolar affective disorder; to identify more cases and to identify them earlier, in order to be able to offer adequate treatment as early as possible. METHOD Standards were decided within the team for the diagnosis of bipolar disorder based on the DSM4 criteria for the diagnosis of Bipolar I and Bipolar II illness. Patients were reassessed and patient data from 2006, 2007, 2010 and 2011, as well as from 2013, with respect to psychiatric diagnoses. The results were audited and analysed in every year in question. The proportions of total bipolar, bipolar I affective disorder and bipolar II affective disorder diagnoses, as well as the proportions of recurrent depressive disorder and other unipolar depression diagnoses were determined. RESULTS There was a steady increase in the proportions of both bipolar I and bipolar II diagnoses -from 10.5% in 2006 to 11.0% in 2013 for bipolar I affective disorder, and from 0% in 2006 (4.9% in 2007) to 9.7% in 2013 for bipolar II affective disorder-, and a steady decrease in the proportions of both recurrent depressive disorder and other unipolar depression diagnoses - from 16.1% and 18.7%, respectively, in 2006, to 4.8% and 8.0%, respectively, in 2013. DISCUSSION The results confirm that it is possible to increase the sensitivity of bipolar affective disorder diagnosis and that this results in an increased number of diagnoses of the disorder, and a decreased number of diagnoses of unipolar depression. Unexpectedly, the data also showed that increasingly more patients are receiving multiple psychiatric diagnoses. CONCLUSIONS This paper shows that it is possible to increase the sensitivity of diagnosis of bipolar affective disorder. This may be particularly useful in the light of increasingly more mental health problems being treated exclusively in primary care, since bipolar diagnoses will be less likely to be missed. Better identification, and therefore treatment, of bipolar affective disorder is likely to lead to better social and professional functioning of affected individuals.