Diagnostic stability in bipolar disorder in clinical practise as according to ICD-10

J Affect Disord. 2005 Apr;85(3):293-9. doi: 10.1016/j.jad.2004.11.001.


Background: The diagnostic stability of the ICD-10 diagnosis of mania/bipolar disorder has not been investigated in clinical practice.

Methods: All patients who got a diagnosis of mania/bipolar disorder at least once in a period from 1994 to 2002 at outpatient treatment or at discharge from psychiatric hospitalisation in Denmark were identified in a nationwide register.

Results: Totally, 4116 patients got a diagnosis of mania/bipolar disorder at least once; among these, 2315 patients (56.2%) got the diagnosis at the first contact, whereas the remaining patients (43.8%) got the diagnosis at later contacts. Approximately 30% of patients with an initial diagnosis of mania/bipolar disorder eventually changed diagnosis during follow-up. A substantial proportion of patients initially presented with prodromal syndromes such as transient psychosis, reaction to stress/adjustment disorder or mental and behavioural disorder due to psychoactive substance use and got a diagnosis of bipolar disorder later on. Especially younger but also female patients were at increased risk of delay of the diagnosis of bipolar disorder.

Limitations: Only patients from psychiatric settings were included.

Conclusions: Clinicians should, especially in younger and female patients, be more observant on manic symptoms in patients who as first glance presents with transient psychosis, reaction to stress/adjustment disorder or with psychoactive substance abuse and follow these patients more closely over time identifying putable hypomanic and manic symptoms as early as possible.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Ambulatory Care
  • Bipolar Disorder / classification
  • Bipolar Disorder / diagnosis*
  • Bipolar Disorder / epidemiology
  • Bipolar Disorder / psychology
  • Cross-Sectional Studies
  • Denmark
  • Diagnosis, Differential
  • Female
  • Humans
  • International Classification of Diseases*
  • Male
  • Middle Aged
  • Patient Discharge
  • Psychometrics / statistics & numerical data
  • Psychotic Disorders / classification
  • Psychotic Disorders / diagnosis
  • Psychotic Disorders / epidemiology
  • Psychotic Disorders / psychology
  • Registries
  • Reproducibility of Results
  • Sex Factors