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一项收纳100位被诊断为重郁症或双极性异常病患的研究发现，其中仅有26%是真的确诊罹患焦虑性异常、思考异常（精神分裂异常）或个性异常。
David J. Muzina医师与其同事针对100位住进俄亥俄州Lutheran医院情绪异常临床中心的连续病患进行研究，他们报告焦虑性异常、思考异常与其他健康问题经常被误诊为情绪异常。
研究作者Akhil Sethi医师向Medscape精神医学表示，我们可以说每四位病患中即有一位没有获得正确的诊断，这是一个相当庞大的数字。
这对病患、健康照护者与社会来说都是非常重要的，要了解情绪紧绷与忧郁是有很多原因的，且这超过了可诊断的重大情绪异常；Muzina医师向Medscape精神医学表示，其他精神疾病状况可能被误认为重郁症或双极性异常，并不是每一位经历情绪痛苦的人都罹患“精神异常”。
他表示，寓意是很清楚的，安全性与有效治疗的关键在于正确地诊断，并不是每个人都需要药物，有时候交谈治疗是主要的治疗方式，且如果必须药处方药物，最重要的是要诊断正确，因为这些诊断分类所使用之最适当的药物大不相同。
这项研究发表于美国精神科医学会精神服务机构第60届年会上。
【第一，做出正确诊断】
越来越多的重点放在提供精神病患以实证为基础的照护，然而，适当的治疗有赖于正确的诊断。
虽然有些研究根据回溯性病历审查以及主观的病患访谈，报导了双极性异常的误诊率，但对于精神疾病病患的误诊盛行率与特征，我们所知道的很少。
根据研究者表示，情绪异常的误诊率证实与精神疾病高住院率与医疗支出有关；他们想要研究2008年时，成人病患因为被误诊罹患情绪异常而住进情绪异常中心的盛行率。
这项研究报导来自从其他精神医疗院所、急诊室或是经由精神科医师转介住院的前一百位病患结果。
在这些病患住院后，研究助理以迷你国际神经精神访谈（MINI-Plus）对这些病患进行访谈；接着，根据结构诊断访谈合并Muzina医师进行的精神评估结果来确立诊断。
70位主要诊断为单极性忧郁症的住院病患，在进行MINI-Plus访谈后，剩下53位病患维持原本的诊断；然而，这些剩下的病患中，主要诊断被变更为双极性异常（7位）、焦虑异常（2位）、思考异常（5位）或是其他（3位）。
在30位主要诊断为双极性异常的病患中，11位根据MINI-Plus访谈结果维持原来的诊断；然而，剩下的病患中，主要诊断被变更为双极性异常（3位）、焦虑异常（8位）、思考异常（4位）或是其他（4位）。
Sethi医师指出，在这些因为双极性异常诊断住院的病患中，仅有大约60%真的罹患双极性异常。
他指出，如果你没有正确的诊断，你无法提供病患适当的治疗。
【MINI-Plus访谈可以提供协助】
研究者表示，当医师第一次看到这位病患，要做出诊断并不容易，因为不同精神疾病的症状可能重复；花多一点时间，使用结构性诊断访谈工具，例如MINI-Plus或是其他筛检措施，可以加强诊断过程的正确性。
他们呼吁应该进行更多的研究，来进一步了解误诊对病患造成的风险。Muzina医师的中心是一个与安大略多伦多大学情绪异常精神药理学部门合作的中心，以进一步透过这一个大型、国际情绪异常资料库来探索这个重要的健康议题。
Muzina医师是阿斯特捷利康药厂、格兰素威康、辉瑞、Sepracor药厂的谘询专家，且接受Abbott实验室、礼来药厂、格兰素威康与诺华药厂、以及惠氏药厂的研究经费。
One in 4 Adults Admitted to a Mood-Disorder Clinic Are Misdiagnosed
By Marlene Busko
Medscape Medical News
A study of 100 patients with a primary diagnosis of major depression or bipolar disorder found that 26% actually had an anxiety disorder, a thought disorder (schizoaffective disorder), or a personality disorder.
David J. Muzina, MD, and colleagues examined 100 consecutive patients admitted to the Cleveland Clinic Center for Mood Disorders at Lutheran Hospital, in Ohio, and reported that anxiety disorders, thought disorders, and other health problems are commonly misdiagnosed as a mood disorder.
"We can say that about 1 in 4 patients didn't have the correct diagnosis, which is quite a big number," study author Akhil Sethi, MD, told Medscape Psychiatry.
"It is very important for patients, healthcare providers, and society to understand that there are many reasons for emotional distress and depression beyond a diagnosable major mood disorder," Dr. Muzina told Medscape Psychiatry, adding that other psychiatric conditions may be mistaken as major depression or bipolar disorder, and not every experience of emotional human suffering is a "mental disorder."
"The implications are clear: safe and effective treatment hinges on making the right diagnosis. Not everyone needs medication; sometimes talk therapy is the primary treatment needed, and if medication must be prescribed, it is of paramount importance to get the diagnosis right, since the appropriate medications differ greatly among these diagnostic categories," he said.
The study was presented at here at the American Psychiatric Association 60th Institute on Psychiatric Services.
First, Make the Correct Diagnosis
Increasing emphasis is being placed on providing evidence-based care for psychiatric patients. However, appropriate treatment hinges on an accurate diagnosis.
Little is known about the prevalence and characteristics of misdiagnosis among psychiatric patients, although some studies, based on retrospective chart reviews and subjective patient reporting, have reported misdiagnosis of bipolar disorder.
According to the investigators, misdiagnosis of mood disorders has been linked to higher rates of psychiatric hospitalization and medical costs. They sought to investigate the prevalence of misdiagnosis of mood disorders in adult patients admitted to a mood-disorders unit in 2008.
This study reports on results from the first 100 patients admitted to the inpatient unit from other psychiatry units, emergency departments, or by psychiatrist referral.
After the patients were admitted to the unit, they were interviewed by a research assistant using the Mini-International Neuropsychiatric Interview (MINI-Plus). Diagnosis was then confirmed based on the results of this structured diagnostic interview in combination with the psychiatric evaluation performed by Dr. Muzina.
Seventy patients were admitted to the unit with a primary diagnosis of unipolar major depression, and this diagnosis remained the same for 53 patients following a MINI-Plus evaluation. However, in the remaining patients, the primary diagnosis was changed to bipolar disorder (7 patients), anxiety disorder (2), thought disorder (5), or other (3).
Of the 30 patients who had been admitted with a primary diagnosis of bipolar disorder, 11 kept the same diagnosis based on the MINI-Plus evaluation. However, in the remaining patients, the primary diagnosis was changed to unipolar major depression (3 patients), anxiety disorder (8), thought disorder (4), or other (4).
"Of the patients admitted with a diagnosis of bipolar disorder, only about 60% really had bipolar disorder," Dr. Sethi pointed out. "If you don’t have a correct diagnosis, you can't give patients the appropriate treatment," he said.
MINI-Plus Can Help
When a physician sees a patient for the first time, it can be difficult to pin down a correct diagnosis, since symptoms from different mental disorders can overlap, the investigators note. Spending a bit more time and using a structured diagnostic interview such as the MINI-Plus or other screening measures can strengthen the diagnostic process.
They call for further study to better understand factors that place patients at risk for misdiagnosis. Dr. Muzina's center is collaborating with the mood-disorders psychopharmacology unit at the University of Toronto, in Ontario, to further explore this important health issue through the creation of a large, international mood-disorders database.
Dr. Muzina is a consultant to AstraZeneca Pharmaceuticals, GlaxoSmithKline, Pfizer, and Sepracor and has received research grant and support from Abbott Laboratories, Eli Lilly, GlaxoSmithKline, Novartis Pharmaceuticals, and Wyeth-Ayerst.
American Psychiatric Association 60th Institute on Psychiatric Services meeting: Poster 85. Presented October 3, 2008.