Troubles maniaco-dépressifs : du sous-diagnostic au sur-diagnostic

PROVIDENCE (Rhode Island) – Depuis quelques années, beaucoup de spécialistes disent que les troubles maniaco-dépressifs – une maladie grave avec un taux de morbidité assez important qui s'accompagne d'un taux de mortalité élevé – sont insuffisamment pris en compte, notamment dans le cas de patients souffrant de dépression importante. Souvent les patients doivent attendre plus de dix ans avant que le diagnostic exact ne soit posé.

La difficulté de diagnostiquer un trouble maniaco-dépressif chez des patients en dépression se traduit par une sous-prescription de médicaments stabilisateurs de l'humeur et un risque accru de cycles rapides (passages d'une phase maniaque à une phase dépressive). Mais - et c'est peut-être une conséquence des efforts accomplis pour améliorer la reconnaissance des troubles maniaco-dépressifs - nous observons depuis quelques années l'apparition du phénomène opposé, le sur-diagnostic.

Dans notre propre pratique, mes collègues et moi-même rencontrons des patients qui nous disent avoir été diagnostiqués comme maniaco-dépressifs, alors qu'ils ont un passé vierge d'épisodes maniaques ou hypomaniaques. Il est vrai que nous rencontrons aussi des patients demandeurs d'un traitement contre la dépression, alors qu'ils souffrent de troubles maniaco-dépressifs. Mais dans l'ensemble, il semble y avoir davantage de sur-diagnostics que de sous-diagnostics.

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