The Compelling and Persistent Problem of Bipolar Disorder Disguised as Major Depression Disorder

An Integrative Review

Stiles, Brandie M.
Fish, Anne F.
Vandermause, Roxanne
Malik, Azfar M.

¹Brandie M. Stiles, PhD, MSN, PMHNP-BC, University of Missouri-St. Louis, St. Louis, MO, USA; Centerpointe Hospital, St. Louis, MO, USA
²Anne F. Fish, PhD, RN, FAHA, University of Missouri-St. Louis, St. Louis, MO, USA
³Roxanne Vandermause, PhD, RN, University of Missouri-St. Louis, St. Louis, MO, USA
⁴Azfar M. Malik, MD, MBA, Centerpointe Hospital, St. Louis, MO, USA

Brandie M. Stiles, 506 Wedgewood Lane, Columbia, IL 62236, USA. Email: [email protected]

Journal of the American Psychiatric Nurses Association 24(5):p 415-425, September/October 2018. | DOI: 10.1177/1078390318784360

BACKGROUND: Up to 40% of patients with bipolar disorder are misdiagnosed, usually with major depression disorder. OBJECTIVE: The purpose was to describe the current state of the science of the misdiagnosis of bipolar disorder, with the ultimate goal of improving psychiatric diagnostic workups including screening. DESIGN: An integrative review was conducted using standard criteria for evaluating research articles. RESULTS: Forty-nine articles met the eligibility criteria. Articles explored patient-related and health care provider-related factors contributing to the misdiagnosis of bipolar disorder as well as consequences of misdiagnosis. Clinically oriented, reliable, and valid screening tools for bipolar disorder also were reviewed. CONCLUSIONS: Awareness of multiple, challenging patient-related factors and more comprehensive assessment and screening by health care providers may reduce misdiagnosis.