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Delays to diagnosis and treatment in patients presenting to mental health services with bipolar disorder

Published online by Cambridge University Press:  23 March 2020

R. Patel ,
H. Shetty ,
R. Jackson ,
M. Broadbent ,
R. Stewart ,
J. Boydell ,
P. McGuire  and
M. Taylor
R. Patel*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
H. Shetty
Affiliation:
South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, United Kingdom
R. Jackson
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
M. Broadbent
Affiliation:
South London and Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, United Kingdom
R. Stewart
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, London, United Kingdom
J. Boydell
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
P. McGuire
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
M. Taylor
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

There are often substantial delays before diagnosis and initiation of treatment in people bipolar disorder. Increased delays are a source of considerable morbidity among affected individuals.

Aims

To investigate the factors associated with delays to diagnosis and treatment in people with bipolar disorder.

Methods

Retrospective cohort study using electronic health record data from the South London and Maudsley NHS Foundation Trust (SLaM) from 1364 adults diagnosed with bipolar disorder. The following predictor variables were analysed in a multivariable Cox regression analysis on diagnostic delay and treatment delay from first presentation to SLaM: age, gender, ethnicity, compulsory admission to hospital under the UK Mental Health Act, marital status and other diagnoses prior to bipolar disorder.

Results

The median diagnostic delay was 62 days (interquartile range: 17–243) and median treatment delay was 31 days (4–122). Compulsory hospital admission was associated with a significant reduction in both diagnostic delay (hazard ratio 2.58, 95% CI 2.18–3.06) and treatment delay (4.40, 3.63–5.62). Prior diagnoses of other psychiatric disorders were associated with increased diagnostic delay, particularly alcohol (0.48, 0.33–0.41) and substance misuse disorders (0.44, 0.31–0.61). Prior diagnosis of schizophrenia and psychotic depression were associated with reduced treatment delay.

Conclusions

Some individuals experience a significant delay in diagnosis and treatment of bipolar disorder, particularly those with alcohol/substance misuse disorders. These findings highlight a need to better identify the symptoms of bipolar disorder and offer appropriate treatment sooner in order to facilitate improved clinical outcomes. This may include the development of specialist early intervention services.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
FC09
Information
European Psychiatry , Volume 33 , Issue S1: Abstracts of the 24th European Congress of Psychiatry , March 2016 , pp. S75
Copyright
Copyright © European Psychiatric Association 2016
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