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Ten-year diagnostic consistency of bipolar disorder in a first-admission sample


  • The authors of this paper do not have any conflicts of interest regarding the findings or the publication of this manuscript, financial or otherwise.

Corresponding author:
Camilo J. Ruggero, PhD
Department of Psychology University of North Texas
1155 Union Circle, #311280
Denton, TX 76203, USA
Fax: (940) 565-4682


Ruggero CJ, Carlson GA, Kotov R, Bromet EJ. Ten-year diagnostic consistency of bipolar disorder in a first-admission sample.
Bipolar Disord 2010: 12: 21–31. © 2010 The Authors.
Journal compilation © 2010 John Wiley & Sons A/S.

Objectives:  A number of reports have examined the stability of the diagnosis of schizophrenia, but fewer studies have considered the long-term consistency of a bipolar diagnosis or factors that influence the likelihood of a diagnostic change. The present study sought to estimate how consistently a bipolar diagnosis was made across a 10-year period and factors associated with consistency, particularly demographic and clinical characteristics, childhood-related factors, and illness course.

Methods:  The sample included 195 first-admission patients presenting with psychosis who were assessed soon after hospitalization and at 6-month, 2-year, and 10-year follow-up and diagnosed with bipolar disorder on at least one of these assessments. Diagnoses were made using best-estimate procedures and were blind to all previous consensus diagnoses. Respondents who were consistently diagnosed with bipolar disorder were compared to those whose diagnosis shifted across assessments.

Results:  Overall, 50.3% (n = 98) of the 195 respondents were diagnosed with bipolar disorder at every available assessment, but 49.7% (n = 97) had a diagnostic shift to a non-bipolar disorder at least once over the course of the 10-year study. Childhood psychopathology and poorer illness course were among the few variables associated with increased odds of a change in diagnosis.

Conclusions:  Even with optimal assessment practices, misdiagnosis of bipolar disorder is common, with complex clinical presentations often making it difficult to consistently diagnose the disorder over the long term.