Running Head: THE DIAGNOSIS OF BIPOLAR DISORDER 1

The delay in the diagnosis of bipolar disorder

Chamberlain College of Nursing

NR 326: Mental Health

00/ 2018

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BIPOLAR DISORDER2

Introduction

Bipolar disorder has a significant cause to morbidity and mortality rate. Although we

have an active treatment, there is an extensive wait before diagnosis and treatment are initiated.

This research was done to examine factors associated with the delay of bipolar disorder before

the diagnosis and the onset of treatment. Bipolar disorder is also called manic depression. This

disorder is characterized with the events of mood swings ranging from depressive lows to manic

highs. The history of bipolar disorder presents with depression, so initial episodes look very

similar to a major depressive disorder. Therefore, there is often a prolonged delay in the exact

diagnosis of bipolar disorder, and any significant wait influence the initiation of appropriate

treatment. This paper investigates whether the delay in the diagnosis of bipolar disorder is

inescapable. This means is the delay in diagnosing bipolar disorder unavoidable or unpreventable

(Fritz et al, 2017).

Article summary

Bipolar disorder frequently beings with an early diagnosis of depression. This creates a

delay in the exact judgement and treatment of bipolar disorder. Although research has focused on

predictors in the analytic change from the depression stage to bipolar disorder. The research on

this prolonged diagnosis is scant. These researchers examine the time it took to diagnose one

with bipolar disorder after an early diagnosis of major depressive disorder to understand the

patient features and psychological factors that may explain the delay. However, when manic

signs are evident, the diagnosis changes to be bipolar disorder. Research shows that the time

from diagnosing a major depressive disorder to the time of diagnosing bipolar disorder is about

10 years. This means before the optimal treatment for bipolar disorder can be made, there might

be a delay in treatment for almost a decade. This is one of many reasons why it is important to

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BIPOLAR DISORDER3

investigate the cause, and the delay from the diagnosis of major depressive disorder to time of

bipolar disorder (Fritz et al., 2017).

One of the most common predictors of exploratory conversion from major depressive

disorder to bipolar disorder is with antidepressant treatment resistance. There is a rise in the rate

of diagnostic conversion to bipolar disorder after a failure to respond to two treatments with the

use of antidepressant. Another factor that is associated with the diagnostics change from major

depressive disorder to bipolar disorder is with the initial onset of depression. Studies show that

patients who were formerly diagnosed with major depressive disorder are likely to be diagnosed

with bipolar disorder if they had an early onset of depression and were unresponsive to

antidepressant treatment. Also, the conversion to bipolar disorder has been found related to the

patient family history, but the findings are not truly reliable (Fritz et al., 2017).

The information from the article could be used in nursing practice because it educates the

nurse on the factors that might affect the early diagnosis of bipolar disorder. For example, some

statistical data from this research proves the delay as it was stated in this article. The conversion

time from major depressive disorder to bipolar disorder was about 42.8% lesser in female than it

was in male. Also, for every 1-year increase in the initial diagnosis of major depressive disorder,

the time for bipolar disorder conversion decrease by 2.8%. This data was made after a clinical

evaluation of 382 patients by a psychiatrist and with the of use series of questionnaires. When

there is an increase in the diagnosis of major disorder there is a decrease in the diagnosis of

bipolar and verse versa. Another example is to understand those factors associated with the delay

in bipolar disorder which will help the nurse better understand why some patients are diagnosed

with bipolar and other patients showing the same behavior have not been diagnosed. This article

will help the nurse better understand the diagnosis and the delayed process of bipolar disorder

(Fritz et al, 2017).

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BIPOLAR DISORDER4

Article critique

Based on the study done, the delay is due to the disease process and other factors that

prolong the diagnosis. This article is informative about the process it takes to diagnose bipolar

disorder. The researchers put together resources from various aspect from their research to

provide why the delay is present. For example, Fritz et al. (2017) found an undesirable

correlation between the age at which the disease is initialed to the time of diagnostic conversion.

This means the younger the age of the patient, the longer the delay in diagnosing the patient.

Therefore, understanding the patient’s features and psychological behavior are also reasons that

may delay bipolar disorder from being diagnosed after an early diagnosis of a major depressive

disorder (Fritz et al, 2017).

Weakness

I feel that although the article did tell us about the factors that are associated with the

delay to diagnose bipolar disorder, the researchers did not show how those factors can be

evitable. Within the article there should have been a clear picture or graph explaining ways to

reduce the long process to diagnosing one with bipolar disorder. The weakness I believe in this

article is not especially from the article presentation, but it is from the disease process. The

weakness in this article is seen in the length of time it takes to diagnose one with bipolar.

Recommendations

I will recommend this article to a colleague because it gave a detailed explanation of the

aim of this research. This article is a good starting point to know why there is a prolonged wait in

the diagnosis of bipolar disorder. As a nursing student, this article makes me understand why

most people who exhibit similar behavior with people diagnosed with bipolar disorder have not

been medically diagnosed. As it was explained in the article, age makes a big difference to

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diagnose a person with bipolar disorder because of patient characteristics and psychological

factors. Younger patients are not mentally developed as an adult patient would be.

Conclusion

In conclusion, this study shows that certain individuals experience a significant delay in

diagnosis and treatment of bipolar disorder which varies depending on different factors. I believe

when there is a better understanding of the factors associated with the delay to diagnose bipolar

disorder, then there will be developmental strategies to reduce them. These findings indicate the

need for an early recognition and initiation of active treatment of bipolar disorder which will

most likely diminish disability and improve outcomes.

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References

Fritz, K., Russell, A., Allwang, C., Kuiper, S., Lampe, L., Malhi, G., (2017). Bipolar disorder: Is

a delay in the diagnosis of bipolar disorder inevitable? 19, 396–400. doi:10.1111/bdi.12499.

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