In the Amish Study of affective disorders, 79% of the 28 active bipolar
I patients, diagnosed according to Research DIagnostic Criteria, previously
had received hospital record diagnoses of schizophrenia. Both cultural and
clinical factors hindered correct diagnosis, and cultural influences
particularly complicated the interpretation of the manic symptoms of
grandiosity and excessive involvement in activities. Other factors central
to misdiagnosis were form of thought (flight of ideas), content of thought
(grandiose and religious delusions), paranoid features, and the failure to
recognize the presence of a manic syndrome.Abstract Teaser