Improving and accelerating the correct diagnosis of Bipolar Disorder using a two-stage diagnostic approach.
- Mon 22nd Jan 2024
- Wolfson Lecture Theatre, Churchill College, Storey's Way, Cambridge, CB3 0DS and Zoom
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Currently the diagnosis of Bipolar Disorder (BD) and Major Depression (MDD) is based on the subjective reporting of symptoms which are evaluated through clinical interviews.
Unfortunately, around 40% of BD patients are initially misdiagnosed as MDD and the average time until a correct diagnosis is achieved is 7.5 – 12 years.
To improve the correct diagnosis of BD, we have developed a two-stage diagnostic approach combining an online questionnaire, which assesses symptoms and demographic patient characteristics, in conjunction with a biomarker test using mass spectrometry (MS) on self-collected dried blood spots.
The two-stage diagnostic approach was evaluated in the Delta Trial. In total, 924 individuals provided a dried blood spot and participated in a CIDI diagnostic interview (World Health organisation Composite International Diagnostic Interview). Relevant data from 688 participants was analysed. We were able to identify BD patients previously misdiagnosed as MDD and differentiated them from those with confirmed MDD diagnosis with excellent accuracy (sensitivity of 0·92±0·03). Core predictors included elevated mood, grandiose delusions, talkativeness, recklessness, and risky behaviour. Additional validation in participants with no previous mood disorder diagnosis also showed good to excellent accuracy for separating newly diagnosed BD patients (from MDD patients and those suffering from subclinical low mood, respectively). Validation in participants with a previous psychiatric diagnosis of BD demonstrated a sensitivity of 0·86±0·11. Several protein biomarkers were reproducibly altered but were not among the top predictors for a BD diagnosis. However, we recently performed an extensive metabolomics analysis and identified a metabolite biomarker signature with good predictive performance to differentiate unipolar and bipolar depression.
I will also report on findings from a 6- and 12-month follow-up questionnaire and the development of Censeo, a digital psychiatric assessment platform, which was developed by the Bahn lab in collaboration with Psyomics Ltd. The Censeo platform has now been implemented in several NHS trusts.
Funding Stanley Medical Research Institute, Psyomics Ltd.
Professor Sabine Bahn and colleagues, University of Cambridge
Professor Sabine Bahn is a practising psychiatrist, Chair in Neurotechnology and Director of the Cambridge Centre for Neuropsychiatric Research at Cambridge University. Her main research interests are to understand the molecular basis of neuropsychiatric disorders, with a focus on schizophrenia and mood disorders. Professor Bahn has published many articles in high impact journals. In 2005, she co-founded Psynova Neurotech Ltd, which has launched the first blood test aiding in the early diagnosis of schizophrenia. In 2011 Psynova Neurotech was acquired by Myriad Genetics, a NASDAQ listed company. In 2015 she co-founded Psyomics Ltd, which aims to transform mental health through digital diagnosis. In 2015 she was elected as Fellow of the Royal Society of Biology. She is a fellow of Lucy Cavendish College.
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