La manía por diagnosticar desorden bipolar

PROVIDENCE, RI – Durante los últimos años, muchos expertos han sugerido que el desorden bipolar -una enfermedad grave que causa una importante morbilidad social y un exceso de mortalidad- no se reconoce lo suficiente, particularmente en pacientes con depresión grave. Incluso los pacientes a quienes se les diagnostica desorden bipolar a menudo esperan más de 10 años antes de que se comience a buscar un tratamiento que permita dar con el diagnóstico correcto.

Entre las implicancias clínicas del no reconocer el desorden bipolar en los pacientes deprimidos se incluyen la sub-prescripción de medicamentos estabilizadores del ánimo, y un aumento del riesgo de que se produzca un "ciclaje" rápido, es decir, cambios entre fases maníacas y depresivas. Sin embargo, quizás como consecuencia de los esfuerzos concertados por mejorar el reconocimiento del desorden bipolar, durante los últimos años hemos observado el surgimiento del fenómeno opuesto: el sobrediagnóstico.

En mi propia consulta, mis colegas y yo hemos encontrado pacientes que nos informan haber sido diagnosticados previamente con desorden bipolar, a pesar de carecer de un historial de episodios maníacos o hipomaníacos. Por supuesto, también hemos visto pacientes que buscan tratamiento para la depresión y que, en realidad, sufrían de desorden bipolar. Sin embargo, parecía haber más sobrediagnóstico que subdiagnóstico.

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