Sensitivity of 73% and specificity of 90% for a bipolar diagnosis
Methods
MDQ positive defined as:
Seven symptoms or more marked
Several positive symptoms occurring over same period of time
Moderate to severe functional impairment
Methods
If patients were screened positive on the MDQ, they were interviewed further
Antidepressants halted or tapered and mood stabilizers started
Referred to Mental Health and Behavioral Health
Results
406 patients/charts with dx of major depression interviewed/reviewed
160 patients eligible for MDQ
Ages 20-70
Mean age 50.2 years at onset of study
Results
Results
Results
Results
Results
Results
Results
Results
Analysis of Results
Confirm that females outnumber males in having mood disorders
Confirm that caucasians outnumber other races in having mood disorders
Analysis of Results
Primary care providers (11%) underutilize mood disorder questionnaires in the assessment of depressive episodes
16% of clinic patients diagnosed as having major depression were likely misdiagnosed
Discussion
We showed in our results that bipolar depression can be misdiagnosed as unipolar depression
Patients will report on periods of depression but neglect to report periods of elevated mood
Discussion
It is important to distinguish between the two, because treatment differs
Major depression – Antidepressant
Bipolar disorder – Mood Stabilzer
Use of antidepressants in bipolar disorder
Significant risk of mania
May cause rapid mood-cycling
No reduction in mortality (completed suicides)
Less effective than mood stabilizers in preventing depressive relapse
Discussion/Recommendation
There was a misdiagnosis of bipolar disorder as major depression in our clinic population.
The Mood Disorder Questionnaire (MDQ) is an easy tool to screen for bipolar disorder in the primary care setting and should be used when screening for unipolar depression and before any antidepressants are prescribed.
Sample size
Retrospective study
Convenience sampling
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MEASURE resource module 8
MEASURE resource module: Unipolar vs Bipolar Depression