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Logo of bmcpsycBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Psychiatry
 
BMC Psychiatry. 2012; 12: 13.
Published online Feb 29, 2012. doi:  10.1186/1471-244X-12-13
PMCID: PMC3317873
Classification of bipolar disorder in psychiatric hospital. a prospective cohort study
Terje Øiesvold,corresponding author1 Mary Nivison,2 Vidje Hansen,3 Knut W Sørgaard,4,5 Line Østensen,5 and Ingunn Skre6
1Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, and Division of general psychiatry, Nordland Hospital, Bodø, Norway
2Clinic for substance abuse and specialized psychiatry, University Hospital of Northern Norway, Tromsø, Norway
3Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, and Division of general psychiatry, University Hospital of Northern Norway, Tromsø, Norway
4Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
5Division of General Psychiatry, Nordland Hospital, Bodø, Norway
6Department of Psychology, Faculty of Health Science, University of Tromsø, Tromsø, Norway
corresponding authorCorresponding author.
Terje Øiesvold: terje.oiesvold/at/nlsh.no; Mary Nivison: mary.nivison/at/unn.no; Vidje Hansen: vidje.hansen/at/uit.no; Knut W Sørgaard: knut.sorgaard/at/nlsh.no; Line Østensen: line.ostensen/at/nlsh.no; Ingunn Skre: Ingunn.skre/at/uit.no
Received September 27, 2011; Accepted February 29, 2012.
Abstract
Background
This study has explored the classification of bipolar disorder in psychiatric hospital. A review of the literature reveals that there is a need for studies using stringent methodological approaches.
Methods
480 first-time admitted patients to psychiatric hospital were found eligible and 271 of these gave written informed consent. The study sample was comprised of 250 patients (52%) with hospital diagnoses. For the study, expert diagnoses were given on the basis of a structured diagnostic interview (M.I.N.I.PLUS) and retrospective review of patient records.
Results
Agreement between the expert's and the clinicians' diagnoses was estimated using Cohen's kappa statistics. 76% of the primary diagnoses given by the expert were in the affective spectrum. Agreement concerning these disorders was moderate (kappa ranging from 0.41 to 0.47). Of 58 patients with bipolar disorder, only 17 received this diagnosis in the clinic. Almost all patients with a current manic episode were classified as currently manic by the clinicians. Forty percent diagnosed as bipolar by the expert, received a diagnosis of unipolar depression by the clinician. Fifteen patients (26%) were not given a diagnosis of affective disorder at all.
Conclusions
Our results indicate a considerable misclassification of bipolar disorder in psychiatric hospital, mainly in patients currently depressed. The importance of correctly diagnosing bipolar disorder should be emphasized both for clinical, administrative and research purposes. The findings questions the validity of psychiatric case registers. There are potential benefits in structuring the diagnostic process better in the clinic.
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