Assessing and staging bipolar disorder

We have long argued that bipolar disorder is often underdiagnosed in community mental health teams, and that the reason for this is often failure to assess the longitudinal trajectory of patients suffering from recurrent depression. We have attempted to remedy this by developing a series of twenty-nine questions to be used in the history taking of all patients with depression and recurrent depression in order to demonstrate the developmental trajectory of the illness.These questions are presently being field tested in Bedford and at the University of Perugia. We have also demonstrated that when the systematic assessment of the trajectory of bipolar disorder is carried out in a community mental health team, the number of bipolar patients among the patients assessed by the team increases, but there remain a number of patients who do have unipolar depression To propose a staging model of Bipolar Disorder , we require similar neuroimaging results describing the differences between the individual stages.