Can the MiniSCID improve the detection of bipolarity in private practice?

Several recent studies have re-examined the prevalence of Bipolar Disorder, raising the suspicion that it is being underdiagnosed, particularly early in the course of the disease. The MiniSCID is a screening instrument for Axis-I diagnoses. A chart review was performed on all 1161 active patients seen in an outpatient setting. Data collected included demographic information, initial clinical diagnosis, current clinical diagnosis, MiniSCID diagnoses, and SCL-90 results. Of the 796 patients who had taken the MiniSCID at their initial visit, 256 have a current clinical diagnosis of Bipolar Disorder, and 540 have a nonbipolar diagnosis. They were seen over an average period of 5.3 years. The MiniSCID had a sensitivity of 0.58 and a specificity of 0.63 in predicting a current diagnosis of bipolar disorder. There are 201 patients who endorsed current or past mania/hypomania on the MiniSCID, yet have a current clinical diagnosis of a nonbipolar illness. These patients had a SCL-90 profile that was much closer to those of bipolar patients than those of unipolar patients. The major limitation is the reliability and validity of the MiniSCID. There is a large group of patients who are potentially bipolar, but are not yet clinically diagnosed as such. Several factors relating to this finding are discussed. The use of MiniSCID and SCL-90 as an in-office-screening tool can improve recognition of Bipolar illness.