2019 Expert Panel Meeting for Adult Guidelines – Bipolar Disorder (McIntyre)
Bipolar disorder (BD) is a severe, lifelong group of disorders with an estimated prevalence of approximately 2%. Approximately three-quarters of individuals with BD exhibit features of the disorder prior to the age of 25 highlighting the neurodevelopmental aspects of the disorder as well as the importance for screening and timely diagnosis, especially in younger populations presenting in clinical settings with clinically significant depressive and anxiety symptoms. Misdiagnosis representing a conflation of both false positives and false negatives continue to be one of the greatest unmet needs in BD. The consequences of missed and delayed diagnosis are protean and include the accumulation of comorbidities (e.g., obesity, substance abuse), unmitigated suicide risk, erroneous treatment selections, human suffering, and increased morbidity.
The panel agreed that screening for BD is essential for any person presenting with mood related symptoms and/or in clinical scenarios wherein conventional treatments for a mood disorder are inadequate. Results from longitudinal studies consistently report that most individuals with BD exhibit depression, depressive symptoms, and/or episodes as the predominant presentation of the illness as well as polarity at first presentation. Consequently, many adults with BD transition from the diagnosis of Major Depressive Disorder (MDD) to BD over multiple years of prospective follow-up. For example, it is reported that approximately 1% of adults with “MDD” transition to BD annually underscoring the importance of vigilance for hypo/manic presentations in adults originally diagnosed with having MDD.