Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Diagnostic Stability in Bipolar Disorder

A Narrative Review

Cegla-Schvartzman, Fanny B., MD; Ovejero, Santiago, MD; López-Castroman, Jorge, MD, PhD; Baca-García, Enrique, MD, PhD

doi: 10.1097/HRP.0000000000000187

Learning objectives After participating in this activity, learners should be better able to:

• Evaluate diagnostic stability in bipolar disorder

• Analyze the factors contributing to diagnostic stability

Objective Diagnostic stability is the degree to which a diagnosis remains unchanged during follow-up. It is an important measure of predictive validity in bipolar disorder (BD). In this study, we review the literature concerning diagnostic stability in BD, analyze the factors contributing to diagnostic stability, and describe the implications of diagnostic boundaries and diagnostic delay.

Methods A comprehensive literature search of MEDLINE and EMBASE databases was conducted, including all studies published from 1980 to 2016, to evaluate the diagnostic stability of BD. Thirty-seven articles were included: 6 focusing mainly on BD, 18 on psychotic disorders, 10 on depression, and 3 on diagnostic stability in psychiatric disorders in general. Data analysis was performed in standardized fashion using a predefined form.

Results Despite a high variability of the methodological approaches taken, an acceptable degree of diagnostic stability was found. The most common criteria for evaluating diagnostic stability were prospective consistency and retrospective consistency. The mean prospective and retrospective consistencies were 77.4% and 67.6%, respectively. A large majority of studies were performed in Europe or in North America (67.5%), compared to 21.6% in Asia and only 10.8% in Africa, Oceania, and South America. Extreme ages, female gender, psychotic symptoms, changes to treatment, substance abuse, and family history of affective disorder have been related to diagnostic instability.

Conclusions Several factors appear to have a negative impact on the diagnostic stability, but the evidence is insufficient to draw any robust conclusions. Nevertheless, despite variable prospective and retrospective consistencies, the overall diagnostic stability is good. Standardized methods need to be used to obtain more accurate assessments of stability.

From the Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid (Drs. Cegla-Schvartzman, Ovejero, and Baca-García); University of Montpellier, Centre Hospitalier Universitaire de Nîmes, and French National Institute of Health and Medical Research (INSERM) Unit 1061, Montpellier (Dr. López-Castroman); Departments of Psychiatry, Universidad Autónoma (Madrid), Hospital Universitario Rey Juan Carlos (Móstoles), Hospital General de Villalba (Madrid), Hospital Universitario Infanta Elena (Valdemoro) (all Spain) (Dr. Baca-García); Centro de Investigación en Salud Mental (CIBERSAM), Carlos III Institute of Health, Madrid (Dr. Baca-García); Universidad Católica del Maule, Talca, Chile (Dr. Baca-García); Department of Psychiatry, Columbia University (Dr. Baca-García).

Supported, in part, by Instituto de Salud Carlos III grant nos. ISCIII PI13/02200 and PI16/01852, Delegación del Gobierno para el Plan Nacional de Drogas grant no. 20151073, and American Foundation for Suicide Prevention grant no. LSRG-1-005-16 (all Dr. Baca-García).

Correspondence: Enrique Baca-García, MD, PhD, Department of Psychiatry, Fundación Jiménez Díaz, Av. Reyes Católicos 2, 28040 Madrid, Spain. Email:

Supplemental digital contents are available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

Harvard Review of Psychiatry offers CME for readers who complete questions about featured articles. Questions can be accessed from the Harvard Review of Psychiatry website ( by clicking the CME tab. Please read the featured article and then log into the website for this educational offering. If you are already online, click here to go directly to the CME page for further information.

© 2019 President and Fellows of Harvard College
You currently do not have access to this article

To access this article:

Note: If your society membership provides full-access, you may need to login on your society website