Experts call for earlier diagnosis of bipolar disorder

Delays in the diagnosis of bipolar disorder, particularly in those with alcohol and substance misuse disorders, could be preventing people from receiving effective treatment for the condition, according to a new study by researchers from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN)? at King’s College London, and the NIHR.

Published in PLOS ONE, the study found that two months was the average delay from presenting to mental healthcare services to the diagnosis of bipolar disorder. However, in people with alcohol and substance misuse disorders the average delay was two years, with some experiencing delays of over five years. This was in addition to a period of around 10 years from first experiencing symptoms to receiving specialist mental healthcare.

According to the study authors, the substantial delays reported among those with prior diagnoses of alcohol or substance misuse disorders could reflect a failure to recognise the symptoms of bipolar disorder and attribute them to alcohol or substance misuse, rather than considering a diagnosis of bipolar disorder or dual diagnosis of both disorders. Dual diagnosis is when someone with a mental illness also misuses alcohol or illicit drugs. Failing to recognise and treat dual diagnosis leads to worse outcomes as alcohol and drugs can worsen the symptoms of mental illness as well as reduce the effectiveness of treatment.

Previous research also suggests that people with symptoms of mania, hypomania or depression are at increased risk of developing alcohol and substance misuse disorders after initial onset of these symptoms.

Dr Rashmi Patel from the Department of Psychosis Studies at the IoPPN, King’s College London, said: ‘Our findings suggest that bipolar disorder could be missed in certain groups of people, such as those who misuse alcohol or illicit substances, leading to substantially longer delays in receiving effective treatment.’

He added: ‘We need to develop better strategies to identify bipolar disorder, perhaps through specialised early intervention services, in order to offer appropriate treatment sooner. This is particularly important because treatments are more effective if they are given sooner rather than later.’

Dr Patel added: ‘While current UK treatment guidelines highlight the need for prompt recognition and treatment of bipolar disorder and substance misuse disorders, there is a clear need for further research to better understand how to treat people with a dual diagnosis of both disorders.’ 

Researchers accessed anonymised mental health records from the SLaM BRC Case Register on more than 1,300 adults diagnosed with bipolar disorder. They examined how long it took for these individuals to be diagnosed and to receive treatment after presenting to mental health services.

This research was funded by the Medical Research Council (MRC) and the National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) at the South London and Maudsley NHS Foundation Trust (SLaM) and King’s College London.