Journal of
Public Health and Epidemiology

  • Abbreviation: J. Public Health Epidemiol.
  • Language: English
  • ISSN: 2141-2316
  • DOI: 10.5897/JPHE
  • Start Year: 2009
  • Published Articles: 655


The dilemma of diagnosis in bipolar patients with psychiatric disability in the Caribbean setting

Asha Bissessar1* and Harrinath D. Maharajh2
1San Fernando General Hospital, San Fernando, West Indies, Trinidad and Tobago. 2Department of Clinical Medicine, The University of the West Indies, St. Augustine, Trinidad and Tobago.
Email: [email protected]

  •  Accepted: 24 October 2012
  •  Published: 31 December 2012


Although there has been a surge in research relating to psychiatric disorders, diagnosing bipolar disorder still proves to be an immense feat. This dilemma can seriously impact on the quality of life of bipolar patients with psychiatric disability. These case studies sought to highlight several factors which may fuel this diagnostic uncertainty. Two in-patients at the Eric Williams Medical Sciences Complex were evaluated. In the first case, the patient admitted for approximately one month, was diagnosed with a co-morbid personality disorder. Although he met the Diagnostic and Statistical Manual (DSM IV) of mental disorders criteria for bipolar II disorder, further evaluation led to the axis II diagnosis with resulting prognostic implications. In the second case, the patient was admitted for six days and his presentation could have been accounted for by several psychiatric disorders. Understandably therefore, the art of diagnosing is complex and numerous factors such as co morbidity, socio-cultural variations, current DSM IV guidelines, cannabis use and genetics play a major role. Analysis of the DSM IV guidelines and identifying how it can be adapted for a Caribbean setting is necessary. It is also recommended that further exploration of links, if any, between bipolar disorders and personality disorders be done, thus enhancing diagnosis and eventually allowing more complete management of patients with psychiatric disability.


Key words: Bipolar disorder, psychiatric disability, Caribbean, diagnostic and statistical manual of mental disorders (DSM IV).