Misdiagnosis of Bipolar I Disorder among patients with the diagnoses of paranoid schizophrenia and schizoaffective disorder in Russian Federation

Abstract

The objective of this crossLsectional, clinicalLdiagnostic study was to detect Bipolar Affective Disorder (BAD) in accordance with the ICDL10 criteria in the population of inpatients with Paranoid Schizophrenia of episodic type (“Paroxysmal Schizophrenia”), or “Schizoaffective Disorder”, having signs of psychomotor agitation at admission, using standard diagnostic procedure based on M. I. N. I structured interview. The total number of subjects enrolled in the study was 347, including 314 (90 %) patients having current diagnosis “Paranoid Schizophrenia of episodic type” and 33 patients (10 %) with Schizoaffective disorder (F25). According to ICDL10 criteria, in 40,3 % of the subjects population BAD could be diagnosed. Evaluation of the diagnostic groups showed differences in PSP scale and in the frequency of mood stabilizers and antiLcholinergic drugs usage. Average score on PSP scale was 52,6 ± 19,4 in BAD group and 41,0 ± 16,3 in Schizophrenia group (p = 0,006). In the mood stabilizers group (which included lithium, valproate, CRBM) 27,3 % of prescriptions were registered in the BAD group and 6,7 – in the Schizophrenia group (p = 0,0001). Anticholinergic drugs were more often prescribed in Schizophrenia group thank in the BAD group – 12,8 % and 5,1 % respectively (p = 0,015). Differential diagnostics of manicLdelusional states associated with BAD or Schizophrenia in accordance with ICDL10 criteria is quite challenging, however it is an important clinical target, as it determines the scope of different therapeutic strategies. Using formalized approach along with high compliance with diagnostic requirements can help improve BAD detection and lead to timely selection of treatment strategy.