Upgrading Screeners for Patients With Bipolar Disorder

Studies have shown that up to 40% of patients with bipolar disorder can be misdiagnosed, and these patients are often misdiagnosed with major depressive disorder (MDD). So how can mental health professionals ensure that they are making the right diagnosis the first time when patients with bipolar disorder come to them? Desiree Matthews, PHMNP-BC, from Monarch community mental health center in Charlotte, North Carolina, recommends that clinicians use screeners in order to help them properly diagnose bipolar disorder when patients come to them. In this video from on-site at NP Institute, Nurse Matthews discusses which screeners she recommends as well as how she encourages medication adherence.

Nurse Matthews discussed this and other topics at the 2023 Psych Congress NP-Institute in Boston, Massachusetts. Save the date for next year's NP Institute In-Person, March 20-23, 2024, in San Diego, California! For more information, visit the meeting website. Keep up with pre-conference meeting coverage in our newsroom. 

Read the Transcript:

Psych Congress Network: What are some tips you have for providers confronted with the challenge of a patient not adhering to their treatment plan for bipolar disorder?

Desiree Matthews: If my patients with bipolar disorder continued to struggle with medication adherence, they're stopping treatment, I talk to them. Are they stopping because they're having side effects? Do they feel it's not taking care of the symptoms that they're experiencing that are important to them? Are the medications costly? So really digging deeper to understand why they're not adherent. Maybe it's simply they're just forgetting and potentially maybe they would like a long-acting injectable product, that they don't have to remember to take a pill every day. Maybe they're sick of taking handfuls of pills and maybe a long-acting injectable would be a better option. Maybe it is that sedation, maybe it is that weight gain, and that way I can talk to my patients about whether we have X, Y, Z options that have less side effects, potentially little to no weight gain or sedation, and offer those treatments instead.

PCN: How can clinicians improve screening processes for bipolar disorder?

Nurse Matthews: Unfortunately, as many of us know, bipolar disorder is underdiagnosed and undertreated or treated inadequately. If you look at the literature out there, unfortunately it can take up to 10 to 12 years from the onset of clinically relevant symptoms of bipolar disorder to actually get a correct diagnosis. By the time patients come to my door in community mental health, they've had 4, 5, 6 diagnoses, treatment plans all over the place for borderline personality disorder, ADHD, impulse disorder, anxiety, panic, and ultimately, unipolar depression or MDD.

Many of these patients present to your office when they're depressed. Bipolar disorder patients present because they're depressed. They can't get out of bed. They're eating too much. They're missing work. They're not coming to you necessarily when they're having manic or hypomanic symptoms. Oftentimes, patients forget to report these symptoms. So what I would suggest and really recommend any patient that you get complaining of depression, before you write a prescription for an SSRI or anything for depression, make sure that you dig deeper. Make sure that you rule out bipolar disorder and a history of mania or hypomania to the best of your ability.

A few suggestions is standardized screening. So we have different screeners out there, like the mood disorder questionnaire, the rapid mood screener. These are fairly quick and it can be done before the patient even gets into your waiting room. So for me, I like to have this done on intake for all new patients, as well as considering doing the rapid mood screener or mood disorder questionnaire when you have a patient that's not doing well on treatment, and rescreen for bipolar disorder. Try to get collateral, talk to a significant other, talk to a family member, look through hospital discharge paperwork, because unfortunately, our patients don't always report the mania or hypomania or even realize that this has been happening to them.

Desiree Matthews, PHMNP-BC, is a board-certified Psychiatric Mental Health Nurse Practitioner. She received her Bachelor's of Nursing from University at Buffalo and her Master's of Nursing at Stony Brook University. She currently resides in Charlotte, NC, and practices at Monarch, a community mental health center providing telepsychiatry services to adult patients. Clinical interests include the treatment of schizophrenia, bipolar disorder, treatment-resistant unipolar depression, and drug-induced movement disorders, including tardive dyskinesia. She has provided faculty expertise and insight into the development of a clinical screener for TD called MIND-TD.