Professor Mary Phillips, professor of psychiatry and director of the Clinical and Translational Affective Neurosicence Program at the University of Pittsburgh, told the Congress that missed and delayed diagnosis was a major problem with bipolar disorder.
She said: “Only one in five sufferers are correctly diagnosed at first presentation to a doctor and it can take up to ten years before suffers receive a correct diagnosis.” A major problem for clinicians is the difficulty of differentiating between unipolar (normal) depression and bipolar disorder. Professor Phillips explained: “The problem is that sufferers [of bipolar disorder] frequently fail to tell their doctors about hypomanic phases because they can be experienced as quite pleasant or judged not to be abnormal at all.”
Yet research carried out at Pittsburgh has shown that BPD may in the near future be more accurately diagnosed with a combination of a Functional MRI, which scans the brain’s ‘software’ or neural pathways, as well as a DTI (Diffusion Tension Imaging) which scans the brain’s white matter.
Professor Philips told the Congress that scans of the brains of people who are suffering depression or bipolar disorder show ‘functionally coupled’ activity in two regions of the brain, the amygdala which processes emotions, and the pre-frontal cortex, important for emotional regulation.
Professor Phillips’ study involved MRI scans comparing brain function in two groups of people, one group with bipolar disorder and the other with depression. It revealed that the two types of depression appear to be easily distinguished “by a very different and distinct pattern of brain activity”.
She said: “If there’s a plan to do just one MRI in the future to try to decide whether someone has bipolar or depression , I’d suggest focussing the right pre-frontal cortex. If there is any abnormality in functioning between the right and pre-frontal cortex and right amygdala, the chances are that the person has bipolar.”
Professor Phillips suggested that the scans may also be used at some point to predict a future onset of bipolar disorder in young people who are not yet affected by the disease.
Telephone: 020 7235 2351 Extensions. 6298 or 6127
International Congress of the Royal College of Psychiatrists, Edinburgh, 21-24 June 2010.