Over-Diagnosis of Bipolar Disorder Solved by DSM-5?

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bipolar disorder,                       overdiagnosisBipolar criterion needs to be stated more clearly.

Bipolar disorder has known to be both under-diagnosed and over-diagnosed, depending upon how certain symptoms are interpreted. In fact, this is all part of the reason for the more clearly stated criterion in DSM-5, due out soon.[1] Director of the Mood Disorders Program at Samaritan Mental Health, James Phelps, M.D. reviews the concept of over-diagnosis in his essay “Overdiagnosis: Examine the Assumptions, Anticipate New Bipolar Criterion.”1

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No bipolar in-between.

First of all, according to Phelps, a patient either has bipolar disorder or they do not.1 There is no in-between, or such-and-such disorder with bipolar characteristics. In the DSM-5, there will be a dimensional approach to bipolar, in comparison to the current categorical approach.1 However, as Phelps states that the DSM-5 Work Group decided to work on the depression severity scale rather than the unipolar depression scale, over-diagnosis may continue to be an issue even after the new DSM is published.1

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Using the SCID with patients who may have bipolar.

Second, clinicians should always judge their diagnosis against the Structured Clinical Interview for Diagnosis (SCID), the “gold standard” which helps to judge diagnosis accuracy; however, they should not rely solely on it.1 SCID assures that relevant diagnosis questions are asked in achieving a diagnosis, all in a semi-structured fashion.1 SCID provides completeness, which enhances the accuracy of data and, therefore, diagnosis.1 Still, the SCID can oversimplify bipolar symptoms, leading to over-diagnosis.1 It is a combination of the clinician and the scale that leads to correct diagnosis.

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Still, new criterion and the SCID do not override the chances of over-diagnosis; therefore, Phelps continues to wonder whether or not the DSM-5 will lessen the chances or miss its mark.1

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[1] Phelps, J. (2013, March 13). Overdiagnosis: Examine the Assumptions, Anticipate New Bipolar Criteria – Psychiatric Times. Psychiatric Times. Retrieved April 11, 2013, from http://www.psychiatrictimes.com/bipolar-disorder/content/article/10168/2132832

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