New report highlights need for accurate diagnosis and management of bipolar I disorder

A new report launched today, ‘Paying the ultimate price’, highlights the urgent need for accurate diagnosis and management of bipolar I disorder in order to address a significant burden on society, patients and carers. Due to lack of understanding of a severe form of bipolar I disorder (mania with depressive symptoms), millions of people worldwide are not receiving timely and accurate diagnosis leaving them at a heightened risk of suicide, according to world-leading experts.

In recent years, bipolar I disorder has been re-defined through recognition that manic and depressive symptoms can occur concurrently; these feelings of depression during mania occur in over two thirds of patients and represents a severe form of bipolar I disorder. Patients are at their most vulnerable at this time, with up to one out of two sufferers attempting suicide during these episodes. They are also approximately three times more likely to be hospitalised than bipolar patients without mixed symptoms, and the duration of these hospital stays are on average 40 per cent longer. Aside from the impact this has on friends, family and society, the financial burden of suicide attempts and hospitilisations are also significant.

Professor Allan Young, Director of Centre for Affective Disorders, King’s College London, comments:

Sadly, in the UK, the numbers of suicides are increasing. In 2013 alone there were 6,233 suicides in the UK, an increase of 4% from the previous year. Whilst these cannot all be attributed to mania with depressive symptoms, the increase is a worrying trend. Despite the known increase in suicides, mental health trusts in England are forecasting significant cuts to their funding over the next four years. This reinforces the urgent need for psychiatrists to recognise and acknowledge vulnerable patients suffering from disorders such as mania with depressive symptoms quickly, in order to treat them effectively.

Professor Eduard Vieta, Director of the Bipolar Disorders Program of the Hospital Clinic at the University of Barcelona, Spain, comments:

It is important to ensure that patients experiencing mania with depressive symptoms are diagnosed quickly and accurately. We now understand that almost three quarters (72%) of patients experiencing mania with depressive symptoms report symptoms of anxiety, irritability or agitation. Simple recognition of these hallmarks can enable healthcare professionals to intervene and treat patients, reducing hospitalisations often costing healthcare economies billions of euros and potentially saving thousands of lives worldwide.

The direct costs, such as caring for patients who have attempted suicide, are estimated at €6.45 billion a year in the US alone. Evidence reveals that 45 per cent of direct costs associated with suicide are attributable to hospitalisation, costing approximately €23,000 within the first year after a suicide attempt in the US. The indirect costs associated with bipolar I disorder also have a huge impact on society, patients and carers. Evidence has shown that over one sixth (16.5%) of indirect costs are incurred by lost productivity of family members and caregivers in the US; and it is estimated that the indirect costs are 4 times higher than the direct costs.

Mr Paul Arteel, Executive Director of Global Alliance of Mental Illness Advocacy Networks (GAMIAN) Europe comments:

Bipolar I disorder, in particular mania with depressive symptoms, has a severe effect on those living with the condition. It not only has a significant impact on the patient’s life, but has a drastic effect on their family and friends – who are often also their ‘carers’. We find that family and friends close to bipolar I disorder patients can live in constant fear that suicide could take the lives of their loved ones.

Despite the significant financial burden and increased risk of suicide among this patient community, 72 per cent of psychiatrists are unaware that up to 64 per cent of people diagnosed with bipolar I disorder experience at least one depressive symptom during an episode of mania. This lack of recognition could lead to the misdiagnosis of vulnerable people with bipolar I disorder, putting them at greater risk of suicidality and placing a devastating burden on families and carers.

Professor Maurizio Pompili, Professor of Suicidology, Faculty of Medicine and Psychology of Sapienza University, Italy, who contributed to the report, said:

Suicide prevention among bipolar I patients could be improved through greater education and understanding of depressive symptoms during mania. Psychiatrists are too often afraid to broach the topic of suicidality with their patients, as they are fearful they may seed such an idea. This is sadly the opposite of what patients need; a combination of intervention and human support is vital. It is important that psychiatrists ask and understand why patients either want to attempt suicide or have attempted suicide; how can patients move forward when they haven’t understood why it happened in the first place?

The ‘Paying the ultimate price’ report has been developed by a global faculty of expert psychiatrists, a suicidologist, patient group representatives and carers affected by bipolar I disorder in collaboration with H. Lundbeck A/S. It calls for an improvement in diagnosis and management of mania with depressive symptoms, as well as greater support around the associated risk of suicide.