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World J Psychiatry. Aug 19, 2025; 15(8): 106125 Published online Aug 19, 2025. doi: 10.5498/wjp.v15.i8.106125
Early diagnosis of bipolar disorder
Peng Cui, Dong-Yu Han, Cheng-Hao Yang
Peng Cui, Dong-Yu Han, Cheng-Hao Yang, General Psychiatry Ward, Tianjin Anding Hospital, Tianjin 300222, China
Co-first authors: Peng Cui and Dong-Yu Han.
Author contributions: Cui P and Han DY contributed to the literature screening and original draft together; Yang CH contributed to the funding acquisition, conceptualization, writing-review and editing; All authors have reviewed and approved the final version.
Supported by Research Plan Project of Tianjin Municipal Education Commission, No. 2022KJ264.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: February 17, 2025 Revised: April 12, 2025 Accepted: June 6, 2025 Published online: August 19, 2025 Processing time: 172 Days and 16.9 Hours
Abstract
Bipolar disorder (BD) is a severe mood disorder characterized by recurrent episodes of mania and depression, and it is prone to delayed diagnosis, which can lead to worsened outcomes, including more frequent mood episodes, greater functional impairment, and comorbidities. Early diagnosis of BD remains a significant challenge, although recent advances offer promising insights, such as research in molecular biomarkers, neuroimaging, exosomes, genetics, and epigenetics. This mini-review highlights their potential for providing earlier, more accurate identification of BD and discusses the underlying reasons why current research has not yet succeeded. For instance, the high heterogeneity of symptomatic presentations leads to low consistency in study participants; delayed BD diagnosis results in the inclusion of potential BD patients in the depression group; low specificity of biomarkers stems from limited understanding of BD pathophysiology; and there is a possibility that BD is not innate but develops over the course of the disease. Deepening our understanding of BD pathology, identifying more specific biomarkers, and integrating multiomics approaches for validation studies in well-defined homogeneous cohorts hold promise for significant breakthroughs.
Core Tip: Bipolar disorder (BD) is a severe mood disorder with delayed diagnosis, leading to worsened outcomes such as frequent mood episodes and comorbidities. Early diagnosis remains challenging, despite advances in biomarkers, neuroimaging, and genetics. This review explores these advances and highlights issues like symptom heterogeneity, delayed diagnosis, low biomarker specificity, and the evolving nature of BD. A deeper understanding of BD pathology, more specific biomarkers, and multiomics validation in homogeneous cohorts could lead to significant breakthroughs in early BD diagnosis.
