Overdiagnosing bipolar disorder

An article in Acta Psychiatrica Scandinavica, of which one of the authors is Nassir Ghaemi (whom I have mentioned before eg. see post), says that the claim of overdiagnosis of bipolar disorder is mistaken. True, the paper which is commonly quoted to substantiate this point also found considerable underdiagnosis. Of 145 patients who reported they had had a previous diagnosis of bipolar disorder, only 63 were diagnosed as such using the Structured Clinical Interview for DSM-IV (SCID). But there were also another 27 patients picked up on SCID that had not had that diagnosis.

The article uses these figures to argue that bipolar disorder is mainly underdiagnosed. This is motivated by the authors' belief that antidepressants are not very effective in bipolar depression and these people would do better on mood stabilisers. However, the dispute about the significance of the figures misses the main point about the validity of bipolar II disorder. Has the diagnosis of bipolar disorder been extended too far to include people who would not necessarily have been seen on that spectrum (see previous post)?

Is it critical to use the term 'schizophrenic patient'?

A comment on my previous post (as does a tweet from Jacqui Dillon) takes me to task for using the term 'schizophrenic patient'. But, is it such a crime? I am a doctor and I do see patients. I don't think the term 'patient' should be monopolised by biomedicine.

Patients may also be diagnosed as schizophrenic. Of course there is an issue about what this means. The point I was making in the post is that schizophrenia cannot be diagnosed from a brain scan, and even the most biomedical of psychiatrists, such as E Fuller Torrey and Stephen Stahl (see previous post) agree with that. This message needs to be understood more widely. Public perception is often that schizophrenia can be diagnosed from a scan.