Diagnostic Stability in Bipolar Disorder: A Narrative Review

Abstract

Learning objectives After participating in this activity, learners should be better able to: • Evaluate diagnostic stability in bipolar disorder • Analyze the factors contributing to diagnostic stability Objective Diagnostic stability is the degree to which a diagnosis remains unchanged during follow-up. It is an important measure of predictive validity in bipolar disorder (BD). In this study, we review the literature concerning diagnostic stability in BD, analyze the factors contributing to diagnostic stability, and describe the implications of diagnostic boundaries and diagnostic delay. Methods A comprehensive literature search of MEDLINE and EMBASE databases was conducted, including all studies published from 1980 to 2016, to evaluate the diagnostic stability of BD. Thirty-seven articles were included: 6 focusing mainly on BD, 18 on psychotic disorders, 10 on depression, and 3 on diagnostic stability in psychiatric disorders in general. Data analysis was performed in standardized fashion using a predefined form. Results Despite a high variability of the methodological approaches taken, an acceptable degree of diagnostic stability was found. The most common criteria for evaluating diagnostic stability were prospective consistency and retrospective consistency. The mean prospective and retrospective consistencies were 77.4% and 67.6%, respectively. A large majority of studies were performed in Europe or in North America (67.5%), compared to 21.6% in Asia and only 10.8% in Africa, Oceania, and South America. Extreme ages, female gender, psychotic symptoms, changes to treatment, substance abuse, and family history of affective disorder have been related to diagnostic instability. Conclusions Several factors appear to have a negative impact on the diagnostic stability, but the evidence is insufficient to draw any robust conclusions. Nevertheless, despite variable prospective and retrospective consistencies, the overall diagnostic stability is good. Standardized methods need to be used to obtain more accurate assessments of stability.

Family Genetic Risk Scores and the Genetic Architecture of Major Affective and Psychotic Disorders in a Swedish National Sample

“…Fourth, congruent with evidence using both family and molecular designs, individuals with major depression at high genetic risk for bipolar disorder had a considerably elevated rate of conversion to bipolar disorder. We could usefully compare our specific results with those obtained recently using the PRS from a Danish national sample .…”

Relationship of Family Genetic Risk Score With Diagnostic Trajectory in a Swedish National Sample of Incident Cases of Major Depression, Bipolar Disorder, Other Nonaffective Psychosis, and Schizophrenia

“…Using a national Swedish sample of incident cases of 4 psychiatric disorders-MD, BD, ONAP, and schizophrenia-we assessed whether the patterns of genetic risks for these disorders were associated with diagnostic trajectories over a 13-year follow-up period. Consistent with smaller prior studies, [6][7][8][9][10][11][12][13] we showed substantial associations between the genetic risk profiles and diagnostic trajectories. Of our many specific findings, we emphasize 8.…”

“…4,5 Previous studies have shown that in individuals with major depression (MD), high genetic risk for bipolar disorder (BD) is related to the risk for subsequently transitioning to BD. [6][7][8][9][10][11][12] Furthermore, schizophrenia PRS in both the Suffolk County Mental Health Project 13 and the Danish iPsych cohort 10 predicted progression from affective illness to a nonaffective psychosis.…”

Blue Light Blocking Treatment for the Treatment of Bipolar Disorder: Directions for Research and Practice

“…An important parameter in any study of BD patients is the diagnostic consistency of the disease. A recent comprehensive review of published articles found a mean prospective consistency of 77.4% and a retrospective consistencies of 67.6% [ 65 ]. The results are acceptable as a whole, yet the inclusion of patients with a first-time episode in a study would be best avoided.…”