Diagnose-Manie bei bipolarer Störung

PROVIDENCE, Rhode Island – In den vergangenen Jahren vertraten viele Experten die Ansicht, dass die bipolare Störung – eine ernsthafte Krankheit, die zu signifikanter psychosozialer Morbidität und übermäßiger Mortalität führt – vor allem bei Patienten mit schweren Depressionen nicht erkannt wird. Sogar Patienten mit diagnostizierter bipolarer Störung warten oft mehr als zehn Jahre auf diese Diagnose.  

Zu den klinischen Auswirkungen der nicht diagnostizierten bipolaren Störung bei depressiven Patienten gehören die Unterversorgung mit stimmungsstabilisierenden Medikamenten und ein gesteigertes Risiko rasch abfolgender „Zyklen“ – Schwankungen zwischen manischen und depressiven Phasen. Womöglich als Folge der konzertieren Bemühungen, die Diagnose der bipolaren Störung zu verbessern, haben wir in den letzten Jahren nun das gegenteilige Phänomen beobachtet – die Überdiagnose.

In meiner eigenen Praxis haben meine Kollegen und ich mit Patienten zu tun, die berichteten, dass bei ihnen trotz fehlender manischer oder hypomanischer Episoden schon eine bipolare Störung diagnostiziert wurde. Natürlich gibt es auch Patienten, die ihre Depressionen behandeln lassen wollen und in Wahrheit aber an einer bipolaren Störung leiden. Dennoch schien Überdiagnose öfter vorzuliegen als Unterdiagnose.

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