Annals of Indian Psychiatry (Jan 2019)
Bipolarity and temperament in depression: Making the right diagnosis
Abstract
Background: Diagnosis of bipolar disorder is often missed clinically in cases presenting in depression, and temperament is an important clue to correct it. We, therefore, studied cases diagnosed as depression to see the evidence of undiagnosed bipolar disorder as well as temperament. Materials and Methods: Patients of a depressive episode (ICD-10, F32), between 18 and 60 years of age and within mild or normal range on Hamilton Depression Rating Scale at the time of interview were included in this study. The patients were diagnosed retrospectively using mini-international neuropsychiatric interview (MINI) mania hypomania scale to look for missed diagnoses of mania or hypomania episodes. Bipolar spectrum diagnostic scale (BSDS) was used to evaluate bipolar spectrum, and temperament assessment scale and Temperament Evaluation of Memphis, Pisa and San Diego Auto questionnaire (TEMPS-A) was used to assess affective temperament of participants. Chi-square test was used to compare the cases. Results: Out of 100 patients, 35 cases were diagnosed with hypomania and two cases with mania. BSDS was positive in 16% cases whereas it was positive in 9% cases with past episodes of hypomania and 1% case of mania. On TEMPS-A, 12% of cases had depressive or dysthymic temperament, 37% of cases had cyclothymic temperament, 21% of cases had hyperthymic temperament, and 5% of cases had irritable temperament. Cases with irritable or dysthymic temperament had no evidence of bipolar disorder on MINI and were statistically significant (P < 0.001). Limitations: Consecutive sampling, cross-sectional design, retrospective diagnosis. Conclusion: The misdiagnosis of Bipolar II disorder and bipolar spectrum disorder can happen as depression. Temperament can help assert evidence for bipolar disorder in cases presenting as depression and using standardized tools like MINI can help correct diagnosis and management.
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